A&E Inquiry Findings Published

Wednesday 27 May 2015

The Human Rights Commission has today published its report into Emergency Health Care in Northern Ireland with over one hundred findings and making 26 recommendations to improve the human rights of patients, families, carers and staff.

Chief Commissioner Les Allamby commented:

“With around 700,000 visits each year to emergency departments in Northern Ireland this is an issue which touches almost everyone’s life. Public participation was at the centre of this Inquiry and throughout we heard from patients, families, staff, management and the Department.

The Commission considered quality, accountability and governance of the service. We visited emergency departments throughout Northern Ireland during the day and night. We heard from dedicated staff striving to maintain patient dignity in an often challenging and crowded environment. In such circumstances there were reported instances where patients did not receive assistance with personal care needs, no pain relief, and no access to food and fluids. Of particular concern were cases involving end of life care, the inappropriate transfer of older patients from nursing homes and the experiences of those presenting to A&E in mental health crisis, with dementia or disabilities.

The Commission heard individual cases which amounted to inhuman and degrading treatment but, did not discover evidence of systemic violations of human rights. The importance of human rights are most obvious when we are at our most vulnerable. The right to the highest attainable standard of health is a standard that must be strived for and the respect for dignity and other human rights principles must be adhered to.

The Inquiry also heard of good practices and experiences. Often the introduction of relatively simple measures significantly improved the human rights of patients. Many of these have been introduced with modest costs and there is a clear need to share good practices throughout the system on a more structured basis.

The report recognised that emergency care departments do not control who comes in through the doors or whether the services are in place to allow a patient to move elsewhere in the hospital or back home. The report examined how much money had been allocated to the transition to impending Transforming Your Care following the Compton report in 2011. It is clear that the money has gone on a number of important areas of care and service but, has not focussed on implementing the earlier review. The report recommends getting Transforming Your Care on track alongside other recommendations to improve the situation in emergency care departments. The report’s aim is to be constructive and show that a human rights based approach can improve emergency care department services for both patients and staff.”

Inquiry Key Findings include:

1. There were reported instances where assistance with personal care needs was not provided, no pain relief, and no access to food and fluids for patients.

2. While interactions with staff were often reported to have been positive, person-centred care was, at times, undermined by a perceived disregard, lack of attention or kindness from health professionals.

3. Concerns were raised about the practice of older persons, particularly those with dementia, being transferred alone at night in taxis.

4. A lack of physical provision for blind and partially sighted persons. A lack of buzzers and braille information, made Emergency Departments difficult to navigate. The online version of the 10,000 voices survey was not accessible to blind and partially sighted persons.

5. A number of patients, staff and community and voluntary sector organisations expressed concerns about the lack of privacy for persons experiencing mental health crisis, such as self-harm and attempted suicide, presenting to Emergency Departments. The PSNI identified that 21% of all persons reported missing were from hospitals and predominantly Emergency Departments.

6. The ‘Card Before You Leave’ scheme which instructs that a patient presenting with mental health crisis is given a written appointment with specialists before leaving ED was regarded as critical. Concerns were raised, however, about inconsistencies in its implementation.

7. The Inquiry learned that the amount of Transforming Your Care 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.

For further information please contact Claire Martin on: claire.martin@nihrc.org or 0771 7731873 (mobile).

Notes to editors:

1. The Commission initiated a Human Rights Inquiry into Emergency Healthcare in the summer of 2014. The Commission launched a confidential phone line and held public hearings across N.I from September to December 2014. You can watch all the public hearings again here

2. The Inquiry Panel included NIHRC Chief Commissioner Les Allamby, Commissioner Marion Reynolds, a former social services inspector, and Professor Paul Hunt, the former United Nations Special Rapporteur on the Right to Health. Watch the Panel speak about the Inquiry in this short clip

3. With over 700,000 total attendances at emergency departments (EDs) each year, almost everyone in Northern Ireland will have visited or known someone who has needed to use accident and emergency services. Having completed a scoping exercise in March 2014, taking into account public concern, as well as the ongoing reviews of the health and social care system, the Commission concluded that a human rights examination of emergency healthcare was necessary.

4. The Inquiry was launched on 3 June 2014. It was the first time anywhere in the world that emergency health care had been the subject of a human rights inquiry. The Commission initiated a call for evidence and received 185 submissions were made through the Freephone, written and online arrangements alongside contributions from focus groups.

Public Hearings: Eleven public hearings were held from 4 September 2014 to December 2014. The Inquiry heard from 139 witnesses: including the minister for health, the chief medical and the chief nursing officer, chief executives of the Health and Social Care Board and health and social care trusts, clinicians, professional medical bodies, trade unions, NGOs and patients themselves.

5. The Northern Ireland Human Rights Commission is an independent statutory body first proposed in the Belfast (Good Friday) Agreement (1998) and established in 1999 by the Northern Ireland Act (1998). It is answerable to Parliament at Westminster.