Analysis
Emergency services may have breached human rights law Northern Ireland’s government is responding to public and professional concerns. Jennifer Sprinks reports
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July 2014 | Volume 22 | Number 4
Ms Devlin explains that, given the design of EDs, treating people for more than 24 hours is difficult. Too few EDs have suitable cubicle layouts, for example, or adequate toilet provision. ‘EDs are like outpatient departments, where people’s conditions are stabilised so that they can be moved on rather than nursed and nursed,’ she says. A spokesperson for NI’s Department of Health, Social Services and Public Safety, says that health minister Edwin Poots has welcomed the review, adding: ‘The minister has instigated a substantial body of work in recent months aimed at ensuring the quality and safety of services in our emergency departments.’ Major incident In January, following a major incident at the Royal Victoria Hospital, Belfast, Mr Poots commissioned the Regulation and Quality Improvement Authority (RQIA) to mount an inspection of emergency care at the hospital. RQIA published its report in May, following a four-day visit to the hospital. It concludes that immediate action is Alamy
EMERGENCY CARE in Northern Ireland (NI) is under the spotlight following the launch last month of an investigation into the treatment of patients. The NI Human Rights Commission (NIHRC) wants to establish whether the human rights of patients who have encountered problems in emergency departments (EDs) have been violated. The commission will also explore whether people’s human rights are protected by NI’s legal, policy and regulatory framework for emergency care. It will seek to identify good practice and, in April next year, will recommend improvements to the NI Executive. NIHRC interim chair John Corey is calling for evidence from emergency care staff and from anyone who has recently experienced emergency health care. In September, public hearings involving government representatives, staff, trade union members, patients and their family members will begin at various locations across NI. Mr Corey explains: ‘The inquiry will consider the total experience of emergency health care from a human rights perspective. This includes the individual’s right to dignity, access to information and involvement in decision making.’ Emergency nurse practitioner Roisin Devlin, a member of the RCN Northern Ireland Emergency Care Network, says: ‘The fact that there has been an inquiry into whether human rights are being violated is sad but it recognises that there is a problem, and [will help to] ensure that patient dignity and human rights are not being breached.’ She adds: ‘Emergency nurses have been saying for years that patients’ dignity has been compromised in emergency departments, not because staff give the wrong care but because of the environment.’
needed to relieve pressure on staff and reduce risk in critical areas. The report makes 25 recommendations for the ED, including reviews of staffing levels and the role of the ED senior sister to ensure his or her duties are in line with her staffing grade. They also called for improvements in staff recruitment and retention, and in appraisals. Mr Poots later announced the deployment of 40 nurses in the hospital’s ED and acute medical unit. Meanwhile, chief nursing officer for NI Charlotte McArdle has called for the development of an emergency nursing career framework to resolve the crisis in urgent care in the country. The framework, which sets out professional standards for emergency nurses, is being draw up by RCN NI’s Emergency Care Network and the NI Practice and Education Council for Nursing and Midwifery. In May, Mr Poots announced the development of advanced nurse practitioner (ANP) and consultant nurse roles in NI. He said that up to 20 ANPs in emergency care would appear soon, and that the role would be extended to cover children’s services and primary care. Ms Devlin has welcomed the development of the ANP role, which she expects will boost the recruitment and retention of staff, and help speed up patient transitions through EDs. Referring to the role, she says: ‘It will be attractive to nurses because it is a senior post that can still operate at a clinical level.
The Royal Victoria Hospital, Belfast, where a major incident prompted an inspection of emergency care services
EMERGENCY NURSE
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Analysis
Recommendations ■■ Emergency departments (EDs) should include out-of-hours primary care facilities. ■■ EDs should implement escalation policies and full-capacity protocols to reduce patient numbers. ■■ Hospital discharge processes should operate seven days a week. ■■ Community teams should be co-located in EDs. ■■ Each ED should have an appropriate staff-to-patient ratio. ■■ Established and alternative roles, including those of emergency and advanced nurse practitioners, should be developed and reviewed. ■■ Contracts for staff on 24/7 services should allow for an equitable ‘work‑life balance’. ■■ EDs should be able to share clinical information electronically with other urgent care providers. EMERGENCY NURSE
Pressure on staff prompts debate about charging for primary care The chief problem is lack of funds for the NHS but, as the proposer of the relevant motion at RCN congress admitted, the underlying factor is increasing pressure on EDs. Andy McGovern, a hospital nurse from east London, said: ‘We need to have a robust and honest debate about what we are going to do because the money is not there. Patients are struggling to see GPs and that is having a knock-on effect on emergency departments.’
Alamy
Previously, if nurses wanted to move to higher grades, they had to move into management. This enables them to stay in a clinical role but advance their careers.’ Further developing the ANP role is one of 18 draft recommendations for the improvement of emergency care published by the College of Emergency Medicine (CEM) NI last month. The recommendations, which are due to be finalised this month, are drawn from discussions between government and senior emergency leaders, including nurses, at the CEM’s unscheduled and emergency care summit, in Belfast in April. CEM NI regional chair Richard Wilson says there is a ‘consensus’ among government officials, professional bodies and practitioners on the need to improve emergency care in the country. He says: ‘Getting staffing numbers right for the workload and decreasing the burdens on emergency departments are imperative. There is urgency to improving emergency care, but some of the solutions and recommendations we propose will take time to implement.’ Some of the CEM NI recommendations are shown in the panel below.
Ipsos MORI survey suggests that 800,000 emergency department patients could have been seen by GPs, writes Nick Triggle OVER THE past year, much of the national debate about the NHS has concerned pressures on emergency departments (EDs). In recent weeks, however, the focus has shifted to GP access. Latest results from the national GP Patient Survey, which was undertaken by survey agency Ipsos MORI on behalf of NHS England, show that one in ten ED patients could not book a GP appointment the last time he or she tried. Setting down a marker ahead of the general election next year, Labour has already promised to guarantee that such appointments will be fulfilled within 48 hours of being made. Meanwhile, the suggestion that people should be charged to see their GPs was discussed at a British Medical Association GP conference in York two months ago, and at RCN congress in Liverpool last month. As may be expected, the idea was rejected on both occasions, but that it has been debated at all indicates the scale of the problems facing the NHS.
Access and demand There is growing evidence that Mr McGovern is correct. For example, research commissioned by the College of Emergency Medicine shows that one in seven patients who attends EDs could have been seen by a GP. Of course, not all of such patients presented to EDs because they could not make GP appointments, but analysis of the GP Patient Survey by the House of Commons library indicates that GP access and ED demand are linked. As well as the 10% who could not book GP appointments, the survey found that a further 8% of patients could not book GP appointments that were convenient. When patients who had been unable to make convenient or any GP appointments were asked what they did instead, 9% said they went to an ED or walk-in centre. This percentage is equivalent to more than 800,000 visits, or just under 4% of the average number of ED or walk-in centre attendances in a year. RCN Emergency Care Association chair Janet Youd says: ‘These figures seem about right. We are seeing patients in emergency departments, particularly in evenings and at weekends, who could be seen by GPs. It is a sign of the growing demand on health services, and is being seen across the board in general practice and hospitals.’ Nick Triggle is a freelance journalist
Find out more The Ipsos MORI GP Patient Survey can be accessed at www.gp-patient.co.uk July 2014 | Volume 22 | Number 4
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Emergency services may have breached human rights law Northern Ireland’s government is responding to public and professional concerns. Jennifer Sprinks reports
8
July 2014 | Volume 22 | Number 4
Ms Devlin explains that, given the design of EDs, treating people for more than 24 hours is difficult. Too few EDs have suitable cubicle layouts, for example, or adequate toilet provision. ‘EDs are like outpatient departments, where people’s conditions are stabilised so that they can be moved on rather than nursed and nursed,’ she says. A spokesperson for NI’s Department of Health, Social Services and Public Safety, says that health minister Edwin Poots has welcomed the review, adding: ‘The minister has instigated a substantial body of work in recent months aimed at ensuring the quality and safety of services in our emergency departments.’ Major incident In January, following a major incident at the Royal Victoria Hospital, Belfast, Mr Poots commissioned the Regulation and Quality Improvement Authority (RQIA) to mount an inspection of emergency care at the hospital. RQIA published its report in May, following a four-day visit to the hospital. It concludes that immediate action is Alamy
EMERGENCY CARE in Northern Ireland (NI) is under the spotlight following the launch last month of an investigation into the treatment of patients. The NI Human Rights Commission (NIHRC) wants to establish whether the human rights of patients who have encountered problems in emergency departments (EDs) have been violated. The commission will also explore whether people’s human rights are protected by NI’s legal, policy and regulatory framework for emergency care. It will seek to identify good practice and, in April next year, will recommend improvements to the NI Executive. NIHRC interim chair John Corey is calling for evidence from emergency care staff and from anyone who has recently experienced emergency health care. In September, public hearings involving government representatives, staff, trade union members, patients and their family members will begin at various locations across NI. Mr Corey explains: ‘The inquiry will consider the total experience of emergency health care from a human rights perspective. This includes the individual’s right to dignity, access to information and involvement in decision making.’ Emergency nurse practitioner Roisin Devlin, a member of the RCN Northern Ireland Emergency Care Network, says: ‘The fact that there has been an inquiry into whether human rights are being violated is sad but it recognises that there is a problem, and [will help to] ensure that patient dignity and human rights are not being breached.’ She adds: ‘Emergency nurses have been saying for years that patients’ dignity has been compromised in emergency departments, not because staff give the wrong care but because of the environment.’
needed to relieve pressure on staff and reduce risk in critical areas. The report makes 25 recommendations for the ED, including reviews of staffing levels and the role of the ED senior sister to ensure his or her duties are in line with her staffing grade. They also called for improvements in staff recruitment and retention, and in appraisals. Mr Poots later announced the deployment of 40 nurses in the hospital’s ED and acute medical unit. Meanwhile, chief nursing officer for NI Charlotte McArdle has called for the development of an emergency nursing career framework to resolve the crisis in urgent care in the country. The framework, which sets out professional standards for emergency nurses, is being draw up by RCN NI’s Emergency Care Network and the NI Practice and Education Council for Nursing and Midwifery. In May, Mr Poots announced the development of advanced nurse practitioner (ANP) and consultant nurse roles in NI. He said that up to 20 ANPs in emergency care would appear soon, and that the role would be extended to cover children’s services and primary care. Ms Devlin has welcomed the development of the ANP role, which she expects will boost the recruitment and retention of staff, and help speed up patient transitions through EDs. Referring to the role, she says: ‘It will be attractive to nurses because it is a senior post that can still operate at a clinical level.
The Royal Victoria Hospital, Belfast, where a major incident prompted an inspection of emergency care services
EMERGENCY NURSE
Downloaded from RCNi.com by ${individualUser.displayName} on Dec 04, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
Analysis
Recommendations ■■ Emergency departments (EDs) should include out-of-hours primary care facilities. ■■ EDs should implement escalation policies and full-capacity protocols to reduce patient numbers. ■■ Hospital discharge processes should operate seven days a week. ■■ Community teams should be co-located in EDs. ■■ Each ED should have an appropriate staff-to-patient ratio. ■■ Established and alternative roles, including those of emergency and advanced nurse practitioners, should be developed and reviewed. ■■ Contracts for staff on 24/7 services should allow for an equitable ‘work‑life balance’. ■■ EDs should be able to share clinical information electronically with other urgent care providers. EMERGENCY NURSE
Pressure on staff prompts debate about charging for primary care The chief problem is lack of funds for the NHS but, as the proposer of the relevant motion at RCN congress admitted, the underlying factor is increasing pressure on EDs. Andy McGovern, a hospital nurse from east London, said: ‘We need to have a robust and honest debate about what we are going to do because the money is not there. Patients are struggling to see GPs and that is having a knock-on effect on emergency departments.’
Alamy
Previously, if nurses wanted to move to higher grades, they had to move into management. This enables them to stay in a clinical role but advance their careers.’ Further developing the ANP role is one of 18 draft recommendations for the improvement of emergency care published by the College of Emergency Medicine (CEM) NI last month. The recommendations, which are due to be finalised this month, are drawn from discussions between government and senior emergency leaders, including nurses, at the CEM’s unscheduled and emergency care summit, in Belfast in April. CEM NI regional chair Richard Wilson says there is a ‘consensus’ among government officials, professional bodies and practitioners on the need to improve emergency care in the country. He says: ‘Getting staffing numbers right for the workload and decreasing the burdens on emergency departments are imperative. There is urgency to improving emergency care, but some of the solutions and recommendations we propose will take time to implement.’ Some of the CEM NI recommendations are shown in the panel below.
Ipsos MORI survey suggests that 800,000 emergency department patients could have been seen by GPs, writes Nick Triggle OVER THE past year, much of the national debate about the NHS has concerned pressures on emergency departments (EDs). In recent weeks, however, the focus has shifted to GP access. Latest results from the national GP Patient Survey, which was undertaken by survey agency Ipsos MORI on behalf of NHS England, show that one in ten ED patients could not book a GP appointment the last time he or she tried. Setting down a marker ahead of the general election next year, Labour has already promised to guarantee that such appointments will be fulfilled within 48 hours of being made. Meanwhile, the suggestion that people should be charged to see their GPs was discussed at a British Medical Association GP conference in York two months ago, and at RCN congress in Liverpool last month. As may be expected, the idea was rejected on both occasions, but that it has been debated at all indicates the scale of the problems facing the NHS.
Access and demand There is growing evidence that Mr McGovern is correct. For example, research commissioned by the College of Emergency Medicine shows that one in seven patients who attends EDs could have been seen by a GP. Of course, not all of such patients presented to EDs because they could not make GP appointments, but analysis of the GP Patient Survey by the House of Commons library indicates that GP access and ED demand are linked. As well as the 10% who could not book GP appointments, the survey found that a further 8% of patients could not book GP appointments that were convenient. When patients who had been unable to make convenient or any GP appointments were asked what they did instead, 9% said they went to an ED or walk-in centre. This percentage is equivalent to more than 800,000 visits, or just under 4% of the average number of ED or walk-in centre attendances in a year. RCN Emergency Care Association chair Janet Youd says: ‘These figures seem about right. We are seeing patients in emergency departments, particularly in evenings and at weekends, who could be seen by GPs. It is a sign of the growing demand on health services, and is being seen across the board in general practice and hospitals.’ Nick Triggle is a freelance journalist
Find out more The Ipsos MORI GP Patient Survey can be accessed at www.gp-patient.co.uk July 2014 | Volume 22 | Number 4
Downloaded from RCNi.com by ${individualUser.displayName} on Dec 04, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
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