THE number of patients forced to wait longer than the national four-hour target has been under-reported across all the Capital’s emergency departments, it has been revealed.
According to NHS Lothian, reporting guidelines were breached at the Royal Infirmary, the Royal Hospital for Sick Children and the Western General’s Acute Receiving and Assessment Unit (ARAU).
The revelations, published by the health board after an internal review, come just weeks after a whistleblower raised similar concerns about St John’s Hospital in Livingston.
Staff at that hospital were found to have set up their own recording system, which meant emergency department patients waiting longer than four hours were not being properly logged.
The news prompted health secretary Shona Robison to call for an independent review, which has now got under way and is expected to report back in the new year.
In the meantime NHS Lothian has said it will remodel its reporting practices for emergency waiting times. Officials said they had “already created a robust Standard Operating Procedure (SOP), instructed comprehensive staff training around it and begun development work to better support staff”.
But Conservative health spokesman Miles Briggs said the news was “deeply concerning”. He added: “The initial concern was focused on the A&E unit at St John’s but this report indicates under-reporting has taken place across local A&E facilities which means this is an even bigger issue than previously thought.
“Lothian patients deserve to have complete faith in the accuracy of A&E data and NHS Lothian must ensure this internal report’s recommendations are implemented in full and without delay.
“In addition, NHS Lothian must be ready to adopt the recommendations of the external review into these matters.”
The report states that the number of discharges initially recorded as exceeding the four-hour target but then altered to being within it almost doubled from 5.7 per cent in October 2015 to 10.5 per cent in September 2017.
It advises improved staff training, greater monitoring and stricter governance, and states those measures could have prevented some of the practices earlier.
Jim Crombie, NHS Lothian’s deputy chief executive, said: “The report has made a number of recommendations and the board members will discuss them in greater detail. We have already put several of them into place, including the creation of a Standard Operating Procedure and created staff training.
“We also have to do work with our teams across NHS Lothian to help them feel supported and that will feature as a key strand in our development plans.
“As soon as we received these initial concerns, an internal audit team was appointed, headed by a senior non-executive director to oversee the investigation. We now have the results and the recommendations from that report and we will develop a plan to ensure effective action is taken.”
Ms Robison said she remained “very concerned” but that it was important to await the outcome of the Academy of Medical Royal Colleges review to fully understand the situation.
She added: “In the meantime, I welcome the interim actions taken to ensure practices in NHS Lothian are brought into line with ISD’s [Information Services Division] guidelines to ensure accuracy going forward.”
Labour health spokesman Anas Sarwar said: “It is extremely disappointing to see NHS Lothian’s emergency department waiting times may in actual fact be much worse than initially published.
“The truth is waiting times are far too long in the Scottish NHS, with targets being missed on a weekly basis. It is vital that we are able to have confidence in figures published on the performance of our health service, and the health board must rectify this error as a matter of urgency.”
It comes five years after former NHS Lothian chief executive Professor James Barbour OBE abruptly retired after evidence of waiting time manipulation surfaced.
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