Commissioner slams Belfast Trust on night tranfers of elderly

The Commissioner for Older People in Northern Ireland has criticised the late-night transfers of elderly patients saying it was an “indictment of the state of our health service”.

Claire Keatinge was commenting following a BBC report into the written complaint of several senior nurses who described the out-of-hours hospital transfers of frail, elderly patients in Belfast as an abuse of vulnerable adults.

In a letter to the Belfast Health Trust, the nurses allege the Trust was not complying with its own policy and procedures.

They say following a series of incidents in 2014, agreements and policies were put in place. However, the nurses say these have been ignored at times during the past fortnight. The arrangement put in place included:

•     All patients who are suitable for transfer to Musgrave Park Hospital should be identified by the time of staff’s morning bed meeting
•     Musgrave Park Hospital will be contacted to request bed availability
•     All transfers should take place before 19:00 in the evening
•     Elderly patients must not be transferred out-of-hours
•     The decision regarding transfer will be made by the fracture team and not by anyone outside the team

Claire Keatinge has now asked the Health Minister when he will escalate his response to a chronic lack of funding and staffing in the health service. She said: “Dignity and respect must be at the centre of how our health system operates, particularly for vulnerable patients. People living with dementia who find themselves in a hospital setting can find new surroundings upsetting, causing distress and anxiety, and so it is essential that all aspects of their care are framed around their needs.

“It is an indictment of the funding and management of our health service that the drive to free up beds is resulting in late night transfers of older patients to accommodate the needs of the system rather than the needs of the individuals it operates to serve. This is not only a breach of the Belfast Trusts’ own policy on the transfer of patients, but the fact that decisions taken to transfer patients are not taken by the appropriate clinicians mean that the patient is potentially put at risk, which is completely unacceptable.

“The letter sent by the eight nurses evidences the huge pressure and frustration faced by frontline staff, but we can take some comfort in the fact that they have come forward to raise these concerns to senior management – though the fact this was made public suggests this was the only way they felt they could make an impact.”

“Last week’s RQIA Review of Care of Older People in Acute Hospitals suggests a range of measures, including an increase in nursing staff, improved person-centred care, as well as a review and update of the use of escalation beds, which would improve the experience of older people in the hospital setting. But this on its own is not enough.

“The BBC report highlights a system that is lurching from crisis to crisis as a result of under investment and chronic lack of staff, and worryingly shows that an escalation plan is being deployed as the rule rather than the exception. This is not conducive to an effective and efficient health service, nor is it in the interests of patients or staff.

“It is essential that if older patients need to be transferred on clinical grounds that this is done in an appropriate manner, adhering to the policy in place, and is based around the rights and dignity of the individual. But in order to be able to deliver this level of care, urgent action is needed to enable staff to do the job they need and want to do, and so it is time that the Minister and Executive plug the gap before it is too late.”