Northern Ireland's worst performing health trust has come under fire for failing to meet basic hygiene standards, it can be revealed today.
Blood-stained walls and faeces on equipment were discovered during an unannounced hygiene inspection of beleaguered Antrim Area Hospital earlier this year.
The hospital is managed by the Northern Health & Social Care Trust, which was at the centre of a fatal superbug scandal linked to the deaths of 31 patients.
During a subsequent inquiry into the C Difficile outbreak, it emerged Antrim Area Hospital suffered a mop shortage and it was claimed there were not enough cleaners to cope with the workload.
Four years on, a leading public service union has claimed staff there are still struggling to cope as the findings of an inspection by the Regulation and Quality Improvement Authority (RQIA) were published.
The health watchdog inspection on March 5 highlighted a series of failings including:
- Blood splashes on a worktop in the A&E
- A urine-filled bedpan was found lying on the ground in the cardiac ward
- Blood stains on the wall in a medical ward
- A junior doctor carrying a nasogastric tube to insert under the arm of a patient
- Stained medical equipment in the resuscitation area in the A&E
- Faeces on a bedpan marked as clean in a medical ward
- The number of sinks for staff to wash their hands not meeting guidelines
- A doctor not washing their hands after leaving a patient in a surgical ward
- Old and worn hand washing sinks
- Unlocked medication trolleys
- The inspectors also raised concerns over patient dignity after they found a female patient being treated in a male ward
In addition, the RQIA inspectors also raised concerns over patient dignity after they discovered a female patient being treated in a male ward.
And they also found a password attached to a computer in the hospital's A&E, meaning patient details could be accessed.
The RQIA report said: "This has the potential to compromise the confidentiality of patient information."
Stormont health committee member Kieran McCarthy said: "Heads must roll over this.
"The Northern Trust has been given opportunity after opportunity to address the failings and this latest report demonstrates that patients are still being put at risk.
"There has been a succession of chief executives, reviews and inquiries and nothing seems to change."
Mr McCarthy said the RQIA report will make difficult reading for relatives of those who died during the C. Diff outbreak.
He continued: "We were told after the public inquiry that lessons had been learned and yet the RQIA finds faeces and blood on equipment.
"This is shocking, it's startling and it is time that someone is held accountable.
"This is certainly not an attack on the staff who are doing their best under extremely difficult conditions."
Stephanie Greenwood, Unison branch secretary, said: "The staff in Antrim would say we are fed up getting slammed when we strive daily for excellence.
"We love our roles serving the public, our patients; however, we feel pressurised daily to find bed space which is often inappropriate.
"We are short-staffed, the Department of Health must inject more funding into this trust.
"Morale is low and sickness levels are due to excessive demands."
Ms Greenwood said while there is not a large vacancy list in domestic posts, there is a high level of genuine long-term sickness.
She said the trust relies heavily on agency staff, and addressing this issue would result in consistency, better trained, skilled staff.
She continued: "This would provide job security and improve morale which in turn would reflect positively on the patients' experience.
"Some of the factors found in the report in our opinion are not as a result of lack of dedication of staff because in Antrim Hospital the goodwill, devotion and skill and professionalism of our staff carry a hospital which is fundamentally short-staffed, due to a large deficient and a lack of adequate funding from the department."
Responding to the findings, the trust said it "fully accepts that a small number of the findings were unacceptable".
"On the day of inspection the trust received feedback form the inspectors and, where shortcomings were identified, remedial action was taken immediately. The trust has taken this extremely seriously and those wards, teams or areas found not to be following procedures were identified and an action plan was put in place immediately," a statement read.
"Hygiene levels within the trust are taken extremely seriously. In October 2012 the RQIA report clearly stated that the NHSCT wards were compliant with standards. In 2013 the trust was the only one in Northern Ireland that did not require RQIA re-inspection.
"This RQIA report in March 2014 also stated 'overall the inspection team found evidence that the Antrim Area Hospital was working to comply with the Regional Healthcare Hygiene and Cleanliness standards'. It found 'areas of strength' and 'good practices' including 'good team work and links with infection prevention and control team'. It assessed the trust compliance across the hospital at 90% on average, which is above the target of 85%. No part of the inspected site was below the 85% standard. Where incidences of non-compliance were identified these were dealt with immediately."
It added: "The trust has in place action plans and systems to maintain and improve cleanliness standards across its sites."
Five hospitals – Antrim Area, Braid Valley, Newtownabbey, Mid Ulster and Moyle – in the Northern Trust were hit by the Clostridium Difficile bug between June 2007 and August 2008. Symptoms can range from none at all to mild or severe diarrhoea, or severe inflammation of the bowel which can be life-threatening. It is spread in faeces as a result of poor hygiene practices.
Problems mount as Northern Health and Social Care Trust unable to address issues
By Lisa Smyth
The long-running problems experienced by the Northern Health and Social Care Trust have been well documented.
In particular, it has been heavily criticised for the waiting times in the emergency department at Antrim Area Hospital.
In 2012, a prominent GP compared the unit to a war zone.
Dr Brian Dunn said the situation there was worse than a Belfast city centre hospital during the height of the Troubles.
It was also reported that seriously ill patients were begging ambulance staff to take them to a different hospital rather than be treated at Antrim.
Last year, consultants branded the system in Antrim "unsafe".
The trust repeatedly blamed the problems on the size of the A&E unit but waiting times have remained an issue since the opening of the new emergency department last summer.
Recent statistics from the Department of Health, Social Services and Public Safety show there were more 12 hours breaches at Antrim's A&E over the last three months than in any other emergency department in Northern Ireland.
One doctor, who did not want to be named, said: "The situation at Antrim is the worst I have ever seen it." In December 2012, Health Minister Edwin Poots announced the appointment of a turnaround and support team to address the issues.
The following year, the team reported overcrowding at the hospital, poor patient flow, poor patient and staff experience.
GPs have frequently reported excessive waiting times for hospital appointments, even for patients suspected of having cancer.
Meanwhile, a question mark hangs over the future of the Causeway Hospital in Coleraine.
There are fears the A&E could be downgraded and other services removed as the trust faces difficulties attracting and recruiting adequately trained and experienced staff to work there.
Staffing issues at two other Northern Trust hospitals, Mid Ulster and Whiteabbey, were given as the reason to reduce services.
In March this year, the trust was hit by a further scandal when it emerged the deaths of five babies were among 11 under investigation.
Mr Poots said he had been made aware of 20 cases in which the trust's response was said to be below standard.
The patients were seen in the emergency, obstetrics, gynaecology or X-ray departments.
Jim Allister, North Antrim MLA, said: "The trust has had numerous opportunities to address the problems but the situation does not seem to be improving."
Despite the criticism, individuals are doing excellent work in trust
By Dr Allen McCullough
As I write, another report into the Northern Health and Social Care Trust – this time from the Regulation & Quality Improvement Authority – is published into hygiene and cleanliness in clinical areas.
They say that good news doesn't get reported and I would highlight the excellent work that is being carried out within the trust by individuals from all disciplines. However, there seems to be issues regarding holistic patient care.
I speak as a GP who interacts with the trust on a daily basis on behalf of my patients, who tell me about a disjointed approach to their care and that of their loved ones by the trust.
There seems to be an apparent dysfunction that has led to several inquiries and turnaround teams being called in.
As regard hygiene and the scourge of Pseudomonas, MRSA and many other pathogens, they have been and probably always will be there.
But the situation is not alleviated while the trust continues practices such as using a hose pipe to remove sewage from a carpeted patient waiting area. The trust has now replaced the carpet to wipe clean surfaces in the building in question – a positive step.
As always, GPs are willing to help mop up the fallout as we try to provide the best care.
Dr Allen McCullough is a GP in Antrim Health Centre and chair of the Northern Trust GP forum