It has long been recognised that our hospital emergency departments often find themselves operating under intolerable pressure, but a new report has set out some of the alarming consequences of this systemic failure.
The Regulation and Quality Improvement Authority carried out an unannounced inspection at the Royal Victoria Hospital's A&E unit last winter, speaking to staff and patients and closely observing its operation day and night.
Its report paints a picture of a service facing almost impossible challenges, attempting to deliver care while operating above capacity and "beyond its core purpose".
Among the most alarming observations was an increased fire risk due to significant and sustained overcrowding, potentially compromising effective evacuations.
Inspectors found a dedicated but very frustrated workforce, expressing serious concerns about burnout and low morale, while patients spoke of anxiety about risks and a lack of dignity in their care.
Medicine management errors were also highlighted, including under-reporting, as well as "increased reported incidents affecting patient safety, including pressure sores, falls and medication".
Read More :
People's experience of A&E getting far worse, report warns
What the latest NHS performance figures show
Ultimately, the report found that the emergency department did not comply with quality standards set out by the government for health and social care services.
The reasons for overcrowding are familiar: high demand for services, combined with blockages when attempting to move patients through the system because of lack of availability of hospital beds and community social care.
And while the RQIA has made recommendations to help alleviate some of the immediate safety issues identified at the Royal, it warns that without service reform, the underlying problems – and increased risk to patients and staff – will remain.
That is of course true for emergency departments across the north and the findings have been shared with the Department of Health.
The issues highlighted should come as no surprise to health chiefs or anyone who has read a succession of other reports over many years outlining the structural problems in our regional NHS.
But with Stormont still mothballed, how far civil servants can go in funding and implementing the kind of reforms that are required is unfortunately limited.
The plea from healthcare professionals and anyone who has experienced long waits in overcrowded emergency departments will be for politicians to prioritise staff and patients and get on with the job of addressing these deep-seated problems before the next round of winter pressures begins.
