'A&E must change' says Ulster Hospital's clinical director Sean McGovern
A senior doctor in charge of one of Northern Ireland's busiest A&E units has criticised the government over its current approach to emergency care.
Sean McGovern from the Ulster Hospital said there is too much focus on waiting time targets and not enough on care.
He added that only one of NI's four larger A&E units had the recommended number of emergency consultants.
He was speaking as a report warned the UK's A&E system could collapse unless there was change.
Dr McGovern, who is the clinical director of emergency medicine at the Ulster Hospital on the outskirts of Belfast, is also a member of the College of Emergency Medicine, which published the report.
He supported its call for an overhaul of A&E provision, the recruitment of more doctors and extra funding to meeting increased demand on the service.
Dr McGovern told BBC Radio Ulster: "When you have departments that are overcrowded, when you have departments that are stretched to the limit, then there are times when patient safety is potentially compromised. That is what this report recognises."
He criticised political and social attitudes towards A&E reform, and said more emphasis must be put on emergency care for priority patients, and less on meeting a "binary four-hour target" for all patients.
The clinical director said that there were "many people who present to emergency departments who don't have time sensitive conditions but yet, are expected to be seen within the four-hour target".
He told BBC Radio Ulster: "Somebody with a stroke, somebody with a heart attack, somebody with a severe infection - they all need to be seen in a timely fashion.
"Someone with back pain that is going on for three weeks may have to wait because we are busy treating the other patients."
Earlier this year, paramedics contacted the BBC to say they had witnessed chaotic scenes at the Ulster Hospital's A&E, and that at one stage on 25 February, ambulances were queued up outside waiting to admit patients.
The paramedics said they had to wait in A&E for hours with patients as the hospital could not cope with the numbers it had to treat.
One of the patients who had to queue up to be admitted to the hospital's emergency department was 85-year-old Margaret Davidson.
Her son, Roger Davidson, told BBC Radio Ulster that when she was admitted, his mother then spent 22 hours on a trolley waiting for a hospital bed.
'Bursting at the seams'
"It was obviously a very, very busy ward and the doctor initially saw her and when he came back several hours later he said: 'Well, would you like to take her home?'
"Words failed me."
Mr Davidson said his elderly mother was "totally immobile" and in great pain and he could not believe that a doctor was asking someone with no medical training if he wanted to take her home.
He said his mother had vascular dementia and osteoarthritis and had required morphine pain relief and the assistance of three ambulance staff just to get out of her own bed.
Mr Davidson praised the paramedics but said the A&E unit appeared to be "bursting at the seams".
Dr McGovern said: "There is a change in demography going on in society where complex issues of elderly care will present to the emergency department because the community infrastructure is not there."
He added: "Year on year, there is a 3 to 5% increase in emergency attendances across the UK with increased complexity. The whole system has to be changed in terms of urgent care, in terms of unscheduled care, and it is not the emergency department alone that has to change.
"The political mantra that arose that there is no change to frontline services was from David Cameron. David Cameron brought that to people's attention - that's part of the reason why he was elected."
While he criticised politicians, Dr McGovern said the that the voices of clinicians and the experience of patients was "not being listened to".
The doctor told the programme it was recommended that larger A&E units that deal with more than 70,000 patients a year employ a minimum of 10 emergency consultants.
He said Belfast's Royal Victoria Hospital, Antrim Area Hospital, Craigavon Area Hospital and the Ulster all deal with that number of patients, but only one of the four emergency departments met the recommended number of A&E consultants.
Dr McGovern said the problem of patients arriving at A&E with non-emergency ailments was a "societal issue" and to date, none of the measures put in place to address it had worked .
He added that he had worked in emergency medicine for more than 20 years and in that time there had been significant changes in treatment but little change to the infrastructure.
"The easiest thing unfortunately for politicians is to maintain the status quo," he said.
"We must move away from the political mantra of no change to frontline services because that, at its heart, predisposes that we have the correct configuration of services at the moment when clearly we do not."