Disparities in out-of-hours emergency care across Northern Ireland

There is a dramatic difference in the way hospitals that deal with emergency admissions across Northern Ireland operate at night and weekends, compared to weekdays, a review has found.
The review of out-of hours provision in all NI hospitals with A&E departments was carried out by the Regulation and Quality Improvement Authority (RQIA).

The issues it highlighted include the availability of patients’ medical records and staff handovers.

The review has made 29 recommendations.

It also found that noise and temperature control were among some of the complaints made by patients.

However, despite breached waiting times and unmet targets, the RQIA report is on the whole positive.

Senior managers

Among its recommendations is that better career pathways should be put in place, to allow nurses to take on the key role of senior nurse lead outside of regular hours.

Also during these times, the review highlighted that better protocols should be in place for nurses to contact senior managers.

It said managers should be more visible to their staff, especially outside of normal hours.

Praise was given to those trusts who have emergency nursing teams to cover potential gaps in services, but the RQIA stressed that all health trusts in Northern Ireland should review weekend access to services including pharmacy and social workers.

At Belfast’s Royal Victoria, Antrim Area and Causeway hospitals, staff advised that access to cleaning services had improved, but at times there were issues with accessing this service at nights and weekends.

At the Downe and Lagan Valley hospitals, cleaning services were available up to either 20:00 BST or 21:00 BST and after that time nurses would assume responsibility for cleaning.

RQIA chief executive, Glenn Houston, said: “Hospitals are busy 24/7, but we know that across all of our hospitals there are reduced service levels in the evenings and weekends, and this review looked at how hospitals co-ordinate (out-of-hours) care.

“One of the key findings of the review is that hospitals have established co-ordinators to ensure that there is appropriate staffing levels in the evenings and weekends, and that staff are working in a joined-up way to make sure that patient safety is a first priority.”

‘Postcode lottery’

Mr Houston added: “What we found was that there are different arrangements across different hospitals.”

He said the review had helped health authorities to identify areas of good practice as well as highlighting places where there are problems.

“What we are saying is, there is a bit of a postcode lottery because not all hospitals are using the same procedures, they are not all following the care pathway exactly the same way, and there are some areas where there is room for improvement,” he added.

The RQIA chief executive said the review had not identified “serious failings” in any particular hospital, but added that his organisation was looking for “improvements across the piece”.

He said the RQIA team held a number of focus group meetings with employees from hospitals across Northern Ireland, during which staff raised the issue of senior managers’ working hours.

“While senior managers might be very visible during the day, Monday to Friday, they are not so visible in the evenings and weekends, and we’re calling for the health and social care trusts to look at that arrangement, because we think it is important that senior managers, and particularly staff at director level, have a good sense of what’s happening in hospitals in the evenings and weekends,” Mr Houston said.