Daniel Sanderson: Does NHS Lothian have room for optimism heading into 2013

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THERE can be no doubt that countless NHS patients in Lothian have been given a raw deal in recent years.

But, as Bob Dylan, the personal hero of our health board’s chief executive Tim Davison once said, The Times They Are a-Changin’.

If you had to use NHS Lothian services last year, the chances are you would have been treated efficiently and on time, by talented and caring staff.

However, a significant minority – thousands of people – were badly let down, whether that meant being forced to wait months too long for a life-changing operation, languishing on a trolley waiting for a space on a ward, being shunted from department to department as there were too few beds, getting stuck for weeks on end in hospital with nowhere to be sent, or hanging around for hours upon hours in A&E.

But if 2012 was NHS Lothian’s annus horribilis in which it apparently lurched from crisis to crisis, the signs are that 2013 will be a year of 

The scale of the task facing the organisation means that its significant problems will not be fixed overnight, and Health Secretary Alex Neil’s prediction that NHS Lothian will be back in the premier division of providers by the middle of the year may yet prove optimistic.

But its patients, not to mention the 23,000 staff who have all too often been stretched to near breaking point, should begin to notice a real difference this year.

There is the promise of hundreds of new doctors and nurses, plans for 80 extra beds at the Edinburgh Royal Infirmary, new much-needed care home places in the Capital, a continuing drop in excessive waiting times and progress towards curing a bullying culture that riddled NHS Lothian at this time last year.

Mr Davison, who took over as temporary chief executive in April before the position was made permanent in late July, has set about promoting a culture of openness.

“I think everyone is committed to leading by example around dealing with these enormous pressures that we have in an appropriate way,” said Mr Davison, reflecting on the changes at board and senior management level.

“The fundamental difference is we are owning the problem. It’s our problem, we’re not blaming the people in the hospitals, we’re not blaming the GPs, we’re not blaming the Scottish Government. We are signing up to the fact it’s our problem and we need to sort it together.

“The organisation is under immense pressure – it’s a pressure cooker environment. We’re trying to tackle a management culture issue at the same time as having to deliver extremely challenging targets.

“That isn’t easy, and when people are under enormous pressure they can get a bit shirty with each other. I couldn’t pretend to say Lothian has transformed into an area of sweetness and gentle light where 
everyone wanders around feeling fantastic, but we have made demonstrable changes.”

But while no doubt a significant issue, a radical culture shift alone will be no cure for the health board’s ills. Indeed, unacceptable behaviour of some managers is perhaps a symptom rather than a cause of the problems at NHS Lothian.

The fundamental issue is that there is not the capacity to treat the huge and ever-increasing volumes of patients in the region, and a disastrous blunder of the past – when the ERI was planned with far too few beds – is increasingly coming home to roost.

The waiting times scandal, which at its peak saw 7000 patients waiting longer than a 12-week target for treatment, will by the end of March have cost £27 million to sort out and the expensive private sector will continue to be relied upon throughout 2013.

But an additional £20m investment in 2013-14 to increase the numbers of patients NHS Lothian can treat – and a similar sum to be pumped in annually after that – has been pledged.

Added to closer co-operation between council social care services and the health board’s acute hospitals, the cash – if used wisely – should make a considerable impact in increasing NHS Lothian’s ability to cope and reduce the need for its patients to be farmed out to private hospitals.

Mr Davison said: “As the capacity in elective care and unscheduled care begins to grow – and that means more doctors, more nurses, more theatre sessions, more beds – I am absolutely anticipating that we will have more patients treated in Lothian and fewer going elsewhere.

“For the NHS to work efficiently, the treadmill has to go at the same pace right through the system. If it slows down in any area, people back up against each other. The investments we’re making are all designed to improve capacity to allow the treadmill to move at the same pace so patients can properly move through the system.”

It sounds like a credible plan, but there’s a black cloud on the horizon and it’s approaching fast.

The financial climate under which the health board will be forced to operate while needing to make these essential multi-million-pound investments presents an incredible challenge.

It is true that the Scottish Government will increase funding for health boards this year, and in recognition of the unfairness of a formula that has left Lothian £50m short, ours will benefit from an above average top-up.

But it will fail to cover the spiralling costs of providing health services at a time when they are needed by increasing numbers of elderly patients, often with highly complex, multiple medical conditions.

It is a considerable achievement that NHS Lothian will balance its books financially for 2012-13, but it will do so in spite of failing to make the efficiency savings it targeted last April. Another £30m in savings will somehow have to be found in 2013-14, and in the year after that.

The financial situation is “difficult”, Mr Davison said, but that is surely an understatement. It is a predicament that could set the health board on a collision course with its Holyrood masters, who are in effect forcing NHS Lothian to do more with less.

It won’t be easy, and when 2013 draws to a close, our health service will be far from perfect, but it will almost certainly be better than it was in 2012.