The emergency department at Medway Maritime Hospital has been condemned as “dangerously unsafe” by one of the top consultants working there.

In an open letter to staff and management, emergency medicine consultant Robert Ritchie has alleged there is a frightening array of failings due to chronic shortages and overcrowding.

The situation, he said, reached crisis point in March.

In what accounts to a damning verdict on facilities and patient care he claimed:

• Patients arriving in ambulances have been “stacked three rows deep on either side of the main hand-washing areas and some were left there for more than two hours
• The resuscitation area is seriously understaffed, at times with just one nurse and one health care assistant dealing with up to five very sick patients
• Clinical errors due to overcrowding have led to drug and medication mistakes and “near misses”, wrong clinical notes and x-rays attached to patients’ records
• Patients, some with symptoms of chest pains, bleeding on the brain and suspected meningitis, not being seen quickly enough
• Many patients not being seen by a doctor for more than four hours
• Doctors spending valuable time pushing patients to other departments, looking for trolleys and getting commodes because there are not enough nurses
• Patients waiting for more than an hour to be assessed by a nurse. The target time is 15 minutes
• Patients bedded in the department for up to 15 hours. The target time is four hours.
• The shop floor and several other areas are filthy with no structured cleaning programme in practice.

In the letter Mr Ritchie said: “We are failing our patients”.

He added that nursing levels were “insufficient to address the ever-increasing demand”.

He has also alleged the running of the department has become so chaotic that patients “get lost in the system” with some waiting two days to be seen by on-call teams and staff “unable to locate patients for worried relatives”.

Mr Ritchie, who has worked in the department for six years, also complained about doctors and nurses having to attend to patients on trolleys and asked “where is the privacy, dignity and patient confidentiality in this process?”

Medway NHS Trust’s medical director, Dr Gray Smith-Laing has replied to Mr Ritchie’s letter.

Dr Smith-Laing strongly disagreed the emergency department is “dangerously unsafe”.

He said: “I do, however, recognise the types of incidents listed in the letter can and do occasionally occur and the risks of untoward incidents do rise when the department is under extreme pressure as has been the case here and across emergency departments in the whole of the UK.”

Dr Smith-Laing stressed many of the problems the trust faces lie with health care partners and needed to be addressed centrally.

"This is the longest period of sustained pressure that anyone can remember"

He agreed there was a “crisis” in March.

He said: “The trust has been in the highest state of escalation due to emergency activity, for much of this year.

"I think this is the longest period of sustained pressure that anyone can remember and the trust and its staff have actually coped remarkably well and continue to do so, given that the pressure shows very little sign of abating."

Describing the current situation as “unsustainable”, he added: “Unfortunately, there are no quick fixes for the foreseeable future”.

Dr Smith-Laing said given the volume of patients treated, clinical errors and “near misses” do occur, but these are infrequent.

He added: “Nursing staff levels are constantly reviewed and are not considered insufficient."

Dr Smith-Laing said patients do not get “lost in the system”.

“We always try to have the patient in the most appropriate are for their clinical needs, but this is not always possible. As in any other emergency department patients are attended to on trolleys.

“I think it would be very unfortunate for the patients and staff of the trust if his letter gives the impression that the situation in our emergency department is unique to Medway. It is not.

“We are very aware of what is happening within our hospital and are working extremely hard to ensure that our patients receive the best possible in what can sometimes be difficult circumstances.”