NI emergency health care inquiry finds 'degrading' cases
A human rights inquiry into emergency health care in Northern Ireland has found individual cases that amounted to inhuman and degrading treatment.
It identified instances where patients did not get help with pain relief, food or personal care, but no evidence of "systemic violations of human rights".
The inquiry, the first of its kind, was conducted by the Northern Ireland Human Rights Commission (NIHRC).
The Department of Health said it was not complacent about the issues raised.
However, their spokesperson added that the NIHRC was not the statutory body responsible for inspecting health and social care services in Northern Ireland.
'Challenging and crowded'
The Inquiry learned that the amount of Transforming Your Care (TYC) transitional monies was not as great as initially recommended, and whilst millions were spent on a number of initiatives, the overall impact has not led to the introduction of TYC as envisaged
Transforming Your Care is the name given to the wide-ranging programme of reform of Northern Ireland's health and social care system, that aims to transfer more hospital-based services into the community.
NIHRC Chief Commissioner Les Allamby said with around 70,000 visits each year to emergency departments in Northern Ireland, emergency health care is an important issue which touches almost everyone's life.
For the past year the NIHRC inquiry team has been examining whether a person's bad experience while attending an emergency department actually amounted to a violation of their human rights.
'Lack of kindness'
The inquiry, the first of its kind anywhere in the world, heard from patients, staff, trade unions and people came to give evidence in public sessions across Northern Ireland.
It found instances where patients did not receive food, water, pain relief or assistance with personal care.
At times interactions with staff showed a lack of kindness. However, the inquiry said violations were not found to be an integral part of the system.
Mr Allamby said that while the inquiry did not find patients' human rights had been violated, the report's findings are still considerable.
The NIHRC team found that certain groups of patients, including the elderly, blind and those with mental health issues, were more vulnerable than others.
Sam Kilpatrick is from Lisburn, County Antrim. He contacted the inquiry with his story.
He described how, in 2013, he was left on a hospital trolley at Lisburn's Lagan Valley Hospital on his own for two hours, without a buzzer to call for assistance.
"A doctor came and took blood after 20 minutes and then left for two hours. I needed to go to the toilet but I was in a private room and had no way of alerting a nurse. I had to ring Lagan Valley Hospital reception on my mobile and get put through to casualty to speak to someone."
Mr Kilpatrick said the entire experience was undignified.
"A nurse came and asked why I did not have a white cane... I said that I did, but I can't find my way about the emergency department. She asked why I hadn't brought it with me. I said it would be no good to me in the hospital.
"The nurse's manner was not nice... I didn't receive any food or water during that time. At the Lagan Valley Hospital emergency department there is no provision for disabled people."
The inquiry raised concerns over patient dignity, including lack of privacy for people experiencing a mental health crisis such as self-harm and attempted suicide.
The NIHRC (Northern Ireland Human Rights Commission) inquiry's findings are:
- While interactions with staff were often reported to have been positive, person-centred care was sometimes undermined by a perceived disregard, lack of attention, or kindness from health professionals
- Concerns about the care of older people, particularly those with dementia, being transferred alone at night in taxis
- The police identified that 21% of all people reported missing were from hospitals and predominantly emergency departments
- A lack of buzzers and Braille information for blind patient made emergency departments difficult to navigate
- Inconsistency in the implementation of the "critical" 'Card Before You Leave' scheme, in which a patient presenting with mental health crisis is given a written appointment with specialists before leaving an emergency department
In a statement, a spokesperson for the health department thanked the NIHRC for its "comprehensive and important piece of work" but added that the statutory authority responsible for assessing the quality of care provided by the HSC (Health and Social Care) is the Regulation and Quality Improvement Authority (RQIA) and not the NIHRC.
"Similar issues were highlighted by the RQIA in its inspection of the Belfast Trust in 2014," the DHSSPS spokesperson said.
"A follow-up inspection of the Belfast Trust late last year found that there had been significant improvement."
The department's statement added that there was a "very clear focus on continuous improvement of the quality of care provided by our emergency departments".
Northern Ireland's Commissioner for Older People, Claire Keatinge, told BBC Radio Ulster: "The important issues arising from the Human Right Commission report are that emergency departments must be properly resourced and planned for, there's no question about that.
"We have to be confident that our older people will know that if they are ill or have an accident, and they arrive at A&E , there will be enough staff with the training and the skill and enough beds."
The inquiry made at total of 26 recommendations, including that the department of health should develop dedicated emergency department minimum care standards, rooted in human rights and providing a benchmark for patient experience.
Those standards should include criterion on the promotion of dignity and measures covering staff behaviour and attitude, adequate facilities.