Damning Government figures are the "clearest sign yet" of the major crisis within Northern Ireland's flagship A&E department, it has been claimed.
Waiting times for June – regarded as one of the quietest months of the year – revealed 190 people had to wait more than 12 hours to be treated at the emergency department at Belfast's Royal Victoria Hospital.
That amounts to six people a day during that month.
The figures – described as "jaw-dropping" – have led to urgent calls for Health Minister Edwin Poots to act and concerns that attempts to address the problems are failing.
Between April and June 2014 the performance at the RVH "declined notably" from 67 to 190 having to wait over 12 hours, according to the report.
Just 12 months before, only one person had to wait half-a-day for emergency treatment in the Royal.
Ministerial targets state that no patient should wait longer than 12 hours to be treated, discharged or admitted.
The figures also showed the health service had to deal with an increase in the number of patients attending emergency departments over the quarter, with figures rising from 60,142 A&E attendances in April to 62,193 patients in June.
In June the Royal's A&E had 711 more attendances, 312 more ambulance arrivals and 91 more emergency admissions than during the same month last year.
Health Minister Mr Poots said that while emergency care services continued to face "enormous pressures" he was confident proposed improvements can be implemented.
The Belfast Trust admitted that the waiting times were "too long" but said the reason for the situation was down to a larger number of patients and the fact the cases needing admission were more complex than before, resulting in longer hospital stays and fewer hospital beds for new patients.
The alarming figures come amid warnings of major staffing problems within A&E units across the Belfast Trust. Earlier this month Dr Sinead Campbell-Grey resigned her top job as clinical lead at the Royal's emergency department because of concerns at "system failures" that led to overcrowding in the unit.
The SDLP's Fearghal McKinney, a member of the Stormont health committee, said action was needed now.
"This is the clearest sign yet of the ongoing crisis across our emergency departments and health system as a whole," he said. "To go from one person in June 2013 to 190 people waiting 12 hours the following year is, without exaggerating, jaw-dropping. There needs to be a deep analysis of why things are still going wrong."
A senior source at the RVH said that despite this being considered the "quiet" summer period staff were still struggling to cope. "Patients are getting treated but they are left to languish in the emergency department," the source said. "As soon as the decision is made to admit them to a specific ward they are lying there for several hours after that when they should be in a proper treatment area. The bottleneck of patients is still happening."
A trust spokeswoman said: "We used to see a big improvement in emergency department performance in the summer months, but pressures on our Regional Trauma Centre have become a year-round phenomenon.
"We know that our waiting times are far too long. We are actively engaging with our senior staff to find better and more effective ways of improving the experience of our patients."
Mr Poots said the aim of a regional task group set up this year was to eliminate all avoidable 12-hour waiting time breaches from this winter onwards.
"The task group will be addressing the design and implementation of more effective patient pathways.
"It is a challenging task, but I am confident it can be achieved," he said.
Surprised? Not after my hellish wait on a trolley
A woman with incurable cancer who spent 26 hours waiting for a bed at the Royal Victoria Hospital's emergency department has said she is "not surprised" by the latest revelations about waiting time breaches.
Maria Gibney (51), from Belfast, had a kidney removed as a result of cancer but the disease continued to spread.
She told the Belfast Telegraph of her "hell on Earth" experience which occurred on April 29.
In excruciating pain, Maria experienced a series of problems as she waited on a trolley bed for the majority of her time in the Royal's emergency department.
At one stage, before she was given a bed on a ward, a doctor at the Royal had wanted to send her home without any further examination or treatment.
After her pain continued unabated, at Maria's routine oncology appointment in June she requested that an X-ray be carried out on her leg. The X-ray revealed cancer in her thigh.
She was admitted to hospital where her eye began to swell and two more tumours in her brain were detected.
With her experience still fresh in her mind, Maria said of the latest waiting figures: "I'm definitely not surprised. There is no system to the system. The amount of people that have come to me and said: 'Mrs Gibney, make people aware of this'. But they have to make their voices heard, too.
"My experience was ridiculous and after all that I've gone through I am so weak. I've lost all my hair and I need looked after 24//7. It's horrific.
"I had an unbelievable time. A doctor who never even touched my forehead said: 'We are sending you home, you'll be all right'. And I had another three cases of tumours.
"But we really need people to take notice and sit up. My anger is targeted at Mr Poots and not just the health service. Is he taking responsibility? If he was the Manchester United manager he would have been sacked."
Turbulent times at A&E: How the emergency department of the Royal has been under increasing pressure... and the efforts being made in a bid to streamline the system
November 2011: Belfast City Hospital's accident and emergency unit closes its doors and the Royal Victoria Hospital becomes the main hub of emergency care in Belfast. Unions warn of added pressure on staff at RVH and Mater A&E units and a number of protests are mounted... to no avail.November 2012: Almost all of the emergency medicine consultants in the Belfast Health Trust raised concerns about the safety of A&E at the Royal. Clinical director of the RVH at that time Dr Russell McLaughlin steps aside. It is understood he felt strongly about the running of the A&E.
October 2013: Reports of excessive waiting times for patients at the accident and emergency department of the Royal Victoria Hospital emerge. Earlier in the year experts from the College of Emergency Medicine visited the hospital and raised major concerns over patient safety. January 2014: Accident and emergency units at both the Downe Hospital in Downpatrick and the Lagan Valley Hospital in Lisburn close. A critical shortage of staff has led to the introduction of weekend closures, fuelling fears more patients will be diverted to RVH A&E, creating more pressure.
January 2014: Dr John D Woods, chair of the BMA Northern Ireland consultant committee, says working in A&E departments needs to be made more enticing. “In the UK some 50% of the trainee posts are vacant and over the last three years over 60 consultants have left the UK altogether,” he says.
January 8, 2014: A Major incident is declared at Belfast's Royal Victoria Hospital on a weekday night due to a large backlog of patients at the A&E department. At one stage, 42 people are left on trolleys to wait for treatment and staff describe the situation as “horrendous”.
January 9, 2014: Health Minister Edwin Poots describes the situation at the RVH as a “one-off” incident, where there has been an “unreasonable spike” in patients needing treatment. A review of A&E is ordered by Mr Poots, led by the Regulation and Quality Improvement Authority (RQIA).
February 2014: It emerges a delay in treatment at the RVH emergency department may have contributed to the death of five patients in 2013. There is talk of a “major crisis of confidence” at the unit, and one nurse says: “The Health Minister needs to stop toeing the line of ‘we are all coping’.”February 2014: The RQIA inspection reveals that medics at the RVH are under “intolerable pressure”, with evidence of bullying and a dysfunctional healthcare system where not enough medics are available at times in the emergency department to properly treat patients.
March 2014: Forty extra nurses are appointed to the A&E department and the acute medical unit after a review of staffing levels at the Royal Victoria Hospital.
April 9, 2014: A major summit on emergency medicine is held in Belfast to discuss tackling the ongoing crisis.
June 19, 2014: The Human Rights Commission announces an unprecedented probe into A&E units in Northern Ireland. The inquiry’s remit is to find out whether the human rights of people seeking emergency care have been properly respected, protected and fulfilled in practice.July 2014: Edwin Poots publicly criticises the Belfast Trust for its failure to plan to cope with pressures in its emergency department. He announces a regional task force is to be set up to ensure recommendations to improve emergency care, issued after the RQIA inspection, are implemented.