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Pressures on Emergency Departments

Maeve Hully, Chief Executive

Over the past few weeks, you might have experience of visiting a very busy hospital Emergency Department, or heard about the pressures facing our Health service on the news. Why is this happening?

The Health and Social Care Board says the number of people attending Emergency Departments has risen by 24% (3,039 patients) since 2013/14 for the Christmas and New Year holiday period.

They have produced information for patients on why our Emergency Departments come under pressure so much around this time of year. Having this information available is useful, so we can all better understand our Health and Social Care system here, and what we can do to help ourselves and go to the right place for care.

There are a range of alternative services that people can access if they do not need emergency care. These include using the online A-Z symptom checker, seeking advice from a pharmacist, going to a Minor Injury Unit, or contacting a GP or the GP Out of Hours services (if their medical condition can’t wait until the GP surgery reopens). People can also check the average waiting times in their local Emergency Department

The Patient and Client Council Care when I need it report shows how much people value the work done by health care staff providing treatment.  It’s anticipated that Emergency Departments and other urgent care services will continue to face pressures in the time ahead, as are other areas in the UK and Ireland.

Many people try to make the right choices, but with challenges like long call backs for GP Out of Hours, and limited opening hours in surgeries and minor injury units they end up with no other option than attending Emergency Departments. For many, an increased wait, is an increased worry.

There is lots of work going on to find solutions to the issues facing Emergency Departments in Northern Ireland. What many people agree on is the need for overall transformation of the whole Health and Social Care system.

What’s been your experience of accessing Health and Social Care over the past few weeks? What do you think needs to happen to help reduce pressures on our Emergency Departments?


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Previous comments ...

Sean Annon 10-Feb-2018 at 11:51 hrs

A single point of access for patinets would be far more beneficial than offering them online symptoms checkers. I guess the predominant demographic of attendees is elderly and frail individuals or young children. The former are less likely to access online resources and the latter are difficult to assess at the best of times and using online services present a risk a lot of parents are not willing to take.

The OOH GP needs to work in collaboration with other health care providers to shed the waiting times and introduce different skill sets to its offer to deal with the waiting times and the content of the call back queue.

Thir sector providers are highly under represented and could deal with the root cause of the issues on a more consistent basis than the OOH, of hours for that matter, providers. EH Social prescribing has a strong evidence base, however, is not widely used. Is it any wonder the depressed individual who has been handed a packet of pills wants to get seen and managed at 01.00 when they are at the lowest ebb, no services or release levers are available to them so it's off to ED as MH services wont see ? intoxicated patients...that is one example off the top of my head.

The back door of Hospital needs to be freed up significantly with a more robust social care system. 8/10 carers in NI suffer with issues of their own brought on by the significant co-morbidity of loneliness. Is this being addressed? If not that issue will never go away.

Have any additional referral pathways and training been provided for the 999 services to divert into primary care, MH, specialist palliative care locations? An ambulance at the front door is far more resource heavy than a walk in patient, this must be addressed and the clinical HUBS in NI developed across 999 and OOH providers. I'm a Paramedic in NI and cant find a one is doubting the pressure that the service is under but I see no sign of innovation or outward looking questions being asked to bottom this out.


Brendan Clarke 28-Jan-2018 at 22:28 hrs

To remove pressure from A & E departments we need to start momitoring the number of patients who need to access emergency departments for illnesses which are not being properly treated because of horrendous waiting lists which themselves are essentially a blatent abuse of the Human Rights to life, a proper family life and freedom from torture. Waiting lists are clearly a large part of the answer to the question posed by E. Murphy above as to why there are so many sick younger and older people.

We need to monitor how many of those visits then result in admission to hospital.

We need to monitor how many patients are discharged from hospital as fit, only to be readmitted to through A & E within days because of the same problem as has happened to a friend of mine 5 times over recent weeks. Statistically that will be shown as 5 visits to A & E and 5 admissions while the actual figures should be 4 misjudged discharges, 1 admission and 1 discharge after having regained fitness.

Allison remembers that things were different in the early 70`s
when she trained as a nurse. This month marks the 50th anniversary of the beginnning of my regular need for hospital services. It is a long time to remember back but I believe that back then the RVH alone contained 1,400 beds which is approximately the same combined total as the RVH City and Mater Hospital maintain today. Beds is a simple euphemism for staff numbers because the more beds there are the more staff required to service them. The less beds the greater the saving in staff costs. The massive reduction in bed capacity obviouusly contributes to the problems of today.

When I first entered RVH hospital, basic care for cardiac patients was 1 week bed rest followed by 2 weeks in wards 5/6. Now you are most likely to be done and dusted within 5 days. This massive and much needed improvement suggests a 75% increase in bed occupancy rates.

Mothers giving birth use to be in hospital for 4/5 days but now are only there for 4/5 hours after birth. Another very substantial increase in bed occupancy rates.

We now also now have key-hole surgery, day procedure clinics and patients being discharged earlier into the care of Primary Care. All of this must benefit bed occupancy rates.

In addition we regularly have the postponement, without a cn individual clinical basis, of what is claimed to be non-urgent surgery. On the basis of what the Health Service tells us is required to have a longer and healthier life, this in many cases actually has a detrimental effect on and the increased potential to shorten the life span of those affected. These unethical postponements also benefit bed occupancy figures in the short-term by simply imposing suffering on people by simply moving the necessary requirement for more beds now to a future date when it will be even more difficult to fund the greater number of extra beds required to clear the increasing back-log.

The management of the Health Service from the Dept of Health downwards seems to be focused on egotistical formulation of the great idea that will transform services. Regularly we have new plans which are going to produce a perfect end-product but which are really a re-hash of the old ideas which have been around since the Health Service was first mooted as a benefit to the nation.

One needs to distinguish between an increased population trying to access A & E and increased numbers of people not receiving proper treatment needing to access A & E because of the failure of the NHS to provide treatment when required because of the cost-cutting exercise of reducing bed numbers.

NHS managers should perhaps look at the Tourist Industry and investigate the pros and cons of providing facilities only open at weekends and only staffed by people who are contracted to have only weekend work. Can complete floors be hired in local hotels for winter weekends to provide beds for patients?


Kristyene Boreland 26-Jan-2018 at 15:42 hrs

Overall transformation via a good public health education starting from schools, family set up , individual accountability to a healthier option of life style.


Peter Martin 14-Jan-2018 at 16:12 hrs

Although I did not have to visit any emergency department in Northern Ireland recently I was in Glasgow on Wednesday 20th December and had occasion to attend Glasgow Royal Infirmary A&E department, I arrived at 2.10pm and was treated and left the hospital at 2.30pm after treatment. I was very impressed with the speed and efficiency of the service I received and how well everything was organized and there was about 10 to 12 other people waiting for treatment as well as myself.


E.Murphy 14-Jan-2018 at 00:47 hrs

Yes I would agree that something clearly needs to change to take the immense pressure off the emergency services. But I am very sceptical about the word transformation. Change is certainly needed but I would be more concerned about why this crisis is occurring in the first place.
Why are we needing more care at the point of crisis? I am fed up with hearing that this is because of the growing older population because the follow up question should then be.. why are there so many sick older people?
I think there should be more done to educate and support people in our community to live healthier lifestyles. More funding towards local health promotion services. Funding for social groups to enable people to develop a more positive outlook, combat lonliness and perhaps give them an opportunity to discuss their concerns and learn how to deal with them before they become a crisis. This, I’m afraid is a more long term solution, but the A&E crisis has not occurred overnight.


Seamus Curley 13-Jan-2018 at 20:56 hrs

Over the last year I have visited the Hospital (Altnagelvin ) on quite a few occasions and was well cared for by an excellent medical professional team although I could see that they were stressed out by the pressure of work.
Having finished their ten hour shift . often without a break,they then drove home and I wondered how safe that journey was after a tiring day.
A lorry or bus driver would never be allowed on the road without having a statuary rest period.
I feel that the present Government's Austerity policies .and their present Privatisation stance is destroying our NHS and that campaign groups are not doing enough to save our publicly owned health care system


Raymond Hynes 12-Jan-2018 at 21:12 hrs

Unfortunately due to angina problems I have had to attend A&E department, Ulster Hospital on a number of occasions, the last being just before Christmas. There were nearly 100 patients in A&E with over 30 awaiting admission to hospital. The staff were magnificent and professional under severe pressure. I thank God for their care and dedication.


Allison 12-Jan-2018 at 19:36 hrs

I feel I must give my honest opinion regarding the state of the NHS. As a nurse who trained in the early seventies I see such a change in the NHS services. We all ask what has changed over the years, well obviously everyone blames an ageing population, but my opinion whether accepted or not is as well as older people living longer we have had such an influx of immigrants over the years and government have not made any extra allowances, instead they have closed brilliant hospitals such as Whiteabbey and others with such rise in population, any wonder it is bursting at the seams. This is not a pop at immigrants if they are in work and pay taxes they have as much right to UK NHS as anyone else. I only know that when I am in my local health centre approx 50% of the patients speak in a foreign language, I have received reports from my friends who say its the same in their GP surgeries and A&Es; I firmly believe that there should be a charge to see a GP who in return must spend more time and effort in making a diagnosis, in order to relieve the hospitals which should only be used in severe cases and needy cases. Anyone who does not turn up for an appointment GP or Hospital without notifiying should be charged and finally and very importantly Prescription charges MUST be brought back, even £2 per item which is affordable and people would think twice before ordering endless amounts of medicines which are not always used. It is outrageous the needless waste of drugs just because they are free. I believe that those who are gluten intolerant should not be prescribed gluten endless amounts of free products. Years ago patients had to make do themselves and they managed!
The NHS needs to be be much more productive and less
wastefull if some of these measures were put in place just imagine how usefull the extra revenue would be.
I feel very passionately regarding our NHS it is a wonderful organisation and we are all so very luckyto have access to it, but unfortunately anything that is free is usually abused and we need stronger, cleverer leaders and that definately does not include Jeremy Hunt who continues to smile sweetly at the cameras and do very little constructively.
Please put Mr Gerry Robinson in charge of the NHS and he would turn it around in less than a year. I remember watching his TV documentaries on the NHS years ago and I thought his ideas were sensible and effective.


charlie lynn 12-Jan-2018 at 19:26 hrs

So sorry to say this but I am completely convinced the present government are going to dismantle the already failing NHS. Only people with lots of money need apply.


julie 12-Jan-2018 at 17:39 hrs

First of all the staff at the Royal Victoria Hospital, where amazing as always, but more so because of the pressure they where under, we waited 6 1/2 hrs before they decided they where keeping my elderly mother, who was taken in by emergency ambulance. There really needs to be something done about the way the paramedics, are tied up for so long waiting to hand patience's over to medical staff, at 1 point all of the 7 crews that cover, the whole of Belfast, where stood waiting in the corridor. 18 hour my mother spent on a trolley, before getting a bed. There where people there getting seen to before other, because the police had brought them in, I personally think if the GPS had more appointments for their patients, it might cut down a bit on our A&E departments, as people cant get to see their GPS so just taking the alternative and going to A&E. I also think that we should be like other countries, where if you are not a resident you must produce health insurance I think some people need to be patient and show our health works respect. You really get your eyes opened when you have to attend these places, we would be lost without them