Many wait 12 hours at Belfast A&Es
Many patients at Belfast emergency departments are waiting more than 12 hours for treatment, the health minister has said.
A concerted effort is still required to make improvements after a major incident was declared at the Royal Victoria last January, Jim Wells said.
He acknowledged progress in cutting waiting times in other parts of Northern Ireland.
Additional staff had to be called in and extra beds opened to cope with the backlog at Northern Ireland's largest hospital at the start of the year and independent inspectors have said more work needs to be done.
Mr Wells said: "I am very disappointed that the assurances that the Belfast Trust made to my predecessor that it would bring about sustained improvement appear to have not been fully realised by the Trust."
He recognised some progress had been made.
"The Trust in recent months has continued to experience, unlike most other Trusts, high levels of patients waiting more than 12 hours in both the RVH and Mater Hospital emergency departments."
The Regulation, Quality and Improvement Authority (RQIA) carried out an unannounced inspection of the Royal's emergency department and acute medical unit in May.
Mr Wells added: "The RQIA's report highlights that although some progress had been made to address its recommendations by May of this year, a concerted effort was still required to ensure recommendations are actioned and implemented in full."
The Executive has allocated £5 million funding to unscheduled care services to help ease winter pressures in the months ahead.
To date some £2.3 million of this has been allocated to trusts, including the Ambulance Service, to fully fund or contribute to the costs of a range of measures to improve unscheduled care, the minister said.
The remaining £2.7 million will fund measures to improve patient flow and expand capacity over the winter.
Mr Wells added: "During the last year the health and social care sector achieved a 44% reduction in the number of patients waiting longer than 12 hours and I am pleased to report that in the first six months of 2014/15 this progress has continued with the lowest number of 12-hour waits in five years."
The minister said considerable improvements had also been made in the transfer of information between nursing homes and emergency departments.
He was updating the Northern Ireland Assembly on efforts to improve the delivery of unscheduled care. A review published in July said hospitals must do better.
Mr Wells said progress had been made in a number of areas, including the care of frail older people. The number of patients assessed and admitted has been steadily increasing over the last number of weeks and the trust has received very positive patient and carer feedback about the experience.
Belfast Trust is in the process of finalising the arrangements to expand direct access of patients to Belfast City Hospital.
A regional approach to unscheduled care has been developed identifying alternatives to emergency department attendances, particularly for older people and those requiring urgent assessment rather than emergency care; an audit tool is also being created to identify any delays in the patient's journey.
This will help trusts identify gaps and take action to correct delays, Mr Wells said. Ambulances have been equipped with mobile phones to allow paramedics to identify which hospital department to bring patients to, potentially bypassing emergency departments.
A Belfast Trust spokeswoman recognised that adult unscheduled care systems were not working as effectively as it wanted them to.
"We are on a journey of significant change and improvement led by senior clinicians and we are very confident that this will deliver real and sustained improvement, though we recognise this is taking time," she said.
"We have a hugely committed body of staff from all professions and disciplines determined to meet this challenge and to continue to work with the Regional Unscheduled Care Task Group to deliver sustained improvement in unscheduled care services for patients and clients.
"Our response to RQIA's re-inspection of our emergency care services which took place six months ago demonstrates the very real progress we are making in key areas. It also makes clear where there are challenges in meeting some of the recommendations.
"However, we are committed to meeting these recommendations and will continue to progress them with the support of the Department of Health, the Health and Social Care Board, and the expertise and skill of our staff."
Staff in the trust have taken forward a number of major initiatives in preparation for the winter months, she said.
"For example, we are working hard to improve our discharge processes to ensure the sickest patients have the quickest access to our beds; we have the ability to open additional beds if we need them at times of increased pressure in our emergency departments; we have opened BCH (Belfast City Hospital) Direct - a new direct access assessment unit for GPs who refer frail elderly patients via ambulance and allow them to bypass the emergency department; we have created extra capacity for imaging at weekends; and we have rapid-access neuro clinics at the Royal Victoria Hospital for people presenting to emergency department with seizures.
"We have recently physically moved 12 wards and six clinics in the Royal Victoria Hospital (308 beds).
"This was a determined effort to put patient safety and experience first by co-locating specialisms; to aid cutting down on patients outlying from their specialism; and to ensure the beds we need for our patients are in the right place and cared for by the right team.
"For example, we now have the whole of fractures service in one area; cardiology, respiratory and cardiac surgery are all on the one floor'; and, we have a newly re-profiled respiratory ward in the Royal to ensure the patient experience is enhanced."