Royal staff claim watchdog report understated pressure in emergency department

Staff at the Royal Victoria Hospitals Emergency Department have penned a letter to say they don't believe a report into a watchdog's unannounced inspection went far enough.

The Regulation and Quality Improvement Authority carried out an inspection between November 2022 and February 2023.

At this time, the crippling pressures were well documented in the media.

Staff burnt out, tending to patients in makeshift beds, desperately trying to help to the sickest patients.

The report into that investigation was published last month and it painted the same picture.

It said that the standard of care did not meet the minimum required standard, that 96 per cent of staff felt patients were not always adequately protected from harm.

It also found that there was a lack of dignity and privacy, and that there were increased reports of incidents impacting safety, including bed sores, falls and medication issues.

However, some staff have written a letter to the regulator to say they do not find the report lacked "explicit focus" on patient safety and that it was "wholly unsatisfactory".

Rita Devlin is from the Royal College of Nursing, and says that for staff, this report was a "last hope" to highlight just how bad things are.

"I've spoken to the the staff within the Royal," she said.

"And I think it's fair to say that when they pinned their hopes on the RQIA report being something that would be a catalyst for change.

"And I think when they read the report, they were very downhearted and disappointed at the fact that it doesn't in any way in their view.

"It doesn't highlight or show the lived experience of nurses and doctors and patients who are within the department, and I think that's been very difficult for them, because if you think that it takes a lot of courage to raise and escalate concerns as they went through all the proper channels, the RQIA was their last hope.

"And I think they believe that the report and itself fell very flat."

She said that the problems elsewhere in the care system "manifest in ED".

"Too many patients needing beds, not enough community access to different types of care, can't get patients out of beds because of the community care issues and the care packages... But the problems all manifest in E.D.

"And it is hard to fix the problem because it's dependent on all the other parts of the organisation working to full capacity. And it is a very complex situation.

"But for the doctors and nurses working there to come in to work every day, fearful that, you know, you're going to make a mistake, fearful that you can't give the care that the patients deserve, it does take its toll on staff and staff are at their wit's end thinking about what they can do to try to make work and where they care for patients safer."

The RQIA insists that the report highlighted "significant and serious" issues, alongside the clear commitment demonstrated by staff on the ground.

A spokesperson said that although the RQIA does not have the power to label the entire system safe or unsafe, the "very serious nature of the issues inspectors observed was apparent" and that five areas below standard were identified.

"During the inspection RQIA found that each of these five standards were breached in relation to: Fire Safety; Workforce; Environment; Infection Prevention and Control; Medicines Management; and Escalation (due to service pressures regionally). 

"This is a very significant and serious outcome.  

"Services operating below the minimum Quality Standards are less able to prevent risks translating into actual events or incidents and resulting in harm.  

"That is what RQIA inspectors observed during this inspection, and this is clearly recorded and reflected in the Report.

"RQIA considers the Inspection Report of the RVH ED does articulate the patient safety impact of patient crowding, and reflects concerns of staff, who were clearly doing their best to provide safe care within the service.

"The Inspection Report provides evidence of specific safety issues, including increases in reported incidents of patient falls, pressures sores and medication incidents; challenges in managing patients presenting with mental health crisis; and impact on patient’s privacy and dignity."

The statement also said that more meetings with Belfast Trust, staff representatives and the Department of Health.

"RQIA will follow up with the Belfast Trust to seek evidence of progress on the actions the Trust has committed to take, which address the issues identified in the Inspection Report.

"The RQIA Chair and Chief Executive have met with staff representative organisations, and with the Chair and Chief Executive of the Belfast Trust to discuss the challenges faced and how these can be addressed more effectively, and will continue to do so over coming months.

"RQIA would encourage anyone with concerns about any health and social care service to contact RQIA at info@rqia.org.uk or tel: 028 9536 1990.”

Meanwhile, a statement from the DOH said that "another very challenging winter period" is expected for health and social care.

"Detailed winter planning preparations are underway for acute hospital care, primary care, community services and social care," a spokesperson said.

"The Department is examining the RQIA’s inspection report in detail and considering how its findings can help inform the work that is ongoing in this area."

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