A MULTI-million pound plan aimed at avoiding a repeat of the winter crisis that gripped Lothian hospitals has been unveiled.
The annual surge in patient levels over the colder months, unprecedented levels of norovirus and a rising number of bedblocking patients created a perfect storm which left the region’s emergency departments on the brink of meltdown last winter, with hundreds of patients left to lie on trolleys for hours on end in A&E.
The Royal Infirmary was especially hard hit, with performance against a four-hour target to process emergency departments among the worst of any hospital in Scotland.
But while icy pavements leading to an increase in fractures and a surge in flu cases may seem a long way away during the current heatwave, NHS bosses have revealed that planning for the winter months has been at the forefront of their minds.
More than £13m will be invested in the current financial year on overhauling services in Lothian, with hopes high that patients will see a vastly improved service in the coming winters.
Among the measures being introduced as part of NHS Lothian’s local unscheduled care action plan are:
• The recruitment of 142 new staff, including 25 new emergency nurses for the Royal Infirmary, while continuing funding for a further 185 existing jobs has been found.
• An increase in bed numbers, including at the Royal Infirmary, Royal Victoria and Western General Hospital sites.
• The possible relocation of some services to St John’s Hospital.
• Introduction of seven-day working in some jobs to ensure patients can be discharged easily at weekends.
• More “ambulatory care”, meaning that patients who would previously have been admitted to hospital will be seen as outpatients.
• Targeting of regular hospital users and an increase in early help.
• Ensuring GPs can get expert advice over the phone to reduce the number of people sent directly to emergency departments.
• Bronchiectasis patients who need intensive IV therapy will be able to get it at home, rather than having to travel to hospital.
• Beefing up infection teams and encouraging more staff to have their flu jab.
• Bringing in more emergency consultants to work at the busiest times, usually evenings and weekends.
While not an issue in the winter, there will also be a drive to spread awareness of the Festival GP practice next month, with the influx of visitors making August the biggest time for the region’s emergency departments.
NHS Lothian admitted that despite having the finance set aside to hire more workers, there remained a possibility that not enough would be available to fill the posts.
But the plan, which has been presented to the Scottish Government, was welcomed by MSPs and medical professionals.
Dr Jason Long, an A&E consultant and chair of the Scottish board of the College of Emergency Medicine, told the Evening News: “I am very supportive of all these proposed actions and these should greatly help with the present challenges faced in emergency departments.”
The measures have been put in place following an internal review of the most recent winter period, in which the number of patients stuck in emergency departments for more than eight or 12 hours soared.
Staff complained of last-minute communication leading to a lack of continuity, not having enough staff, a disconnect between staff on the wards and managers, and inappropriate cases of patients being “boarded”, meaning they were sent to inappropriate areas due to a lack of space.
Labour Lothians MSP and shadow health secretary Neil Findlay said he was pleased plans were in place, given the “chaos” of just a few months ago.
He added: “We should welcome all efforts to ensure only real emergencies attend A&E and I hope that the additional beds and staffing will provide for a better level of care for patients.
“I will be keeping a close eye on how NHS Lothian prepares for the coming winter as we all know the pressures it has faced, not just in A&E, but across specialties and across the health board area.”
MSP and Conservative health spokesman Jackson Carlaw said that he was glad to see the health board “trying to get ahead of the game” by coming up with the plan. “Time will tell if it’s enough, but the signs are encouraging,” he added.
NHS Lothian’s nurse director Melanie Hornett said: “Our plans to invest £13.4 million include providing significantly more staff; extending our Outpatient Parenteral Antimicrobial Treatment (OPAT) service [which allows patients to be treated in their own homes rather than in hospital] to St John’s Hospital; providing additional beds at major hospital sites including the Royal Infirmary of Edinburgh, the Western General Hospital; and Royal Victoria Building and extending our seven-day service to more departments.”
A&E departments targeted
PERFORMANCE at Lothian emergency departments hit record lows over the winter.
The Scottish Government has said that 98 per cent of patients should be admitted to hospital, transferred elsewhere or discharged within four hours of arriving at A&E.
But in December the health board hit the target just 86 per cent of the time across all sites, with 275 waiting beyond eight hours and 67 stuck for 12 hours or more. Performance has improved recently.
While the Sick Kids emergency department performs well and there are some challenges at St John’s, the biggest problems have been at the Royal Infirmary and Western General Hospital.
Often, patients become stuck in A&E because they need to be admitted but there is nowhere to send them. A ‘day of care audit’ at the Royal Infirmary in January, which was used when coming up with the new plan, revealed that the hospital was running at 101 per cent of capacity.
The Scottish Government has told all health boards that steps must be put in place to improve unscheduled care systems.
NHS Lothian has said that it wants to see 95 per cent of patients processed within four hours by September, and hit 98 per cent by March next year.
Vision of the future
THE unscheduled care action plan published by NHS Lothian represents a snapshot of the future of the NHS for patients.
As the health service is forced to deal with a huge increase in numbers of elderly patients with multiple conditions, hospitals would be unable to cope if the status quo is maintained.
Instead, health bosses have said they want to treat more patients at home or in the community, rather than in a hospital.
The plan says that patients who would have previously been admitted may be treated as outpatients while such procedures as intensive IV therapy, which would previously have taken place in hospital, could instead be done at home.
A greater emphasis is to be put on preventative measures to stop people needing to be admitted to hospital in the first place – another key strategy to relieve pressures on the facilities.
NHS Lothian has also said more services will have to be offered at evenings and weekends in the future to cope with the rising demand.