Antrim Area Hospital: Hospital 'unsafe' on Saturday night

A major incident was declared in the Northern Health Trust at the weekend because the situation was "unsafe," the chief executive of the trust has said.

Jennifer Welsh was speaking after people were told not to come to Antrim Area Hospital on Saturday night "in any circumstances".

A major incident means there are too many patients for staff to deal with safely.

The decision was taken after the emergency department reached capacity.

"At the time we called the incident there were 131 patients and about 66 had a decision to admit and no bed available," Ms Welsh told BBC's Good Morning Ulster programme.

"It's not just a numbers game but is about the acuity of the patients and how sick they are," she said.

"Our resuscitation unit was over full," she added.

"We simply could not cope. It was safest thing to do to close the door and convey people to next nearest ED [emergency department] to make sure they begin the urgent treatment they need.

"It was the right call to say it was unsafe - it was at the time."

A social media post from the hospital said the hospital was still under "extreme pressure" on Sunday.

On Monday night, the Department of Health said it remained deeply concerned about the situation in hospitals and across the health and social care system.

"The fundamental reality is that we have a serious mismatch between demand for care and the capacity of the system to provide it," the department said.

"Hospitals do not have unlimited capacity and it is imperative that when patients have been deemed medically fit, they leave the hospital setting."

It's a very brave decision, particularly in Northern Ireland, to declare a major incident.

Over the years we have had a culture where it's been seen as a failure when a chief executive comes out and says they can no longer cope - but when you think about it, being unsafe in a hospital is a contradiction.

I have been told that the emergency department at the Royal Belfast Hospital was in a similar position.

I spoke to a number of staff at the weekend and was told there was serious overcrowding in Belfast and in one person's words "alarming levels of patient congestion".

Staff said it felt like a very unsafe environment for both patients and staff.

They said they felt compromised in being able to deliver care in an emergency environment.

On Sunday morning there were 116 people waiting in the ED, figures similar to Antrim, and 61 people waiting to be admitted.

Staff in Belfast were saying they felt they had to keep their doors open because Antrim got in first.

We heard there was a third trust also experiencing a lot of pressure so it's not an isolated incident and the question is, what happens next?

On Monday evening, the South Eastern Trust warned its emergency department at the Ulster Hospital was under "extreme pressure".

The trust said 164 patients were in the emergency department, 53 awaiting admission.

It issued an appeal for nursing staff to help across critical areas on Monday night.

Ms Welsh said the situation at Antrim Area Hospital would have been "unthinkable" five years ago but now it was "normal business - and not acceptable".

"The situation is pressured and not just in Antrim but across many of Northern Ireland's emergency departments," she said.

She said new beds were coming in February.

Ms Welsh said Antrim Area Hospital had its highest number of attendances last month.

She added that the Northern Trust was Northern Ireland's largest health trust area geographically and had the highest number of people over 75 - two things that drive hospital admission.

Rita Devlin, from the Royal College of Nursing (RCN), told Good Morning Ulster her members were at maximum capacity.

She said the threshold for a major incident was when when a hospital could no longer cope with the amount of patients in its emergency department and there was no possibility of getting patients out of the department.

"We have had times before where the trusts have asked for ambulance diverts but never in my time have I ever heard a hospital tell patients not to come under any circumstances," Ms Devlin said.

"I have been contacted by members from three different trusts about overcrowding and unsafe issues for patients, and nurses telling me they can't go on."

She said the situation should be ringing "alarm bells for everyone in Northern Ireland".

She added that health needed "fundamental transformation," which was impossible without "political leadership".

Dr Paul Kerr, vice-president of the Royal College of Emergency Medicine Northern Ireland, warned that one hospital closing its doors put pressure on other hospitals.

"The domino effect occurs in the situation where one hospital says it has to close its doors and the next hospital is going to get more patients and they're going to face a critical incident," he told BBC Radio Ulster's Talkback programme.

"It's a very small system and we have to try and avoid this situation happening because that is going to put us all at risk of being in the same situation."

Declaring a major incident is rare and under such circumstances, there is a call-out for staff to come into work.

A potential major incident was declared at Antrim Area Hospital in February but was stood down after several hours.

On Sunday the Belfast Trust appealed to any available nursing staff for help during the nightshift.