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A&E crisis: Coalface staff point finger at Stormont over chaos on wards

By Victoria O'Hara

Hospitals across Northern Ireland will face "crisis after crisis" unless vital funding is invested and attempts to transform the system are properly managed, health union bosses have warned.

Nurses and doctors have been left "exhausted, exasperated and frustrated" as trusts struggle to cope with a spike in patients, with hundreds left on trolleys waiting for treatment.

Last night the Health and Social Care Board said although pressure on waiting times was easing, it warned staff will continued to face a "challenging week".

Management in charge of revamping the health service have been told the reason behind the ongoing problems was a lack of funding and bad management of the Government blueprint to change the system, known as Transforming Your Care.

The comments come after ailing hospital trusts were forced to activate escalation plans, with many calling in off-rota staff and cancelling non-emergency care, including routine operations.

The Belfast Health Trust stopped all non-urgent elective surgery up to and including January 11 - leaving many patients facing a further delay for life-enhancing treatments.

The Health and Social Care Board said the situation had improved yesterday morning.

There were 139 people waiting in accident and emergency departments in Northern Ireland and one person was waiting more than 12 hours. This compared to 40 people on Monday at 9am. Over the weekend patients - many elderly - faced hours lying on trolleys or in wheelchairs waiting for treatment.

On Monday this newspaper revealed how Tommy Hall's 73-year-old mother was placed on a trolley in the waiting room area of the Royal Victoria Hospital A&E and wasn't seen by a doctor for eight hours.

Mr Hall claimed at one stage 11 ambulances were queued up outside and described the situation as "chaotic".

Figures also revealed a 7% surge in patients arriving at A&Es compared to the same time last year, leading to staff struggling to cope. GPs had warned that the Transforming Your Care policy, which aims to shift care out of hospitals, is creating additional unresourced workloads.

Janice Smyth, from the Royal College of Nursing, said the problem comes one year after a Major Incident was declared at the RVH emergency unit. At one stage 42 people were waiting on trolleys.

"This is not an emergency department problem, it is a systemic problem and what we need to solve it is a Transforming Your Care approach. But district nurses were very clear last year there was a lack of investment, and until Transforming Your Care takes a strategic turn and looks regionally at the services we need, this is not going to get any better. It is about getting patients out from the hospital and treating them in their homes, but so far the money has not been invested.

"This will happen again because there is nothing in the community to support patients properly when they leave hospital - this is leading to the backlog in wards and pressures."

Dr John O'Kelly from the Royal College of General Practitioners in Northern Ireland said medics were feeling "frustration and despair".

"I don't think anyone would disagree with the idea of Transforming Your Care, but it has to be funded, it has to be done right - so far it hasn't."

Michael Bloomfield, director of performance management with the Health and Social Care Board, said: "Patients in emergency departments who need to be admitted will continue to be placed in beds based on their identified clinical priority."

Case studies

Joanne Gibson, Fintona, Co Tyrone

“I was in pain so my husband rushed me to the South West Acute Hospital in Enniskillen on New Year’s Eve at about 11.30am.

“They knew straight away what the problem was.

“I was lying on a trolley in A&E until about 8.30pm before being moved to assessment ward one.

“At 1.30am I was then moved to the surgical ward.

“They were so, so busy and said they had no beds so it just was a matter of waiting. It was still so busy when I finally left on January 3.

“The staff were amazing and so friendly, even though they were under pressure.”

Doctor George O’Neill

“I have people who wait up to a year to be seen, to be diagnosed, and then they are put on a waiting list to have a procedure carried out.

“We are now getting back to where it was four, five, six, seven years ago.

“We have got to look at different ways of doing things but nobody is doing that.

“What we are doing is we are looking at the model we have and we innovate and improve parts of it. What you hear about emergency departments will be a flurry of activity, money will be put into it.

“Where will that come from?

“That money will come from learning disability, care of the elderly, mental health and children’s services.”

Unidentified mother of two cardiac nurses who called Radio Ulster

“I can see them just falling to pieces over this past three years.

“It is insane the amount of work that has been put upon them. They are both coming home exhausted. They are actually thinking of leaving the country and taking their children because they have no quality of life.

“They are concerned about the care that the patients are getting because they haven’t got the time they want to give to their patients.

“My son had dislocated something in his shoulder by doing something at work and he couldn’t be seen himself by any-body in the hospital. He had to take out private insurance so he could be seen quickly to get back to his work. It is so unfair.”

Eileen O’Brien, from Belfast, attended the Royal Hospital’s A&E department on Monday night with husband Thomas after suffering a seizure. He said:

“Eileen has a brain tumour and was taken in straight away.

“She was in a cubicle in A&E. She was given a bed in the recovery suite at 6am, so she was in a cubicle for around 10 hours.

“I did not know what to expect at A&E. Sometimes you are there for a long time, sometimes not. You take each day as it comes.

“It was very, very busy in the main A&E but the cubicles were all full. There were around eight people on trolleys.

“They have fantastic staff there. As good as they can be. It was a seizure so it was a frightening wait.”

Eileen, now being treated in the main hospital, added: “They were really good with me.”

Female patient at the Altnagelvin Hospital who does not wish to be named.

“The staff were apologising all the time and asking if I was OK and if I was warm enough. They couldn’t do enough and they were up-front about things and just said ‘we have no beds’.

“They opened the day care unit to help cope with the demand.

“The bed I was put on was a recovery bed which is for post-surgery and it is so narrow, so it was not the best thing to try and get a night’s sleep on. While I was there one wee elderly woman was also moved to the day care unit who had been admitted into a ward on Saturday night but they needed her bed.

“You could see management running around trying to deal with it as best they could but it is clear there is a big problem, absolutely.”

Tommy Hall’s 73-year-old mother was admitted to the City Hospital yesterday afternoon. Her case made the front page of Monday’s Belfast Telegraph after she was sent home from the Royal after hours of lying on a trolley. He said:

“Mum’s health has gone backwards since she was sent home from the Royal so they are trying to get her back on her feet.

“Mum was sent home from the Royal on Sunday and her own doctor was keeping an eye on her.

“Her oxygen levels fell so we brought her to the City to save getting an ambulance.

“I reckon people out are there dying because they don’t want the stress of sitting with a whole load of drunks in A&E. Doctors and nurses are doing all they can. The blame lies higher up the ladder. It is political.

“It is cuts and the ordinary person on the street suffers.”

A patient at the Altnagelvin Hospital in Londonderry who does not wish to be named.

“I had an operation a while ago but I had to go back because I was in so much pain. I got there around 7pm and was seen fairly quickly by the triage nurse but waited until 1am to get moved into a cubicle.

“There was no pillow in the cubicle and I could see for myself the doctors and nurses were working flat out so I used my coat for a pillow. The casualty department at Altnagelvin isn’t big enough to cope with the amount of people but you can’t blame the nurses or doctors, they are doing their best but it is a disgrace.”

Robert Anthony from Carrickfergus was rushed into the Royal Hospital’s casualty department on Tuesday evening and is currently an inpatient in the main hospital.

“I came in around 5.30pm,” he said. “I was lucky — I had internal bleeding. They saw me within 10 to 15 minutes. I went straight up to the surgical ward. There were people coming and going, people coming and going all the time in A&E. The pressure they are under means they have to prioritise things. There were people there who could have been elsewhere. One or two you knew had drink taken. The staff — they have to take some stick.

“I have to say they could not do enough for you.”

Man (47) who attended the Altnagelvin A&E said:

“I took my son over to casualty.He went over on his foot and it was badly swollen and we were afraid it was broken.

“It was complete bedlam there.You could see the staff were under pressure trying to find places for people.

“I heard them come over to whoever was in the cubicle next to me and apologise over and over again because they had no bed for the man who I think had cancer, but he was in a bad way.

“The nurses and doctors were doing their best. In fact, I was amazed at how they were able to keep calm when the whole place was at melting point.

“There is not enough money being pumped in the health service and the money that is isn’t being spent in the right areas if you ask me.”

One woman from Co Antrim, who does not wish to be named, attended A&E on Monday after suffering frightening pains in her legs. She arrived at 3pm and was admitted to a ward around 5am.

“They are just throwing you from there into there. It is disgusting, poor, unhygenic.

“That shower has not been cleaned once since I was in there. I was in a different ward before Christmas and it was perfect.

“You press the buzzer, they just say a nurse will be with you. You can wait an hour and 30 minutes.

“I would prefer to be in A&E hands down. Just swap the beds. I would go to A&E. It was getting really busy when I was there, not horrific, like every normal A&E. There were a couple of people on trolleys.”

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