According to the hospital's union secretary, the A&E department resembled a 'M.A.S.H. unit' on Wednesday / Bethany Clarke/Getty Images

Patients were left on trolleys outside the toilets and staff were reduced to tears, according to reports

The A&E department at a Belfast hospital which declared a major incident on Wednesday resembled a “M.A.S.H. unit”, with patients left on trolleys outside the toilets and staff reduced to tears, the hospital’s union secretary has said.

Belfast’s Royal Victoria Hospital was forced to call in extra staff to cope with “extreme pressures” after a surge in attendances in the late afternoon and evening.

The situation led to more than 40 patients having to wait on trolleys, with patients waiting to be seen spilling out of the crowded wards into the X-ray department, according to reports.

Catherine Harte, Unison’s joint branch secretary at the Royal Victoria, said she had been called in to speak to staff as pressures began to mount on Tuesday afternoon. By teatime on Wednesday there were 110 patients attending the department, she said.

Northern Ireland’s Health minister Edwin Poots described the circumstances as “exceptional”, but Ms Harte said that there had in fact been even more attendances on Monday night, and that the situation could happen again.

“On Wednesday afternoon the place was a like a MASH unit, like something out of Beirut,” she said. “There were patients absolutely everywhere. We had patients in the outcomes area, patients lying in the middle of casualty, trolleys outside of the toilets: there was nowhere for relatives to sit.”

She added: “There’s no snow, no major emergency, the population is just getting older and people are converging on the A&E department.”

The NHS was warned of the potential for problems at Royal Victoria in November, when a College of Emergency Medicine report said that the pressures caused by understaffing and lack of funding were “unsustainable”.

Ms Harte said that closures at other hospitals had led to major problems at other A&Es in Northern Ireland, which were redirecting ambulances to the Royal Victoria.

The A&E at the nearby Belfast City Hospital was closed in November 2011, and the department at the city’s Mater Hospital no longer provides emergency surgery. A&E departments at nearby Lagan Valley Hospital, Lisburn, and at Downe Hospital, Downpatrick in County Down, have had their opening hours cut and since 4 January only open between 8am and 8pm, Monday to Friday.

“It is unprecedented for nursing staff [at the Royal Victoria] to contact the trade unions and want to go public,” she said. “Our hospital is one of the best in the UK. Staff are extremely dedicated but the last three days have been just horrendous. No one could keep up that pace.

“It’s not that there are problems in recruiting nursing staff; we have a substantial amount of staff in post. It is just the system itself causing the backlog. The Health minister has described this as a blip. But it’s going to happen again.”

Mr Poots said that there was “no evidence” that the major incident had been exacerbated by changed opening hours at other A&Es.

“Last night’s circumstances were exceptional and it is important not to confuse an exceptional circumstance with overall performance in Belfast where waiting times have been demonstrating some improvement,” he said. “I would like to thank all staff for working long hours, in many cases above and beyond the call of duty, to ensure that all patients received the care they needed.”

But Sinn Fein’s Maeve McLaughlin, chair of the Northern Ireland Assembly’s health committee, said the minister’s strategy on A&E was “in meltdown” and called for a full report into the incident, which occurred on what she said should have been a “routine evening”.