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Human rights concern over A&E care

Published 27/05/2015

Instances of inadequate provision of pain relief, food and fluids were highlighted in an investigation of A&E care by the Northern Ireland Human Rights Commission
Instances of inadequate provision of pain relief, food and fluids were highlighted in an investigation of A&E care by the Northern Ireland Human Rights Commission

Concerns over care standards experienced by patients treated in Northern Ireland's emergency departments have been flagged up by a human rights inquiry.

Instances of inadequate provision of pain relief, food and fluids were highlighted in the investigation by the Northern Ireland Human Rights Commission (NIHRC).

The commission said it found individual cases of inhuman and degrading treatment but had not uncovered evidence of "systemic violations" of human rights.

While the inquiry reported that many patient interactions with staff were positive, it noted that at times care was undermined by a perceived disregard, lack of attention or kindness from health professionals.

One of the main issues of concern was the treatment experienced by some end-of-life patients and older patients, particularly those with dementia.

The commission launched the inquiry last June in response to what it said was "public concern" about delays and treatment standards in emergency departments.

As well as patients and their families, the inquiry took evidence from health ministers, Health Department officials, the Health and Social Care Board, health and social care trust managers, clinicians, trade unions and a number of voluntary organisations.

The report published today made 26 recommendations aimed at improving the human rights of patients, families, carers and staff.

The NIHRC's chief commissioner Les Allamby said: "With around 700,000 visits each year to emergency departments in Northern Ireland, this is an issue which touches almost everyone's life.

"Public participation was at the centre of this Inquiry and throughout we heard from patients, families, staff management and the department.

"The commission considered quality, accountability and governance of the service. We visited emergency departments throughout Northern Ireland during the day and night. We heard from dedicated staff striving to maintain patient dignity in an often challenging and crowded environment.

"In such circumstances there were reported instances where patients did not receive assistance with personal care needs, no pain relief, and no access to food and fluids. Of particular concern were cases involving end-of-life care, the inappropriate transfer of older patients from nursing homes and the experiences of those presenting to A&E in mental health crisis, with dementia or disabilities.

"The commission heard individual cases which amounted to inhuman and degrading treatment but did not discover evidence of systemic violations of human rights.

"The importance of human rights are most obvious when we are at our most vulnerable. The right to the highest attainable standard of health is a standard that must be strived for and the respect for dignity and other human rights principles must be adhered to.

"The inquiry also heard of good practices and experiences. Often the introduction of relatively simple measures significantly improved the human rights of patients. Many of these have been introduced with modest costs and there is a clear need to share good practices throughout the system on a more structured basis."

A spokeswoman for the Health Department said it would give the recommendations detailed consideration.

"While Health and Social Care in NI is not complacent about the issues referred to by the NIHRC, the department would point out that the responsible statutory authority for assessing the quality of care provided by the HSC is the Regulation and Quality Improvement Authority (RQIA) and not the NIHRC.

"Similar issues were highlighted by the RQIA in its inspection of the Belfast Trust in 2014. The minister at that time commissioned the RQIA to carry out a comprehensive review of emergency and unscheduled care and published its report in July last year.

"The then-minister also established a task group to implement the RQIA's recommendations.

"A follow-up inspection of the Belfast Trust late last year found that there had been significant improvement. The task group is continuing its work and the department will consult in the near future on a values and principles statement for emergency care in Northern Ireland, inviting patients and the public to give their views.

"The HSC in Northern Ireland therefore has a very clear focus on continuous improvement of the quality of care provided by our emergency departments."

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