Northern Ireland news

Health service 'action plan' reveals five biggest hospital A&Es should no longer accept walk-ins by next month

A leaked health service 'action plan' has revealed major changes to how patients access urgent and emergency care treatment in Northern Ireland as the system braces itself for a second Covid-19 wave
Seanín Graham

A leaked 'action plan' drawn up by top health officials has revealed Northern Ireland's five biggest hospital A&E departments should no longer accept walk-in patients by next month.

The Department of Health document, seen by The Irish News, sets out a radical overhaul of urgent and emergency care services within "challenging" timescales - but warns this is needed to prepare for a second Covid-19 wave.

Target dates are set for the creation of vital services, including Urgent Care Centres and a regional 24/7 telephone triage number.

A major reshaping of nursing/care homes and ambulance 'handover' hospital zones is also outlined.

The first of its '10 key actions', however, centres on the re-organisation of the north's A&E system, with the "five largest EDs (Emergency Departments) to become ambulance only by August 2020".

Read More: Dedicated 'triage' telephone number planned for post-Covid health service

Hospitals dealing with the biggest volume of emergency patients are the Royal Victoria in Belfast, Antrim Area, the Ulster in Dundonald, Craigavon Area and Altnagelvin in Derry.

It comes a fortnight after proposals were first leaked about the north's A&E departments only receiving patients by ambulances or a doctor referral - with no access for walk-ins.

Health minister Robin Swann insisted at a Stormont briefing that the blueprint was very much at a "draft" stage.

But the updated action plan document circulated in recent days is more detailed and date-specific.

It means the most seriously ill and injured patients - those suffering from strokes, heart attacks and car crash victims - will be admitted to the north's biggest A&Es via 999 ambulances or following a referral by a medic. A similar system operates in Denmark.

Two-thirds of the north's current A&E patients would instead be seen in new urgent care centres, treating illnesses or injuries that "requires urgent attention but is not a life-threatening situation".

Staffed by hospital doctors, GPs and nurses, these centres will ideally be located close to the hospital A&E unit and have the ability to transfer a patient should their condition deteriorate.

A target date for the "definition and specification of Urgent Care Centres" is July 2020.

The report states: "Under the new arrangements, direct access to Emergency Departments will only be possible for patients who arrive by ambulance or who are referred to the Emergency Department from the Urgent Care Centre or by their GP.

"All patients who make their own way to a hospital site will assessed in an Urgent Care Centre. Care will be needed to ensure this does not lead to an increase in 999 calls for an ambulance to access ED."

Under the heading 'When will it be in place?', the report states: '5 largest EDs to become ambulance only by August 2020.

Sources say the reforms are being driven by the department as part of a major post-coronavirus recovery plan and will require no public consultation due to Covid-19 emergency legislation.

A powerful 'management board' headed by the department's most senior civil servant, Richard Pengelly, was set up last month to oversee the massive changes required for a service with the worst hospital waiting lists in Europe prior to the outbreak.

The report warns of the "unsustainable position" of overcrowded A&E departments before the crisis which it says required "radical transformation".

It adds: "However, the impact of Covid-19, and the accompanying focus on infection prevention and social distancing, have driven home the urgency of ensuring that we do not allow EDs or hospitals to reach these levels of crowding in future. Immediate changes need to be implemented in advance of further waves of Covid-19.

"...The timescales set out... are challenging, but they are driven by the necessity of protecting our services and our patients in the event of further waves of Covid-19."

The authors note that just over a third of the 800,000 people who attend A&E each year for treatment could be "defined as an emergency", with the remainder classed as "inappropriate".

They write: "In fact, it is our own system that makes these attendances inevitable and inappropriately channels patients through an Emergency Department because there is no other practical option."

The plan does not make clear what will happen to the other major hospital A&E units in the north, which include Daisy Hill in Newry, Causeway in Coleraine and the South West Acute in Enniskillen.

When asked to comment on the plan, the Department of Health last night said:

“Proposals for the reshaping of urgent and emergency care are under active consideration but have yet to be finalised.

“A package of measures is planned. Component parts of the plans should not be viewed in isolation from the overall package.

“Changes are urgently required, given the continued Covid-19 threat and the need for social distancing. Overcrowding in emergency departments cannot be tolerated.”

Meanwhile, concerns have been raised about the re-opening of the Downe hospital's emergency department as a minor injuries unit next month.

South Down MP Chris Hazzard described the move as a "major slap in the face", but the South Eastern health trust has insisted it "absolutely" remains its intention "to restore the full emergency department at the Downe Hospital to levels delivered pre-Covid-19."

"The re-opening of the Minor Injuries Unit is the only step the trust is able to take at this time, due to a number of critical factors. These include the continuing threat of Covid-19, the ongoing planning required, staffing availability and managing safety and risk for our patients, service users and staff," a spokeswoman said.

"We appreciate the concerns of the local community and that people are keen to receive assurances and a date for re-opening the full Downe Hospital Emergency Department. As soon as we have a date, we will advise."

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