Unions have hit out at Health Minister Edwin Poots for not acting to address staff concerns at Belfast Royal Victoria Hospital A&E department after a damning inspection revealed medics were under "intolerable pressure".
A Major Incident was declared at the RVH last month.
Initial findings of the watchdog body, the Regulation and Quality Improvement Authority (RQIA), found stark evidence of fears over staffing levels, bullying and a dysfunctional healthcare system.
It also said that not enough medics were available at times in the emergency department to properly treat patients.
The inspectors spoke to more than 100 staff.
Mr Poots, who announced the update to MLAs yesterday, said the inspection confirmed concerns about:
- Staffing levels in key areas.
- Allegations of bullying.
- Staff under intolerable pressure, and a system of care that does not function as it should.
Mr Poots told the Assembly there was a focus on relieving the pressures on staff.
"I have made it clear from my first day as minister that the underlying objective for the entire health system is to protect and improve the quality of services that we deliver."
But both the Royal College of Nursing (RCN) and union Unison said they had raised the problems highlighted "for months".
Ray Rafferty from Unison said the findings were no surprise.
"We are aware and we have been raising our concerns on all the issues that RQIA have raised for some time," he said.
"And the other area of major concern is for staff safety and welfare and that is working under intolerable stress and the feeling that staff have is that they are being bullied into making decisions which are not necessarily in the best interests of the patient."
He called the allegations of bullying as "very serious" but highlighted the pressures on staff to hit targets.
"Before the Major Incident we had warned that patients were being admitted because of the target times, rather than the urgency of the patient's condition," he said.
The inspection also revealed there was insufficient space in the emergency department for the number of patients waiting.
Mr Poots said references to a bullying culture caused him "particular concern".
"It is important that we achieve positive change in this culture and approach."
Garrett Martin, deputy director of the Royal College of Nursing (RCN) in Northern Ireland, said: "The RCN was aware that pressures within the emergency department at the Royal Victoria Hospital had been building for some months. Frontline nursing staff have highlighted concerns with us regarding their ability to provide safe, effective and dignified patient care. These professional concerns focused primarily on poor staffing and the inadequate working environment."
Mr Martin said the RCN had formally raised these concerns with the trust.
The external team was commissioned after a Major Incident was declared at the hospital last month due to a backlog of patients at the A&E department.
Following the incident on January 9, Mr Poots rejected claims that the A&E service was in crisis.
Mr Poots said the issues were complex and said there were no easy solutions.
The RQIA's wider review will report to the minister by June.
Sinn Fein chairwoman of the health committee Maeve McLaughlin also criticised the minister saying he appears to be playing "catch up" when it comes to sorting out the problems with emergency department care.
Belfast Trust chief executive Colm Donaghy said: "Staff in our emergency department continue to make strenuous efforts to give their patients the best possible care in as timely a way as possible and we would heartily welcome any opportunity improve the system they are currently working in," he said.
A Major Incident was declared at the RVH site on January 9 to deal with a large backlog of patients at the A&E department. Some faced long waits on trolleys. For three hours the A&E was described by staff as "at breaking point". Minister Edwin Poots rejected the service was in crisis, describing the circumstances as "exceptional" and a "one-off". Last week a RQIA-led review of A&E services was announced. The initial findings for the RVH were announced yesterday and expressed concern about staffing levels, bullying and describing "intolerable" pressure on staff. A full report will be published in June.