The Royal rumbled – the worst Accident and Emergency department in the UK for waiting times keeps getting worse

Previously, I had written on how the Royal Victoria Hospital in Belfast had the worst waiting times in the UK in September 2014, with 64.5% of cases being dealt with within four hours, against a target of 95%. Since this analysis, data has now been published showing performance up to February 2015. For anyone who may need emergency care (i.e. everybody), the data does not make for encouraging reading. In February 2015, only 52.5% of those presenting themselves to A&E at the Royal were treated, admitted or discharged in under four hours.

A&E Performance Belfast

This represents a new record for UK A&E units. Antrim A&E, incidentally, would have also set a new UK record if it hadn’t been for the Royal, with its score of 55% in the same month. Across the Belfast area, 533 patients had to wait for over 12 hours, representing 3.2% of the total cases of 16,645. For comparison, in the same month, 161 patients in the whole of England had to wait more than 12 hours, 0.015% of the total number of cases of 1,074,441. Patients presenting themselves to an A&E department in Northern Ireland are over 210 times more likely to face a 12 hour or longer wait than patients in England.

The usual excuse given is usually that demand for A&E services has increased. Whilst there was a modest uptick in average daily cases in February, there were 250 cases on average in the Royal in January 2015, which was the lowest number of cases for 13 months. Belfast-wide, the average case numbers of 595 in January 2015 was also lowest in 12 months. As I’ve said before, whatever is causing the crisis in A&E waiting times, increased demand is not one of the reasons.

A&E Case Numbers Belfast

I should point out there appears to be a methodological change in how the A&E figures are reported in the Royal, which now splits data between Ear, Nose Throat and Regional Acute Eye Services (grouped together), and all other A&E cases. If these numbers had been amalgamated for February 2015, the overall performance would have been 60%, as performance for ENT and RAES is much better (all 1,230 cases were dealt with within four hours). Of course, the argument could be that before 2015, figures for the RVH were actually worse than they were stated. In any case, it is clear that the performance of A&E units in the Belfast area, and at the RVH in particular, is both appalling and deteriorating rapidly.

With the silly season of the General Election well and truly underway, meat and potatoes issues such as A&E waiting times tends to get even less attention that it does usually, as Northern Ireland focuses on flags, parades, pacts, and all the other nonsense that we all know and love so well. Perhaps the candidates vying for a seat in the next parliament might spare a few moments to explain why, with the highest spend per capita on health in the UK, and double the number of administrative staff in the health service compared with England, we are seeing such an alarming collapse in the healthcare system.

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  • chrisjones2

    Its all themuns fault?

    Its a judgement from God because a gay bakery in East Belfast delivered a gay cake?

    I blame it on Tory cuts?

    We don’t invest enough in the Arts and Orchestras to make people feel better so they don’t get sick in the first place?

    Those figures is all just a plot to justify taking investment away from the North West?

    If we kept Gods holy laws and locked up the playgrounds on Sunday like, the childer wouldn’t get hurt and then wouldn’t need to go to A&E

    Because if people didn’t drink spirits like and stuck to wine like, they would be alright because Spirits make you an alcoholic not wine like?

    The ambulances keep taking people there. If they didn’t do that the queues would be smaller?

    Because we elect fools who cant hold to account the fools we employ?

  • chrisjones2

    By the way another excellent piece of work.

    I am tempted to ask why the Civil Service doesn’t employ people like you to ferret out these issues ….but then I suspect that we all know the answer to that, don’t we

  • Belfast Barman(ager)

    Great analysis, definitely a fan of your work.

    If this happened in any other jurisdiction, heads would roll, and I don’t mean heads of trust, there would have to be a systemic overhaul of, if not the whole health department, how A&E is administered, these figures won’t change because there is nothing in place to change them. How sad that this is what passes for emergency health care for us

  • Zeno

    I was talking to a doctor at lunch time and what he told me about care in the local hospitals was truly frightening. I can’t go into details, but he said it was chaos and a disaster is inevitable. He blamed it on poor management and bad organisational skills.

  • Dan

    Cant we just employ someone who was head of another local quango to take over and ask them to produce a report on what is going wrong?
    Isn’t that how it usually works?

    Meanwhile, I see Dodds is promising the Mater A&E will stay open, no matter what.
    No doubt woodentop won’t be far behind.

  • NMS

    Accepting that the number of patients has not increased, has the number of staff (nurses and doctors) working in the A & Es been reduced?

  • chrisjones2

    It has to be kept open or where else will the drunks from Shankill and Ardoyne and their put upon partners stagger to when full to get treatment for the split heads and black eyes and miscellaneous knife wounds associated with life north of the Lagan

    And you get a better class of fight at the Mater

  • hugh mccloy

    That has been done several times, Valarie new CEO of HSCB being the latest

  • hugh mccloy

    Where did you get febs figures from I have not seen them published yet

    Increased demand is the only factor and that is just not demand for A&E but for hospital services, and it does not take much in that increase to collapse the system. As always the problem does not lay in how many people attend an A&E it is with the hospitals ability to admit, treat and discharge patients, which is rising. When you look post Rutter & Hinds in Antrim where a recommendation of consultants vetting admissions came in, admissions went up about 200 a month. A recommendation which they admittedly thought would of lowered the admission rate made the A&E and wards worse.

    With the Royal the fracture unit is used to bypass figures and with all hospitals short stay and clinical decision wards are used to manipulate figures.

    It is hard to get a true reading on the state of actual wait times

  • hugh mccloy

    Got the figures there, to compare like for like you would need to maintain the ENT & Eye as the port of entry is the A&E which unfortunately for Antrim still leaves it bottom of the pile.

    I met Dr Stevens a couple of weeks ago, my faith in him bringing Antirim up to scratch is very slim considering the artwork of hiding the figures in Belfast.

  • salmonofdata

    I did call out the change in methodology, the four hour wait rate would have been 60% had the ENT and RAES numbers been included, and Antrim would indeed have been the worst. But I’d argue that the 52.5% number is more relevant to the public, if they aren’t going to the ENT or Eye clinic. In any case, the numbers are still appalling.

    It would be better to get a fuller picture of what is going on if there was more data in the public domain on health statistics. Open data would help the public ask more awkward questions.

  • hugh mccloy

    A better breakdown of waiting times as 4 to 12 hours is a big jump, and more info of 30 day readmission as thats an indicator on the level of care.

    I noticed from past meetings and debates that the 30 day figure shuts any board member up.

  • Mike the First

    SOD, I think it’s important when phrasing your commentary around your statistical analysis that these “waits” are due to patients waiting to be admitted to other parts of the hospital, not delays in being seen in A&E.

  • hugh mccloy

    Exactly, usually when these figures come out they come out with a barrage about people who should not be there taking up space and beds, but it is the person who needs admitted waiting. I am still waiting for the pr statement from DHSSPS though

  • And there we have it. Proof that Northern Ireland has too many hospitals. :-/ The fact that there is talk of closing most of the Causeway hospital and moving services to Antrim is just frightening. The argument goes that more per head is spent on health here, but the reality is we drink more booze, smoke more fags, eat more sausage rolls and less vegetables than our friends in any other UK region. Once we have done this, we have to sit on our asses a lot more to recover. To reduce funding to the same level as England would cause a disaster in the health service. Something pretty big needs to be done to get the message of personal responsibility across or else the current funding model will come under increasing pressure.

  • Deke Thornton

    “and double the number of administrative staff in the health service compared with England” Rinse and repeat……