Former A&E doctor at RVH speaks about his experiences

Dr Jonathon Millar spoke to BBC News NI's health correspondent Marie-Louise Connolly

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A doctor who worked in the Royal Victoria Hospital's (RVH) accident and emergency department has said he managed chaos rather than patients when he worked there.

Dr Jonathon Millar left last year and is now a trainee emergency doctor working in Glasgow Infirmary Hospital.

He said it was like working in "two different worlds".

He was among a group of doctors and consultants who emailed the RVH's executive team to raise concerns.

On Tuesday, a senior doctor confirmed delays were a factor in the deaths of as many as five patients at the Royal Victoria Hospital in Belfast last year.

The Belfast Trust's medical director, Dr Tony Stevens, told BBC Radio Ulster's Nolan Show a shortage of doctors, and patient waiting times, had been significant factors in the deaths.

'Pressures'

Dr Millar attended a meeting, along with other medical staff, with Mr Stevens to highlight their concerns last year.

"At that particular meeting we advised the medical director in no uncertain terms about our concerns, particularly our concern that given the pressures in the emergency department, there must be excess mortality in the system, there must be excess morbidity in the system," he said.

A tale of two cities

Dr Jonathon Millar on his experiences in two different cities:

"If you arrive at an emergency department and a doctor, with perhaps 20 years experience, diagnoses you, or has assessed you to have a problem that requires in-patient treatment with a cardiologist, in Glasgow, or other centres in the UK, you will then leave the emergency department to be assessed by a cardiologist on their ward or in a unit within the hospital.

"That's not the case in Belfast.

"What then happens is the consultant with 20 years experience has to phone a much more junior doctor from the cardiology team, and this applies to a number of specialities, to come and review you in the emergency department.

"There might be five or six people waiting for that review, and that is delaying patients in the unit until that is complete and they can go elsewhere and that's what creates an access block to the rest of the hospital.

"That's why this is a problem that originates in the rest of the hospital, but is ending up being played out in an emergency department."

"Over time and across a number of these meetings we were assured that steps were being taken to implement change, to develop a service and really we were placated over time, but as each meeting went past and as each attempt to raise concerns went past, significant change was never forthcoming."

He said that created an "almost nihilistic atmosphere".

'Demoralising'

"People felt is there longer any point in raising these concerns if they're not being acted on?" he said.

"That's incredibly depressing and it's incredibly demoralising for a workforce, not just doctors, but nurses and other staff in a department to feel that even though they are raising what are extremely serious concerns about the safety and the dignity of the patients they're looking after, that no-one seems to be responding.

"I don't think it could be because the problem wasn't understood, because within the Belfast Trust they had a number of external reviews, they had advice from their own staff, we had meetings such as the ones I attended and we had a review from the College of Emergency Medicine."

Dr Millar said working in accident and emergency departments was not without its challenges.

"I'm not going to pretend that emergency medicine across the UK doesn't have problems, and that there aren't problems here (Glasgow)," he said.

"But I'm now working in a completely different system where I have never felt under the same pressure, I've never seen the same scenes that I saw, and again, I've never felt that I'm delivering sub-standard care here, the way that I would have done in Belfast.

"The priority is always patient safety and trying to ensure that the service you are delivering is safe and that becomes very difficult in that kind of environment.

"You're certainly never giving the care that you would want to give and I would be the first to admit on many a night shift or weekend shift that I worked in that department, I did not give a standard of care that I felt was appropriate to patients because our sole focus was just managing the chaos and making sure we got through the night without any kind of major incident."

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