Nurses say night-time hospital transfers are an 'abuse' of elderly
Several senior nurses have described the out-of-hours hospital transfers of frail, elderly patients in Belfast as an abuse of vulnerable adults.
They criticised the system, saying some patients were not being treated with the dignity and respect they deserve.
The complaint was made in a letter signed by eight senior ward sisters.
The Belfast Health Trust said it was concerned that "any patient should be treated in a way that compromises their dignity and for that we are sorry".
"We treat the issues raised in the letter extremely seriously and will be meeting with the staff to review the content of the letter as a matter of urgency," the trust added.
'Not enough beds'
Health Minister Jim Wells said the difficulty was that every bed available had to be used and the numbers were "particularly high".
"What I think the nursing staff were saying this morning is how it was done rather than the actual principle," he said.
"Because if a spare bed is in one hospital three miles down the road from another you really should be using those to alleviate the pressure.
"As it happened most of the people reported were 70 plus and we must ensure that those folk are particularly well treated because of their vulnerability."
The nurses' letter, seen by the BBC, criticises the standard of care some patients are receiving and it reminds management that what is being practiced goes against policy and patient standards.
It was addressed to Brian Barry, the director for trauma and orthopaedics, at Belfast's Royal Victoria Hospital (RVH).
This letter provides a clear and honest picture of what is happening to some extremely vulnerable men and women while in hospital.
While journalists can report what sources tell them, this information comes first hand from those who work at the very heart of the health care system.
The detail is shocking as it lifts the lid on how some patients are being treated; it also reveals the pressure under which some staff are having to work.
It is also shocking that staff feel they have to go to such lengths to be heard, to be noticed and, in their words, to try and make a difference.
Copies have also been sent to senior directors, including those in nursing, orthopaedics and consultant orthopaedic surgeons at Musgrave Park Hospital.
The letter describes elderly and vulnerable men and women being transferred late at night from the RVH to Musgrave Park Hospital in south Belfast.
The patients, who all have fractures, are being moved as there are not enough beds for them to remain at the RVH.
The letter said that in the past two weeks, of the 22 patients that have been transferred, only one was moved within normal working hours.
The letter describes how a 98-year-old woman arrived at Musgrave Park Hospital close to midnight on one night last week.
Nurses were not expecting the patient, who they said was in a very confused state.
It is not clear who agreed to the transfer, as according to the nurses, when the patient arrived there were no beds available.
As a result, the woman had to be nursed alongside male patients, many of whom were also said to be confused.
According to those who wrote the letter, the woman would not have had the "cognitive ability to consent to either the transfer or being cared for in a male bay" - all of which is contrary to patient standards and hospital policy.
The nurses allege the Belfast Health Trust is not complying with its own policy and procedures.
They said following a series of incidents in 2014, the following agreements and policies were put in place, which have been ignored at times during the past fortnight:
- All patients who are suitable for transfer to Musgrave Park Hospital should be identified by the time of staff's morning bed meeting
- Musgrave Park Hospital will be contacted to request bed availability
- All transfers should take place before 19:00 in the evening
- Elderly patients must not be transferred out-of-hours
- The decision regarding transfer will be made by the fracture team and not by anyone outside the team
In a statement to the BBC, the Belfast Health Trust said: "We acknowledge that some patients have been transferred outside of trust guidance, and we are in the process of investigating the reasons for this.
"The transfer of patients across sites should take place in an appropriate manner and at an appropriate time, however we acknowledge that there have been difficulties over the last number of weeks due to unscheduled care pressures and availability of suitable patient transfer."
Speaking on BBC Radio Ulster's Talkback programme the Commissioner for Older People Claire Keatinge described the situation as "shameful".
"I am absolutely appalled at this story. Appalled that older people who are frail, who are vulnerable and who may well be confused and are already injured ,they've had traumatic fractures already, are being moved very late at night when they are often not in a position to give consent.
"I think older people in this situation are being used for the convenience of hospital managers and it is not good enough.
"Older people deserve dignity, respect, proper treatment and care in hospital, as does everybody else," Ms Keatinge added.
In January, BBC Northern Ireland reported how more than 100 orthopaedic operations were cancelled to cater for an overflow of patients from the RVH. The figure related to scheduled operations since the beginning of November last year.
The Belfast Health Trust confirmed that, at one stage, 35 fracture patients were in Musgrave Park Hospital who, in normal circumstances, would have been at the RVH.
Clearly the unavailability of beds at Musgrave Park was impacting on scheduled orthopaedic operations.
While the health trust has described moving patients between hospitals as part of its escalation plan, many of those who work in the sector say that by its definition, such a plan should only be used as a temporary measure.
The nurses' letter appears to support a BBC revelation in January that the escalation plan had become the norm rather than the exception.
It reveals that, since January 2015, approximately 140 patients were told their elective surgery had been cancelled. Some of these patients, according to the letter, have had multiple cancellations.
A man who had his surgery cancelled in February told the BBC he had been travelling to the hospital when he got a call not to bother coming. He is still waiting for a new date.
In its statement, Belfast Health Trust said there had been an "increase in demand for unscheduled care over the winter and fracture services has been no exception".
"We are required to provide care to emergency fracture patients as a priority, and this necessitates the transfer of fracture patients to Musgrave Park Hospital, were they can be appropriately cared for prior to discharge.
"Unfortunately this has led to the cancellation of elective orthopaedic patients to provide capacity to care for the emergency patients. We regret this and we endeavour to reschedule patients as soon as possible."
The trust added that it believes all patients transferred to Musgrave Park Hospital have "received appropriate levels of care".