Fears over safety of water, staffing and leadership at Belfast children's hospital
A series of potentially dangerous failings have been uncovered at Northern Ireland's regional children's hospital.
It has emerged that a surgical ward at the Royal Belfast Hospital for Sick Children was not carrying out adequate checks to protect patients from the potentially deadly pseudomonas bug earlier this year.
Inspectors from the Regulation and Quality Improvement Authority (RQIA) carried out a three-day unannounced inspection of Barbour Ward and the emergency department at the children's hospital in May.
As a result, the Belfast Health and Social Care Trust was ordered to implement a water testing regime at Barbour Ward to ensure the safety of some of the sickest children in Northern Ireland.
It comes after an outbreak of pseudomonas aeruginosa at hospitals here in December 2011 and the beginning of 2012 which led to the deaths of four babies.
Infected taps were subsequently blamed for the scandal by then Health Minister Edwin Poots and measures were put in place in hospital wards across the province to prevent a similar tragedy from happening again.
However, following on from May's inspection, the RQIA has published a damning report highlighting a series of startling concerns over working conditions and the safety and dignity of patients in both units, including concerns about water safety.
The document said: "Many of the surgical/medical specialities catered for in Barbour ward are included in the category of augmented care.
"Barbour ward does not currently operate as an augmented care ward in terms of water management - there is no evidence of water flushing, water testing or records to provide assurance that opportunistic organisms such as pseudomonas aeruginosa are not present in the water system."
During the inspection staff in the unit - where children recover from transplant surgery and newborn babies are treated - described the hospital "as having disconnected leadership".
The RQIA team discovered there had been no ward sister on Barbour Ward since last December, and senior nursing staff were carrying out administrative work at home.
The watchdog's report continued: "Nursing staffing levels and middle grade doctor staff shortages had impacted on overall workload, morale and reduced the ability of staff to avail of educational opportunities.
"Staff reported that a lack of visibility and engagement of senior management and executive teams had been very frustrating, leaving them with a feeling that their problems were not being listened to. The hospital was described as having a disconnected leadership."
It emerged the ward had recently lost six whole time equivalent (WTE) senior nursing staff and had four WTE nursing vacancies. Junior doctors said staff shortages "can frequently lead to delays in important aspects of patient care such as procedures or investigations performed". The inspectors also deemed the layout of the ward had the "potential to impact negatively on safety and quality of care".
Junior doctors in the unit also complained the induction process was "suboptimal" and said they needed training in the likes of paediatric life support and drug calculations.
A call bell system was not in place in the high dependency unit of Barbour Ward and RQIA inspectors saw children being changed without curtains being pulled around their bed space.
Staffing levels were also raised as a major concern in the hospital's emergency department.
The RQIA team was told the "need for additional staff" had been "discussed with senior trust staff over 18 months ago".
However, the matter was still under review at the time of the inspection, which also uncovered "extensive gaps" in the unit's registrar rota.
The RQIA report said: "Currently, 0.75 WTE doctors are staffing a six-person rota at the middle tier level, within the next month there may be no doctors on this middle tier rota.
"Junior doctors reported that rota gaps are not currently impacting on patient care, as emergency department consultants are taking on increased duties and workloads; however, this approach is very unlikely to be sustainable going forward.
"Junior medical staff indicated that at times overnight cover can be insufficient due to the volume and/or complexity of children presenting. Junior medical staff reported they were supported by the medical staff on the hospital wards; however, they are reluctant to regularly rely on this support as the ward-based medical staff were also very busy overnight."
A shortage of middle grade doctors in Northern Ireland has previously resulted in the reduction of services, including the closure of the A&E at Belfast City Hospital and the overnight closure of Downe Hospital's emergency department.
Meanwhile, the future of the emergency department at Daisy Hill Hospital is also under threat due to a shortage of consultants.
The RQIA inspection in May further discovered there was no porter system in the hospital, meaning nurses had to transfer patients to other wards, which the watchdog said "can leave the emergency department short-staffed for periods of time".
The inspection team also raised concerns about a lack of medical equipment and facilities in the adjoining short stay assessment unit.
The Belfast Trust said it welcomed the findings.
"RQIA have confirmed that the Royal Belfast Hospital for Sick Children delivers high quality, effective, efficient and compassionate care. We are pleased that RQIA's report has recognised the tremendous strides made by staff to continually improve the safety of care provided to our patients," it said.
"As a learning organisation, we accept there are areas that would benefit from improvement.
"After inspection, RQIA gave us verbal feedback regarding improvements, staff moved to put them in place and an action plan was implemented."
It said the nurse staffing levels in Barbour Ward are set at the correct nurse/bed ratio.
It added: "The band seven post is currently filled with a temporary member of staff and the permanent post is currently advertised. A Water Safety Group is set up within the trust and water is tested regularly.
"Belfast Trust is fully supportive of RQIA's inspection process and will continue to work with the regulator to improve and enhance patient safety and experience."