Exclusive

Northern Ireland's health system under strain as medics face difficult decisions ahead of winter

Pressure on the Northern Ireland health care system is forcing staff to make difficult decisions on a regular basis.

UTV, as part of a special report, has had exclusive access to witness the frontline battle doctors and nurses are facing.

Nurses in the cardiology ward in Belfast's Royal Victoria Hospital - as well as their normal duties - are having to deliver bad news to patients. 

While filming, senior management told nurses that the changing situation in the emergency department means that admissions to their ward need to be stalled, creating a waiting game both for staff and for the patients.

"Morning Pet," said one nurse.

"Basically, unfortunately at the moment admissions are on hold but I am about to know better at about half two this afternoon.

"Then my plan is to phone you back. Is that alright?

"Obviously they will do everything that they can to let it be that you do get to come in today but it's just unfortunately at the minute there's just a lot of patients in the A&E department and I just haven't been given the go-ahead."

Nurse Noirin Kearney says they have to be honest with patients.

"It's extremely difficult. I think a lot of nurses will always compare it to their own families and what if it was mine or what if it was me? And we do think that a lot. That's what we feel when we're ringing these patients and their family members to say that there are delays in an already waited for surgery.

"So they have already waited for some time. They have finally got their call. they have finally got their letter. They are not looking forward to it but they are looking forward to getting the surgery over and we have to be the ones to say that 'Sorry. Today, we don't know if that's going to happen.'

"We try to be as honest as we can with patients. This is not a situation that any of us want to be in but it's even more difficult for them waiting at home."

At the Ulster Hospital, every inch of space is being used to try to treat the never-ending flow of patients who present themselves. 

Patients face a long wait just to be seen, deeply affecting staff morale and quality of treatment.

Emergency Medicine doctor Andrew Dobbin says the department is so busy, care is not being provided on time.

"If you need emergency care we are not in a good position to deliver timely, safe care to you due to the significant crowding in all our EDs across the region."

And the toll on staff, he says, is significant.

"That is a huge problem for staff. The moral dilemma that we know there are things that we could do if we had the space... patients have much better outcomes if they are treated in a timely fashion... we know those patients are having their care delayed further than we would like."

Linda Cooper lost her father in June 2022.

At the end of his life, he wanted to die at home and his family believed that NHS palliative care would help them ease his pain during his final days. She says they were let down by the system. 

"Dad, we promised him that he would not go back to hospital and we were actually encouraged at one point to bring him to hospital and we said 'No. He's not going.' He wanted to be at home and we wanted him at home."

"Marie Curie's research has shown that in the last years of palliative patients lives, there are 780,000 unnecessary A&E visits.

"That's horrendous and in the last three months of these patients' lives their visits increase, out of hours visits. And if the care was provided to them in their homes, they wouldn't need to be going to A&E when the service is already under pressure.

"We wanted Dad to be at home at we were let down cos everything wasn't in place for him."

It is not hard to identify the issues why our health system is under so much pressure. Staff morale, difficulties seeing a GP and lack of social care all contribute to a situation that is beginning to fail both patients and staff.

"He was crying. He wanted to die.

"He wanted to die because he was in so much pain. And for us as a family that was the most horrendous thing. We promised him that he would be at home and that we would never take him back to hospital again and that he would die at home and we would not let him be in pain and we felt like we let him down. But it wasn't us. It was the service that let us down."

Want a quick and expert briefing on the biggest news stories? Listen to our latest podcasts to find out What You Need To Know.