Inside the emergency department where staff question how long they can keep going

• The hospital has a troubled history, with inspectors highlighting an "incredibly busy department and struggling with shortages of staff"

An emergency consultant has laid bare the challenges of working in one of Wales' busiest emergency departments.

ITV Wales was given exclusive access to Ysbyty Glan Clwyd in Bodelwyddan, Denbighshire, to see the pressures staff are facing in the lead-up to winter.

While there, more than 50 patients were waiting in the 20-bed department, with one person waiting for more than a day.

Dr Jen Dinsdale questioned how long staff can keep working in the current climate, with almost 5,500 people attending A&E last month.

But she emphasised that patients should still attend the department if they need it, describing it as "a precious place for people to come and feel safe, secure, calm, reassured, cared for and protected".

"I would never have thought that nursing an elderly patient with a broken hip on a trolley in a corridor would ever be the health system that we would've aspire to," Dr Dinsdale added.

"You just have to keep going, you can't afford to sit and focus and go 'Oh my goodness isn't this terrible?'

"But it builds up. Doctors might not take breaks, they might put off their own health and well-being, sickness tends to go up, and they tend to work for longer when they really should be resting.

"It's just that sense of finishing your shift and thinking thank goodness that's over, then realising I've got to do it all again tomorrow. You just have to put it to bed and then start the next day and hope that there's been some solution overnight that's relieved the pressure."

Latest figures show that fewer than 47% of the patients attending the emergency department at Ysbyty Glan Clwyd last month waited below the target time of four hours. The average for Wales was 68.7%.

Dr Dinsdale said: "In terms of how long we can keep going, I think that comes down to a numbers game of how long people can keep turning up and I don't know how long that is, I genuinely don't know how long that is.

"If it does worry me I certainly don't want that to be transmitted to the patients I'm seeing. I want them to know that we are focused on them when we see them, we're not thinking about any of that stuff.

"But obviously for the bigger picture and for the future and my daughter's future, she's just turned two, that's where my attention drifts to and what is she going to be facing when she grows up."

The hospital has a troubled history, with inspectors highlighting an "incredibly busy department, struggling with shortages of staff, high numbers of seriously unwell patients and a lack of space to treat them" after their last visit in November 2022.

The health board, Betsi Cadwaladr, was placed back into special measures in February 2023 following "serious concerns about performance, leadership and culture".

Almost six months into the intervention, its chief executive told ITV Wales she is "very clear about the extent of the challenges".

The new boss of Betsi Cadwaladr says we're clear "This is going to take us some time to be able to improve".

Carol Shillabeer said: "We've got quality of care challenges, we've got staff experience challenges, we've got financial challenges along with many others, we've got challenges of governance.

"We're clear about them, we're clear about the steps that we've already started to take but we're also clear that this is going to take us some time to be able to improve. It may be years, I see this as years.

"I wouldn't want us to fix too much on the tag of special measures. We're about building a strong organisation, building strong leadership and engagement.

"We're being really open and transparent about the challenges and we're going to work with people to find the solutions. They won't come overnight though."

One of the solutions already underway is the use of community nurses, who are helping to ease some of the pressure through home visits, keeping "phenomenal" numbers of people out of hospital and preventing readmissions.

Jane Roberts, head of community primary nursing, said: "We do a variety of treatments, we do a lot of wound care, catheter care, chronic disease management.

"We work very much alongside our GPs and practice nurses to support those patients to manage their condition.

"Without the team there would be phenomenally much more patients turning up at the door of our emergency departments and actually also the other side of that at the back door, not being able to be discharged because they still have some element of need.

"So I think it's crucial what happens out here in the community to really support our colleagues in secondary care."

The hospital has also created a discharge lounge, where around 900 patients are being moved every month prior to going home.

Rhodri Morgan, assistant director of operations and head of the site, said: "It's an area that we would move patients that are due to go home or due to go home the next day to have ongoing treatments, to have their relatives come and sit with them etc and to arrange all the transport.

"So they're not staying on an acute ward, they're coming to more of a relaxed environment.

"It just means that we can flow sooner rather than later in the day. We've got a turnaround team who can go into those areas, pull those patients out, make them comfortable and we can release the bed back to the emergency department much quicker."

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