A top doctor has spoken candidly about major problems within the Royal Victoria Hospital's A&E department that are linked to increased death rates.
Dr Brendan Sinnott wrote a scathing exposé in the Ulster Medical Journal about the lack of senior staff available in the casualty department, publishing the staff rota as proof. He also commented on overworked staff, overcrowding and management failings.
His report mentions a worrying link between overcrowding in A&E departments and a rise in death rates. This comes after there were a number of patient deaths as a result of lengthy trolley waits a the Royal's A&E.
"Patient care was compromised and delays led to bad outcomes for some," he wrote.
The Royal has been forced to deal with the overspill since A&E units at the Downe and Lagan Valley Hospitals closed.
In his report, the consultant noted the closures were "unannounced with very little warning or planning" and put "extra pressure" on the RVH.
"This led to greater demand on staff and some consultant colleagues expressed concern regarding burn-out of trainees and consultant colleagues."
The rota clearly shows that while there are consultants on call for the A&E department between midnight and 8am, none are actually present in the hospital. Instead, there is one staff grade doctor and two trainees present.
According to Dr Sinnott, actions speak louder than words when it comes to positive changes being implemented.
"Strategies to deliver safe care to circumvent obstacles were never developed. There is no point in proclaiming initiatives and schemes if they don't deliver meaningful changes," he said.
Dr Sinnott revealed many of his colleagues were afraid to tell the truth about the state of affairs due to a "bullying" culture that exists among management.
A spokeswoman from the Belfast Trust said that it "recognises and values the work its staff has been doing to "address the problems referred to".
She described the "issues" as "complex" and added that the trust will "continue to work with Dr Sinnott and other colleagues and professional bodies to ensure the problems are rectified".
In March the RVH was sued by a doctor and patient for negligent care. Lawyer Patrick Madden, acting on behalf of a senior consultant and A&E patient, said evidence had been given to him that showed the environment in the hospital was "toxic for staff and patients". He said there was "appalling standards of care and neglect of patients".