Royal Victoria Hospital: Delays 'contributed to five deaths'

Belfast Trust chief executive Colm Donaghy explains the trust's position

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As many as five patients died in Northern Ireland's biggest hospital last year partly because they were not treated quickly enough in the emergency department, a senior doctor has said.

The patients died at the Royal Victoria Hospital, Dr Tony Stevens said.

Dr Stevens is the medical director of the Belfast Health Trust, which runs the hospital.

Health Minister Edwin Poots has told the NI Assembly the coroner might have to look into the deaths.

Mr Poots said that the medical response could have been much better if more doctors had been available in each of the cases.

The minister said he had only learned of the five deaths from a BBC Radio Ulster interview with Dr Stevens on Tuesday morning.

In that interview, Dr Stevens also said that a shortage of doctors, and patient waiting times, had been significant factors in the deaths.

Speaking on BBC Radio Ulster's Nolan Show, Dr Stevens said: "Specifically, in terms of a contributory factor from people waiting longer than we would like them to be seen, we believe last year five patients in the Royal."

When asked if that was five patients who had died or who had came to harm, he replied: "Came to harm, and some, I mean, some came to harm, some died."

When he was asked how many of those had died, he replied "four or five".

"These were very sick patients and they were very complex cases, so those patients may have succumbed or died anyway, this is a contributory factor," he said.

Dr Stevens said that some of the patients had not been seen for two or three hours after triage, when they should have been seen within an hour.

"This is something we're not happy about, that their care could have been better and their outcome might have been different, but I need to reassure the public, you cannot assume that five patients came into our hospital and, for want of waiting longer than we would want to, they died."

'Not enough doctors'

Dr Stevens said there was a shortage of doctors throughout Northern Ireland.

"A significant contributory factor for us is that in Northern Ireland, as in the rest of the UK, we're struggling to both train and recruit the high calibre of doctors we require.

"We have very excellent doctors working in the Belfast Trust, very excellent doctors - but we need more of them."

Dr Tony Stevens Dr Tony Stevens said there was a shortage of doctors throughout Northern Ireland

He added: "All these cases are serious adverse incidents. They are reported up to the Health and Social Care Board, they are all fully investigated and part of our policy is to inform the families, so it is my assumption that all the families are fully aware of this, but I am double checking that."

'Distressed states'

Garrett Martin, deputy director of the Royal College of Nursing, said they had raised staff concerns with management some 18 months ago. He said the situation was very disturbing.

"We have many members who have approached us in very distressed states," he said.

Analysis

While it is shocking that waiting too long to see a doctor contributed to five peoples' deaths - it is practically unheard of for a senior health manager to say so.

The BBC's Spotlight investigation has produced documents that confirm what a number of people have suspected for some time.

Too few doctors working in a pressurised environment such as an emergency department cannot have a positive impact on patient care.

In fact, according to the Serious Adverse Incident reports (SAIs), two patients had to wait well beyond times that are considered acceptable.

While the Spotlight investigation initially revealed two deaths, speaking ahead of the programme on Nolan, the medical director of the Belfast health trust, Tony Stevens then admitted that in fact the figure is five.

It's not a surprise that people die in hospitals let alone emergency Departments.

What is particularly annoying for those who work on the front line, is that senior managers even those within the health board and the health department, have been claiming that this side of the health service is running smoothly.

As the health minister reminds us, aspects of the service have improved. But the standard of emergency care is struggling to keep up.

In the past some episodes have been dismissed as mere shroud waving and the media accused of making it up.

Tragically, five families are left wondering if their loved one would still be alive, had another doctor been available,

"They are saying that they do not have the required staffing levels to provide safe and dignified care, certainly it's compromised.

"The physical environment where care is taking place is not adequate."

Maeve Hully, chief executive of the Patient Client Council, said the whole health system had to be looked at.

"I think what's currently happening is that we're trying to fix bits, so whatever the problem is today we try and fix that," she said.

"I think everybody needs to take a step back and say 'let's look at the totality of the problems'."

'Review findings disappointing'

On Monday, Health Minister Edwin Poots briefed the Northern Ireland Assembly on the initial findings of a review set up after a major incident was declared at the Royal over a patient backlog.

The review, by the Regulation and Quality Improvement Authority (RQIA), found that not enough medics are available at times in the Royal's emergency department to properly treat patients.

Mr Poots said it was "disappointing".

In the assembly on Tuesday, the SDLP's Fearghal McKinney asked whether there had been a cover-up about ongoing pressures in the accident and emergency department at the Royal Victoria Hospital.

Mr McKinney referred to remarks made by Mr Poots, following a serious incident at the emergency department in January, "that the pressure situation was a one-off".

Mr Poots said he did not intend to "engage in some kind of ping-pong about people's deaths".

Cathal O'Hoisin of Sinn Féin asked the minister if he would apologise to the families of the five patients who had died.

Mr Poots said he "certainly would express my sympathies".

He said he "attended the RVH on the morning after the major incident was declared and I spoke to staff and I took my actions on the basis of speaking to staff, nothing less or nothing more".

Patients recalled

In June 2013, 105 patients who had been treated at the hospital in the previous eight weeks, were recalled after concerns were raised by medical staff about possible cases of misdiagnosis.

At the time, Dr Stevens said there were "no immediate concerns" about the patients' well-being.

In March of 2012, an elderly patient apparently died unnoticed on a trolley in the hospital's A&E.

After that incident, Dr Stevens said the quality of care given by doctors and nurses was not a concern.

The issue of waiting times is explored in a BBC Northern Ireland Spotlight programme, being shown on BBC One at 22:35 GMT on Tuesday.

During the programme, reporter Declan Lawn tells Health and Social Care Board chief executive John Compton that they have obtained figures that show that waiting times have contributed to two deaths in Northern Ireland.

In response, Mr Compton said: "Serious adverse incidents in my experience are a combination of events.

"They may have time aspects to them, they may have diagnostic aspects to them, they may have classification aspects to them, they may have judgement, decision making aspects to them. What we have is a very robust process that looks at serious adverse incidents."

Spotlight will be broadcast on BBC1 NI at 22:35 GMT on 11 February.

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