In March 2012 a elderly patient died un-noticed on a trolley in the Royal Victoria Hospital, the patient was found by ambulance crews who arrived to move him to a different unit. 6 months later in October 2012 another man died in Antrim Area A&E after waiting 22 and a half hours to be admitted from the A&E into a ward.
More recently we have seen the death of a 3 month old baby who arrived at Antrim Area A&E, the child and its mother spent half an hour in the waiting room waiting for medical care, by the time that help came it was too late and the baby died after being transferred to the Royal.
In a meeting after this incident attended by Save The Mid's Hugh McCloy with a off duty member of staff who witnessed this incident, Margret O'Hagan acute director in the Northern Health & Social Care Trust stated that if it was any consolation the baby would of not lived anyway. Despite this the Acute Director was not willing to admit that the system failed, regardless if the child had lived or died there was a serious failing inside the A&E that was directly related to over crowding and capacity issues and not just the medical condition of the baby.
BMA Warns Of Toxic Overcrowding in A&E
Northern Ireland’s emergency departments are struggling to cope with demand
- Ulster A&E 255 (15%)
- Altnagelvin 232 (14%)
- Antrim 210 (13%)
One of the main aims of this FOI was to determine if there was a material change in the amount of reported A&E deaths following changes in A&E provision.
Does A&E Reconfiguration Lead
To More A&E Deaths.
Antrim A&E 2010:
In May 2010 the Northern Health & Social Care Trust removed A&E services from both the Mid Ulster & Whiteabbey Hospitals, this was part of a wider run down that was taking place for over a year before hand, with patients being diverted from the units to be closed and directed to Antrim A&E . In the transitional year deaths inside Antrim A&E rose 55% , from 36 to 56 deaths in 2010, and stayed at this level ever since.
In a further Freedom of information released to Save The Mid from the Department Of Justice it shows that Coroner investigations into suspicious deaths in Antrim hospital rose from 99 investigations in 2010 to 150 in 2012. This is a rise of 52%
Belfast City A&E Closure 2011:
The last patients treated in Belfast City was November 2011, however prior to this like shown in previous A&E shutdowns, the rundown was taking place before with patients being diverted to both the Royal and Mater A&E's
Mater: In the Transitional year A&E deaths rose 93%, from 14 deaths in 2010 to 27 deaths in 2011. A level that has remained in 2012.
Royal Victoria: In the transitional year deaths rose 29%, from 34 in 2010 to 44 in 2011, this figure has rose again to 51 in 2012. Freedom Of Information figures also show that between 2010 to 2012 there has been a 33% increase in the amount of Coroners investigations into deaths at the Royal Victoria Hospital
Does A&E Attendances
Affect A&E Death Figures
However for the last full year, 2012, the worst ranking A&E's in Northern Ireland for death rates were (per 10,000 attendances):
- Altnagelvin 8.8
- Daisy Hill 7.7
- Antrim 7.0
Unlike the rest of the UK where it has been stated that there is a year on year 6% increase in demand on acute A&E services, Northern Ireland acute A&E system has only seen an increase 0.6% since 2009 to present.
Acute A&E attendances have decreases by 10,000 between 2011 and 2012, but as A&E services are now concentrated on The Royal, Antrim, Ulster, Altnagelvin and Craigavon we are year on year seeing performances that fall far beyond any Ministerial or Medical targets.
These changes are being made on the basis of clinical safety of patients This being the case surely A&E deaths and Coroners investigations should decline. In realty this has not happened and deaths have continued in some cases at a higher rate.
The Antrim Hospital is is the worst offending top 3 statistics in both actual death and death rates, this proving that the reconfiguration changes have adversely impacted on deaths within A&E. While A&E is a whole systems approach, the half built Antrim Hospital was never going to be able to cope with shutting Mid Ulster A&E and despite being pre-warned in 2006 that Antrim needed developed, it was not. If these deaths are related to the operational capacity of Antrim or any other A&E it is time criminal charges are brought against those in managerial decision making posts in health.
Combined Figures Show Shocking Results
- Antrim, Ulster, Craigavon, Daisy Hill and Altnagelvin all have deaths rates above the NI Total.
- The WHSCT has the highest death rate, as its attendances are not as high as other Trusts, Save The Mid believe that some investigation must be made into why this figure is so high. With the possible downgrading of Causeway Hospital, Altnagelvin will be expected to absorb some of this work load.
2013 Death In A&E
Worst 3 A&E's for actual deaths:
1- Craigavon 21 deaths
1- Royal Victoria 21 deaths
3- Antrim 19 deaths
Worst 3 A&E's for death rate per 10,000 attenders:
1- Altnagelvin 10.9
2- Ulster 8.4
3= Antrim 7.6
3= Daisy Hill 7.6
As there is no research or investigations carried out into the closures of A&E's and as Transforming Your Care has failed to address these vital issues it is time that A&E's reconfigurations are halted and that serious investigations are carried out.
In other words, there is no plan B at the moment and this is not acceptable at any level of service delivery within health.
UK Case Study On A&E Death
Recently reported in the media:
Shocking proof A&E closures cost lives: Death rate jumps more than a THIRD after department closes
- Health Minister orders investigation as Mail on Sunday uncovers rise
- Data revealed under FOI rules show 37% rise in emergency patient deaths
- Accident and Emergency in Newark, Notts, closed two years ago
Read more: http://www.dailymail.co.uk/news/article-2323141/Shocking-proof-Accident-Emergency-closures-cost-lives-Death-rate-jumps-THIRD-department-closes.html#ixzz2TTAaCE2T
Configuration Changes of A&E
in N.Ireland since 2009
- On 2nd March 2009, Tyrone County emergency care department was reconfigured from a consultant-led treatment service (Type 2 - emergency care department) to a minor injury unit with designated accommodation for the reception of patients with minor injuries and/or illnesses (Type 3 - emergency care department).
- On 24 th May 2010, Mid Ulster and Whiteabbey emergency care departments were reconfigured from consultant-led treatment services (Type 2 - emergency care departments) to minor injury units with designated accommodation for the reception of patients with minor injuries and/or illnesses (Type 3 - emergency care departments).
- On 4 th April 2011, the South Eastern HSC Trust introduced new arrangements for the provision of emergency care services at the Downe Hospital resulting in the reduction of consultant-led emergency care services, from a 24 hours based service to 8am to 10pm daily, with services provided from 10pm to 8am by an enhanced GP Out of Hours (GPOOH) service. The GPOOH’s provides the urgent care response supported by an appropriate handover period and the appropriate services within the hospital. After 10pm all 999 ambulances go directly to the Ulster or nearest appropriate emergency care department.
- On 1 st August 2011, the South Eastern HSC Trust introduced new temporary arrangements for the provision of emergency care services at the Lagan Valley hospital resulting in the closure of the emergency care department from 8pm to 9am daily. This is a temporary change due to a shortage of medical staff but the change is expected to be in place for a number of months.
- 14. On 1st November 2011, the Belfast HSC Trust closed the emergency care department at the Belfast City hospital. This is a temporary change due to a shortage of senior staff but the change is expected to be in place for the foreseeable future.
- On 21st June 2012, the Western HSC Trust closed the Erne hospital with services (including emergency care) immediately transferred to the new South West Acute Hospital in Enniskillen.
- On 3rd September 2012, the Southern HSC Trust closed the Minor Injuries Unit at the Mullinure hospital, with opening hours at the Armagh Community hospital Minor Injuries Unit temporarily extended to 7pm until the end of March 2013. Previously Armagh and Mullinure provided a joint 24- hour emergency care service with Armagh emergency care department operating Monday to Friday 9am-5pm, and Mullinure emergency care department operating from 5pm-9am on weekdays, and 24 hours on Saturday, Sunday and Bank Holidays.
- On 16th February 2013, the South Eastern HSC Trust introduced new arrangements for the provision of emergency care services at Bangor Minor Injuries Unit resulting in re-opening at weekends (9am to 5pm on Saturdays and Sundays), 10 months after they were closed due to staff shortages.
- Deaths categorized as ‘A&E deaths’ rather than ’deaths in A&E departments’. This data will include deaths en-route to A&E which would not be registered on the A&E system and would not be considered ‘deaths in A&E’.
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