Royal Victoria Hospital emergency department operating beyond capacity and core purpose, report finds

The Regulation & Quality Improvement Authority (RQIA) has published a report into an unannounced inspection at the hospital last winter and has raised concerns around crowding and staff morale. The inspection focused on the model of care delivered in the emergency department, looking at patient flow, staffing and management and governance arrangements.

Inspectors witnessed the operation of the ED, including at night and weekends, and spoke with patients and staff. In their findings inspectors highlighted significant crowding in the department on a sustained basis. With regards to workforce, inspectors found "staff burnout, well-being issues and low morale".

The report said: "Inspectors found the service did not comply with the quality standards set out by the Department of Health for health and social care services in Northern Ireland. "It was clear that the ED was operating beyond its core purpose and capacity.

"This was the result of increased numbers of patients in the department and patients staying in the ED, beyond their need for emergency acute care, and requiring ongoing care. "This was because the pathways out of the ED, whether to admission to hospital wards or for social care needs in the community, were not available.

"This is often referred to as crowding but it is important to recognise that it is a result of the ED operating well beyond its capacity and beyond its core purpose." RQIA's chief executive Briege Donaghy said: "During this inspection, RQIA found a dedicated workforce, who were struggling to deliver care above the ED's capacity and outside of the core purpose of an emergency department.

"We have heard the powerful testaments of patients and their families who have accessed ED services and while commending the staff for their compassion and care, have at times been concerned and anxious. "Clinical staff and their professional bodies have told us of their severe concerns, frustrations, and distress at the persistence of the situation.

"This RQIA inspection report concurs with these experiences. "It describes a service under stress and the inspection findings provide specific evidence of quality and safety at risk." Ms Donaghy added: "The inspection report sets out a quality improvement plan (QIP) that the Belfast Trust has agreed to implement.

"This will help alleviate some of the immediate safety issues identified, but we must caution that these steps will not resolve the underlying problems. "Without service reform, the ED will continue to be pressed to operate beyond its capacity and outside its core purpose with resulting increased risks to patient safety and to its staff.

"RQIA recognise that many of the pressures observed during the inspection are occurring at emergency departments across Northern Ireland." SDLP health spokesperson Colin McGrath said the report should be used as a catalyst for change.

He said: "This report shows just how broken our system is and if we don't act now things are only going to get worse." People Before Profit MLA Gerry Carroll said the report showed the "human cost of austerity".