A leaked email has revealed how a major Scottish hospital came close to meltdown as 36 patients waited up to 17 hours in the accident and emergency department for admission to a bed.
The memo circulated to staff from a senior director at the Edinburgh Royal Infirmary (ERI) described the flagship hospital as being “in extremis” and warned that the cancellation of major surgery was a “serious risk”.
The hospital experienced a surge in patients last Thursday which led to a bed-blocking crisis on Friday morning, when the email was sent to staff.
In the document, which was sent to The Scotsman, teams are asked to look at “anything and everything” that can be done to improve the flow of patients out of the hospital in order to free up bed space, with a focus on decision-making for discharge. One of the options put forward by Dr Andrew Flapan, the associate medical director for the hospital and a consultant cardiologist, is sending patients to other health boards.
Tom Waterson, branch chairman of Unison at the ERI, said similar “in extremis” email requests were sent out by hospital bosses “at least twice a month” but that the extent of the crisis has never been made public.
He said the document provides an insight into the “perilous” lack of patient care at the ERI.
It’s high time that the government took a really strong view of the NHS in Scotland because we’re not going anywhere. It’s just getting worse and worse – what are they going to do about it?Margaret Watt
Mr Waterson added: “Enough care is not being provided in the community at home and this is due to a failure of the home-care system in NHS Lothian.
“The email is sent to emphasise to staff how serious the situation is and the requirement where possible to free up beds via discharge either preferably to a patient’s home or a healthcare home facility.
“The situation doesn’t provide a very good level of care.”
Since 2007, the national standard for A&E waiting times is that new and unplanned return attendances at an A&E service should be seen and then admitted, transferred or discharged within four hours. This standard applies to all attendances for emergency care including attendances in trolleyed areas of assessment unit as well as Emergency Departments and minor injury units.
Margaret Watt, chair of the Scottish Patients Association, said: “It’s high time that the government took a really strong view of the NHS in Scotland because we’re not going anywhere. It’s just getting worse and worse – what are they going to do about it?
“The politicians are so busy fighting among themselves, they forget that we, the public, employ them to look after our needs.”
Scottish Labour health spokesman Anas Sarwar described the memo to hospital staff as “an explosive email that lays bare the shocking and unacceptable pressure that staff at the ERI are under”.
Mr Sarwar said: “This is a full-blown crisis that could have a major impact on patient safety, and the SNP health secretary needs to urgently intervene and publicly reassure patients across Edinburgh that this situation has been resolved and can never happen again. It demonstrates the scale of the crisis facing our NHS, not just in Edinburgh but across Scotland.
“A decade of SNP mismanagement has created a staffing crisis in our NHS. Under the SNP our NHS staff are overworked and undervalued. The SNP government has created a workforce crisis in our hospitals which simply do not have enough doctors and nurses. Only Labour has a plan to invest in social care to ease pressure on our NHS, which is why voters must back Labour on 4 May and 8 June to send a message to Nicola Sturgeon to get on with the job of governing and drop her plans for a divisive second independence referendum.”
Lothians Tory MSP Miles Briggs said: “These A&E waiting times are totally unacceptable and another indication of the massive pressure on NHS services in Lothian which is clearly struggling to cope.
“The SNP government, which is consistently failing to meet its A&E targets, needs to get an urgent grip on this situation.”
Lyn McDonald, ERI site director, said the email was sent after an unusually busy day. She added: “On Thursday 20 April, the Royal Infirmary of Edinburgh Emergency Department had an extremely busy day, particularly in the late afternoon and early evening, after a busy Easter weekend.
“The number of attendances at the department were higher than average, which meant that the site admitted an additional 20 patients more than is normally predicted. This resulted in a number of patients in the Emergency Department waiting to be admitted.
“In response, services across the site were alerted and asked to assist with patient flow. Additionally, other sites and across health and social care responded and assisted appropriately. All of these measures allowed the site to return to normal within a few hours.”
A Scottish Government spokesperson said: “Unnecessary long waits in A&E are not acceptable.
“The board have offered their assurance that they quickly recovered their A&E performance following higher than average attendances at the RIE last Thursday.
“Through the A&E Improvement Programme, we are working closely with hospitals to ensure processes and best practices are in place to minimise delays for patients.
“We have been supporting the RIE to roll out ‘Daily Dynamic Discharge’ across its wards, which is aimed at improving the timeliness and quality of patient care from arrival to discharge from the hospital.”