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The pressures faced by accident and emergency staff at Belfast's Royal Victoria and Mater Hospitals are unsustainable, an independent report has suggested.

It follows an inspection carried out by the College of Emergency Medicine which has been leaked to the 91�ȱ�.

The report said issues faced by medics in the Belfast Trust are probably worse than anywhere else in the UK.

The trust said it welcomed the report and an action plan was in place.

The author of the report, Dr Taj Hassan, said: "We were concerned because staff were working under some intolerable pressures at times.

"They are understaffed, both within the broader workforce and the consultant numbers, for a service like that.

"It reflected underfunding, probably over a number of years, and has now culminated in the present pressures.

"Staff will always work hard to try and maintain a safe system, what gets compromised unfortunately is certain aspects of quality. Those staff are working far far too hard and that's not sustainable."

The inspection, carried out in March, found that pressures on staff were at times "overwhelming , leading to poor clinical care and safety concerns".

Inspectors point to the closure of the A&E unit at Belfast City Hospital as a contributing factor, with a 30% increase in footfall.

The report was delayed to allow further work to improve performance, however, despite good work it says the system remains under significant stress.

The inspectors describe the challenges as serious and say that they must be urgently addressed. The report says that safety needs to be embedded into the culture of the organisation and that senior managers need to show that change is occurring.

Among its 10 recommendations are a dedicated emergency care team to deliver change and a review of the number of emergency consultants.

It also says that the flow of patients and bed management planning should be regarded as a priority for further development by the trust.

'From crisis to crisis'

Janice Smith, from the Royal College of Nursing, said she was concerned that the pressures were leading to decisions being made that were not in the best interest of patients.

She said the report "lends weight to issues that have been raised about that department."

"I don't think it's an overstatement - it would certainly resonate with some of the nurses who work there," she added.

Joe McCusker, from health union Unison, said he was not surprised by the content of the report.

"We go from crisis to crisis, yet nothing is ever done about it," he said.

The chair of the assembly's health committee, Sinn Fein's Maeve McLaughlin, said the committee had to hold the health minister and department to account.

"As a committee we need to ensure that first off, the recommendations are listened to, and secondly are acted on," she said.

While the Belfast Health Trust might argue that some of these concerns have already been addressed, it is not the first time they have been raised by either inspectors or in fact, by members of the public.

The emergency department has been in the spotlight repeatedly over the past two years. While waiting times have significantly improved - the real test will be the approaching winter when the environment and the staff are expected to be under severe pressure.

This is not just a local problem. Emergency medicine is under severe pressure across the UK.

While the number of elderly people is increasing, those who work at the coal face say that fact has not been matched by more money.