Overcrowding 'big problem for A&E'
Overcrowding is the biggest problem facing medics in Northern Ireland's largest emergency department, a senior nurse has said.
Geraldine Byres, a nursing consultant at the Royal Victoria Hospital (RVH) in Belfast also acknowledged that the stressful, busy and frenetic environment had sometimes compromised patient care.
"The biggest pressure for staff in the emergency department is crowding," she said.
"Seeing patients lying on trolleys 10,11, 12 hours -- that's the thing that causes them the greatest pressure."
Addressing a pioneering investigation by the Human Rights Commission Ms Byres said systemic problems in processing patients were clogging up the emergency department and claimed difficulties could not be alleviated by adding more staff or relocating to a new facility.
She added: "Having more nursing staff is only part of the solution. The thing that will improve the situation will be about sorting the system and relieving the congestion in the emergency department.
"If patients cannot be moved on elsewhere then the emergency department which becomes overcrowded and congested."
The Human Rights Commission launched its public hearings following a major incident at the RVH last December and a subsequent critical report into the emergency department by inspectors.
The panel-of-three is holding 12 public hearings and will call medical professionals as well as patients to give accounts of their experience before publishing its report next year.
Emergency department consultant John Maxwell, clinical director at the RVH and Mater Hospitals in Belfast, said a change in management style had given clinicians more influence.
Mr Maxwell said: "The major big headline difference is the enabling of the clinicians to decide what needs to be done for patients and how to improve patient care and managers supporting and facilitating."
Also giving evidence during the second day of public hearings was Dr Nick Morse, who has been working as a consultant in the RVH emergency department for the last 18 months.
He said doctors were able to have "open and frank" discussions with managers and said waiting time targets were not as "rigorously policed" as they were in England.
Among the panel of experts was a former UN health rapporteur, Professor Paul Hunt, who said it appeared senior clinicians and managers at the Royal had a "chummy" relationship.
"Listening to the arrangements described, it all sounded a bit chummy," he said.
However Mr Maxwell told him formal and informal arrangements existed for reporting difficulties.
The inquiry is examining the quality of people's experiences in emergency departments; the final reports and recommendations to the Executive will be published in April next year.
Human Rights Commission's chief commissioner Les Allamby said it was a world first.
Mr Allamby said: "It is about empowerment in a situation where people are in fact in a position of vulnerability and don't generally feel empowered.
"This is new territory for human rights institutions in that it is the first inquiry of its kind into accident and emergency services anywhere in the world.
"We do not have a template for that."
Yesterday Health Minister Edwin Poots highlighted problems with X-rays and scans, undignified treatment of elderly patients at emergency departments, bed blocking and issues surrounding effective admissions.
He said too many people were still attending emergency departments who did not need to and added others were left waiting while specialist doctors decided who could treat them.