Emergency Medicine in the RVH and the challenges it faces from a clinician's perspective

The National Health Service (NHS) is an organisation providing services and treatments in Primary, Secondary, Tertiary care across a spectrum of specialties. Disruptive technologies, treatments and new ways of delivery require the doctor and manager to work in an ever changing environment. Belfast like many cities across the UK needed big changes in delivering Emergency Medical Services. Prior to November 2012 there were three Emergency Departments (ED’s) within a one mile radius; The Royal Victoria Hospital (RVH), Belfast City Hospital (BCH) and Mater Infirmorum Hospital (MIH), each providing a 24/7 Emergency Service. This was not sustainable. A decision for rationalisation of the Emergency Departments was long overdue. Staffing, training and resourcing of the three units were problematic. The BCH ED closure was deemed the most politically and legally viable decision – (Trust status of the Mater Hospital would require new legislation and therefore it was decided in the short term to close the BCH ED). The MIH ED continued as an emergency department and faced the same challenges with staffing and service provision. Acute surgical and laboratory services have been since withdrawn.