New era dawns as £150m A&E department opens in Belfast's Royal Victoria Hospital
A new emergency department at Northern Ireland's flagship hospital is set to finally open this week after a series of delays - but bosses say they "cannot guarantee" it will stop patients facing 12-hour waiting times.
Doors will open at the Emergency Department in the multi-storey regional critical care building in the Royal Victoria Hospital in Belfast at 8am on Wednesday, almost three years behind schedule after serious problems with plumbing and pipework.
But Trust bosses hope the new £150m building will provide a "new era" in emergency care after facing heavy criticism over its management, lack of staff morale and spiralling waiting times. It is expected that the old A&E department, which has been criticised as "not fit for purpose", will be cleared by lunchtime. And the opening of the first phase of the landmark development has resulted in leading doctors saying that Transforming Your Care - the plans to shift patient care to more community-based treatment - is "dead in the water". They have said now an opportunity has been created to start serious discussions over reshaping the Northern Ireland health system.
But it will be next year before the surgical theatres and critical care units are open. This, according to the Trust, is due to work to "address changes in standards and guidance".
It will be at least four years before the main Maternity floors, due to cover level 7-9 in the same building, are complete.
A contractor is not expected to be appointed until 2016 with at least three years needed to build it. The new ED has 3,000 extra square feet and three new adult ED consultants have been employed, bringing the total to 19 working across both the RVH and Mater. But there are still concerns there is a need for more A&E staff.
Cathy Jack, medical director of the Belfast Health Trust, said: "We have struggled with recruitment and have been successful with the new three appointments, bringing the number of consultants in our adult EDs to 19. We are in the process of hopefully recruiting more. But it still remains a challenge."
Work started in 2008 on the multi-storey building which was due to be handed over to the Belfast Health Trust in November 2012, but that deadline was missed.
In 2013 corrosion was found in the building's new heating system. A major repair job had to be completed before it opened to patients. It is understood the damage to the pipes was detected in the hot water heating system during final checks. Ms Jack said the Trust had come through "difficult number of years" and in particular for the emergency department.
In January 2014 a major incident was called and at one stage, 42 people were waiting on trolleys and staff described the situation as "horrendous". Last July a health watchdog report by the RQIA identified planning and "systems failings" by the trust in the period leading up to it. In November 2012, almost all the emergency medicine consultants in the Belfast Health Trust raised concerns about the safety of A&E.
Ms Jack said the new assessment area will help speed up and move patients to the right treatment area.
"By focusing on that right at the front door we can process the patients very quickly, keep them safe and not necessarily admit them then they can come up to that unit the following day. So they are getting their life back."
Ms Jack said the Trusts are working to reduce the bottleneck, making sure they have access to seven-day services in the community.
On a busy day around 300 patients would go through A&E but it is hoped that the new department and system will ease the 'flow' of patients being treated throughout the hospital.
Ms Jack said: "The new emergency medicine department won't solve that by itself but our new model of assessment and early discharge will help.
"We believe with the new ED the new model of working will help reduce the number waiting... I can't guarantee there will be no patient waiting over 12 hours. We have to make sure the whole system is working."
Leading GP Dr George O'Neill said he agreed that the building was a sign of a "new era" to redevelop the health system.
"We have to restart that discussion about concentrating all skills in one site and that these skills are available 24/7.
"This is the regional trauma centre and it will have repercussions on the rest of the province as well for people who sustain serious injuries.
"The bigger picture is asking the question 'is the present model doing what we want?' It offers us the opportunity to look at the whole system and not just one particular part of it."
He added: "Nobody would disagree with the principles of TYC (Transforming Your Care). Unfortunately it has not been implemented and in my view is dead in the water.
"I think they have to look at other methods and ways of dealing with health and social care."
Janice Smyth, director of the Royal College of Nursing in Northern Ireland, said it welcomed the new building, but said there were concerns that in the middle of the summer period there continued to be high attendance levels at emergency departments, cancellation of planned operations and procedures, and extra beds in hospital wards.
"It has increased the nursing workforce with an additional 30-40 nurses to ensure the delivery of safe, high-quality care," she said.
"The number of patients, the appropriateness of their attendance, the assessment, diagnosis, treatment, admission and discharge of patients are determined by issues that are often beyond the control of staff in the department.
"A new era for emergency care here is dependent on wider issues within the HSC being addressed".