NHS prepares as sources warn of winter meltdown

NHS Lothian could face a "perfect storm" of winter problems this year, with sources warning they will struggle to cope. Picture: Greg Macvean
NHS Lothian could face a "perfect storm" of winter problems this year, with sources warning they will struggle to cope. Picture: Greg Macvean
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health chiefs are on course for a winter meltdown after making the stark admission patient safety is “highly likely” to be hit by a perfect storm of factors which will cause chaos.

A crippling lack of beds combined with a “harsh” long-range weather forecast could result in the whole system falling down, it has been warned.

With an expected norovirus outbreak and a high number of delayed discharges to factor in to a system already under as much strain as this time last year, it is clear to see why health bosses are so worried.

Last year was widely perceived to have been one of the worst winters the NHS has dealt with.

Melanie Hornett, NHS Lothian’s director of unscheduled care, described winter as presenting a “huge risk” and recently told the NHS Lothian board that early reports had suggested the weather in coming months would be “harsh”.

She said: “Year by year, winters for healthcare systems seem to be getting harder and longer. Performance last year was very poor – most of our operational managers would say it was a very hard winter to get through. We didn’t recover to 95 per cent until May, that held until September when it dropped to 94 per cent.

“From experience of winters past we have planned as best we can to ensure patient safety.”

Last winter saw record numbers of patients being parked on trolleys for hours on end as the region’s NHS services neared breaking point, with pressure over bed spaces hitting unprecedented levels and demand on A&E services ­soaring.

Health bosses have put multi-million pound plans in place to avoid a repeat of the fiasco, but new figures have revealed that the region’s A&E departments – which bear the brunt of winter surges in demand – are in roughly the same shape that they were 12 months ago, with pressure already ramping up.

NHS Lothian will also be forced to cope with fewer beds at the Royal Infirmary, which was the hardest-hit major hospital last winter with patient numbers outstripping beds on some days, due to building work associated with the new Sick Kids hospital and a delay in building wards which was blamed on negotiations with Consort, the PFI firm which built and owns the ­hospital.

NHS Lothian has overhauled services and hired new staff in the run-up to winter, and health bosses have said they have done as much as they possibly can to ensure services can cope.

However, they admitted that it is “highly likely” that issues such as a lack of beds, increased patient numbers and a rise in delayed discharges will “continue to impact on performance throughout winter, having a detrimental impact on patient safety, staff workload and performance achievement”.

A senior NHS Lothian source said that a repeat of last year’s severe norovirus outbreak, or particularly harsh weather, could once again see already stretched hospitals plunged into turmoil.

“The widespread view among staff is that the Royal Infirmary will struggle again this winter – there’s no doubt about it,” the insider added. “That will have a knock-on effect for hospitals throughout the region.

“They’re already missing targets in September and October. That does not bode well and it’s not going to be a quiet winter.

“If beds come out of circulation for any reason, the whole system falls down. It’s going to be norovirus and the severity of the winter that determines the fate of NHS Lothian.”

NHS Lothian has been told that 95 per cent of patients attending A&E should be dealt with in four hours – a target reduced from 98 per cent by the Scottish Government.

By September, performance had dropped to 94 per cent, with six patients waiting half a day or longer, with the figure for October so far falling to 93.1 per cent, with nine patients stuck in the department for at least 12 hours this month.

The figures have barely improved on last year’s, when the figures were 93.07 per cent in September and 92.89 per cent of the time in October, with 19 people waiting 12 hours over the two months. The picture has been repeated across Scotland.

In its winter plan, published this month, NHS Lothian said that a new management system had been put in place in hospitals while work is ongoing to reduce the risk of a norovirus outbreak.

While more medical and nursing staff have been hired over the past 12 months shortages remain, the paper warns. Hitting the government’s 95 per cent A&E target will be “extremely challenging for NHS Lothian” it is admitted. Delayed discharges – meaning patients well enough to leave hospital become stuck taking up valuable beds as there is nowhere to send them – are once again on the rise.

It is planned 161 winter beds will be available in January, while a further 87 have been set aside across the region to be used in “extreme circumstances”.

Two new wards which it was originally hoped would be open by the summer at the Royal Infirmary will now not be ready until mid-February.

Scottish Conservative health spokesman Jackson Carlaw called on the Scottish Government to provide “proper funding” to cope with winter.

He said: “At least NHS Lothian is preparing the public candidly for the challenges of the winter ahead.”

Dr Jason Long, an A&E consultant and chairman of the Scottish board of the College of Emergency Medicine, said he hoped performance would have been better but is pleased detailed plans had been drawn up.