MAJOR change is required if the emergency department at Derry’s Altnagelvin Hospital is to avoid another “exceptionally difficult” winter, a senior consultant has warned.
Dr Brendan Lavery said “standing still is not an option”.
He described the system as currently operating on a “knife edge”.
The Department of Health said it was “a very challenging time” for staff “with Covid-19 restrictions impacting on an already fragile system”.
Dr Lavery likened the situation to “Groundhog Day” with decade-long problems like capacity and staffing exacerbated by the lingering effect of the Covid-19 pandemic on other healthcare services.
The department responded: “Well before Covid-19, there was clear evidence that our urgent and emergency care services were under increasing pressure.
“This is an unsustainable position that requires sustained investment and reform, including, of course, long-term investment in staffing. There is no quick or easy solution to these problems.
“The department’s review of urgent and emergency care will be published next month and will be the subject of public consultation.”
Dr Lavery laid bare the scale of the difficulties as BBC News NI cameras were given exclusive access to Altnagelvin Hospital’s emergency department.
“Winter is no doubt going to be exceptionally difficult,” he said.
“Our attendances are increasing month-on-month again.
“We are back up to pre-Covid attendance levels, we simply don’t have enough beds to admit patients to.
“All we can do is try our best as always.”
As the cameras rolled, there were 32 patients awaiting hospital admission, filling many of the assessment cubicles.
Social distancing to ensure safety is making the situation more challenging.
Among the patients was 77-year-old Olive, who had been waiting more than 24 hours for a bed on a hospital ward.
Her daughter, Clare, said: “The doctor came in and he could not have apologised any more.
“My heart broke for him; my heart really broke for him because his hands were tied.
“His words were to me ‘I don’t have any beds’.
“What do you say to that? It’s just unbelievable, it really is.”
Another patient, 90-year-old Charan Nagra, who has dementia, was brought to the hospital in an ambulance which had been called by her GP.
After being assessed on a trolley she was moved to the resuscitation area because there was not enough space in the emergency department.
Her daughter Vindi Torney said: “It kind of worried me at the start when they said she was going into one of the ‘resuss’ rooms but I understand that they are very crowded and that’s where she has to be.
“The staff are brilliant in here and I have every faith in them.
“So wherever they can find a safe space for her, that’s fine with me.
“I have seen A&E a lot busier than this and I have had to wait with her for 12 hours and more. This isn’t too bad. As long as she’s well looked after that’s all we want as a family.”
For those working in the emergency department, the pressures are also relentless.
Deputy Sister Laura Dalzell said: “The most frustrating thing at the minute is coming in to the number of patients awaiting on hospital beds within the hospital.
“We are coming in to an already bunged A&E department. It’s then starting a new day within A&E for A&E patients where we are struggling for space to see new patients presenting to A&E as we have got cubicles full of patients awaiting beds within the hospital.
“Every day we come on shift we live in hope that something will ease or things will improve, but at the present moment it hasn’t changed.”
Last October, Health Minister Robin Swann published a 10-point plan aimed at improving urgent and emergency care.
The ‘No More Silos’ document related to two main areas: how the public access urgent or emergency care when they need it and how older people and others who need support will be offered treatment in the community to avoid admission or long delays in hospital.
A number of initiatives already in place include the Phone First telephone triage service.
The Department of Health said there were plans to establish more urgent care centres across the region in the coming months and new processes are also being put in place to ensure patients can be discharged in a more timely manner.
Dr Lavery called for the same creativity used to deal with the pandemic to be deployed to tackle recurrent problems with overcrowded emergency departments and over-stretched staff.
Dr Brendan Lavery said it was like Groundhog Day as annual problems reoccur
“We are in May. In theory this should be the quiet time of emergency departments and medicine in general. It simply isn’t.
“So, if we do not change things by winter we are looking at potentially very, very serious problems in providing healthcare. And providing emergency healthcare for patients who need it.
“The patients who are here need to be here, there’s no major issue with inappropriate attendances and I think it’s unfair for the public to get the impression that they are part of the problem because, quite simply, they are not.”
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