When senior doctors in a hospital express concern at the level of care being delivered, then it is time for the public to worry. That is the situation at the emergency department at the Royal Victoria Hospital, the province's busiest unit. Consultants called in experts from the College of Emergency Medicine because they feel there is not sufficient staff to cope with the number of patients presenting at the department, the workload is too heavy and their concerns over the supervision of junior doctors.
These are serious issues and feed into a wider picture of a health system creaking at the seams. We have heard scores of stories of people waiting 12 hours or more in emergency departments before being admitted for treatment. The closure of the A&E department at the City Hospital has thrown additional pressure on other units in and around Belfast and there seems to be no coherent plan in place to address the problems.
The number of consultants in emergency units throughout the province are below the recommended level; consultant cover falls short of the required hours and if experts find that supervision of junior doctors is not up to scratch then those doctors could be removed from the units in question. That would mean the virtual collapse of the system in the province as well as the source of the next generation of emergency medicine consultants.
While the Belfast Trust says that it has recruited some more senior doctors, this is only a piecemeal solution addressing one symptom of a service-wide malady. There are suspicions that many people are going straight to emergency units for treatment, by-passing the GP service, particularly during out-of-hours periods. It may be that even GPs are referring more patients to A&E than they should. What is clear from the experience at the RVH is that public confidence in the adequacy and safety of the service has been badly dented. This should be a line in the sand and the Health Minister and Trusts should work urgently to address the shortfalls in staffing and treatment times.