Northern Ireland A&E targets breached as minor injury units close

A&E waiting time target breaches in Northern Ireland increased "markedly" on the same day as it was announced three minor injuries units are to shut.

Figures released on Thursday showed the number of patients who waited more than 12 hours in A&E last month rose 240%, compared to the same period last year.

A total of 76 A&E patients waited over 12 hours during September 2013, but last month, the figure reached 260.

By contrast, minor injuries units met over 99% of all waiting time targets.

The three minor injuries unit closures were among a number of hard-hitting cuts to health and social care services across Northern Ireland announced on Thursday, including the temporary closure of dozens of hospital beds.

'Notable decline'

According to ministerial targets, no patient attending any A&E department should wait longer than 12 hours either to be treated and discharged, or admitted.

The vast majority of the breaches took place at the Royal Victoria Hospital (RVH) in Belfast, where 139 patients waited in excess of 12 hours for treatment last month alone, compared to two patients during the whole of September 2013.

The Department of Health said the RVH had reported "the most notable decline in performance" in terms of 12-hour targets.

Latest figures for A&E units' performance, against ministerial targets, on waiting times

There are 13 minor injuries units (MIUs) across Northern Ireland, and the service was set up to treat injuries that are not life-threatening or critical.

MIUs can deal with broken bones, burns, bites, wounds and minor head injuries, as well as other less serious ailments.

The facilities help to take pressure off hospital A&E units, which should be reserved for seriously ill patients who require emergency care.

However, on Thursday, the Northern Ireland Health and Social Care Board (HSCB) confirmed that minor injuries units in Armagh, Whiteabbey and Bangor will close temporarily, beginning this winter.

'Inevitable impact'

Armagh minor injuries unit will be the first to close, shutting on 17 November, while Whiteabbey MIU, County Antrim, and Bangor MIU, County Down, will both close on 1 December.

In a statement the HSCB said that "patients who normally use these services can visit their pharmacist, wait to see their own GP, use another MIU or visit their nearest emergency department if appropriate".

The nearest emergency departments to Whiteabbey and Bangor were under considerable pressure last month.

In addition to the 139 breaches at the RVH, Belfast's Mater Hospital failed to treat 72 patients within the 12-hour target; the Ulster Hospital in Dundonald had 28 breaches, while Antrim Area Hospital recorded 21 breaches during September.

Maeve Hully, chief executive of the Patient and Client Council, said the MIU closures would have an "inevitable" impact on waiting times in emergency departments.

'Massive increase'

The British Medical Association (BMA) also expressed concern that delays and duplication would be among the consequences of shutting MIUs.

BMA representative Dr Frances O'Hagan, who works as a GP in Armagh, said she believed patients who normally use MIUs would opt to visit their GPs instead, in the hope that they would not need hospital treatment.

Armagh GP Dr Frances O'Hagan said closing MIUs would lead to delays and duplication in the treatment of patients

"That has two effects - the patient who does need to attend the hospital will have duplication, in that they will be seen twice and it will delay their patient journey," Dr O'Hagan said.

"But also, those appointment slots will be filled and will be unavailable to the other patients that we're meant to see, so again, we're seeing a massive increase in the workload of general practice," she added.

Internal memo

The MUI staff affected by the closures are to be redeployed in other areas, including hospital emergency departments.

However, the redeployed staff will replace existing agency and bank staff, meaning there will be no extra medical personnel to treat any extra patients who arrive in A&E units as a result of the MIU closures.

Minor injuries units, which are classified as "Type 3" emergency departments, had an almost 100% success rate in meeting their waiting times targets over the last quarter

The BBC has obtained an internal memo from the Northern Ireland Ambulance Service which was sent to staff last Friday, 24 October.

The memo said an agreement had been reached that paramedics should take take patients who are assessed with only minor injuries directly to MIUs rather than A&E.

The memo said the changes would begin on 3 November and would mean that patients are "likely to receive more timely treatment and be less inconvenienced".

The list of six MIUs that had agreed to accept ambulance admissions in the memo included the three units that are now set to close.

Protesters held a demonstration outside the Downe Hospital in Downpatick on Thursday, one of several hospitals affected by dozens of temporary bed closures

In a statement to BBC Radio Ulster's Evening Extra programme, the Northern Ireland Ambulance Service said it would "now revise our plans for making use of these minor injury units from 3 November".

On Thursday, HSCB chief executive Valerie Watts, said that while painful, the "unavoidable" austerity measures affecting health and social care services across Northern Ireland would not affect patient safety.