NHS staff shortage: Heart patients sent to Glasgow

The delay in getting patients into surgery while they travel from Edinburgh to Glasgow could be the difference in surviving or dying
The delay in getting patients into surgery while they travel from Edinburgh to Glasgow could be the difference in surviving or dying
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PATIENTS who need lifesaving heart surgery will have to be sent to Glasgow for emergency treatment after vital members of a surgical team refused to cover out-of-hours shifts.

The small team of clinical perfusionists in Lothian, who ensure patients receive enough oxygen during open heart surgery, have told health bosses they are unwilling to work over a weekend, after becoming frustrated due to a long-term shortage in their numbers.

The ERI. Picture: Greg Macvean

The ERI. Picture: Greg Macvean

The planned walkout has sparked fears further action could follow.

Their absence means that emergency open heart surgery at the Royal Infirmary – one of only three centres in Scotland to offer the highly complex procedure – will not be carried out and patients will instead have to be rushed to the west for operations, if last-gasp efforts to fill the rotas prove unsuccessful.

One senior medical source at the health board said that there was no doubt that patients’ lives would be put at risk as a result of the development, as they are unlikely to be operated on within a vital first “golden hour” from the point of trauma.

They said: “Perfusionists are an integral part of cardiothoracic theatre and they feel they have been taken advantage of for far too long, and now things have come to a head.

“They have said they are not going to work over and above their contracted hours and won’t supervise locums even if NHS Lothian manage to source them. It means the service won’t run.

“Not this weekend but the following weekend it means emergency patients who need an operation that requires a perfusionist will be sent to Glasgow. It’s going to be one to two hours before a patient will see the inside of an operating theatre. There’s no doubt that will pose a significant threat to life and could quite easily mean the difference between living and dying.”

There are currently seven-and-a-half full-time equivalent roles for clinical perfusionists in NHS Lothian, but just three-and-a-half are filled. The health board has been relying on locums to fill rotas, who cost significantly more than full-time staff but do not routinely provide out-of-hours cover.

The burden of offering cover for emergency patients has therefore fallen on the small group of specialists.

A source close to the team said that they had become tired of covering a “brutal” on-call rota, and claimed one staff member could provide cover for seven days in a row.

He said: “They haven’t been able to recruit staff for many years and now it’s got to the situation that there’s less than half of the staff they should have available.

“If people have a heart attack in Edinburgh next weekend, it won’t be the best idea and there’s the potential for serious harm.

“Managers have been warned for a long, long time that there is a problem and that something was going to go seriously wrong, but they’ve been told to ignore it.”

Sarah Boyack, Labour MSP for Lothian, said the developments were “deeply worrying”.

She said: “It’s vital that urgent action is taken to ensure that skilled staff are recruited to fill these vacancies. I’m particularly concerned to hear that this service has been understaffed for some time. There should be a process to avoid this happening again in this or any other NHS Lothian service.”

It is understood that NHS Lothian has struggled to fill posts in part because NHS pay grades, which are set nationally, mean perfusionists are paid more in England than Scotland.

But in a further twist, it emerged that NHS Lothian’s perfusionists recently negotiated a 20 per cent pay rise in recognition of their low numbers.

Tom Waterson, Unison branch chair for Lothian, said that he was “extremely disappointed” to hear of the perfusionists’ stance, given the pay increase which it is believed will be backdated to April last year.

He said: “I am aware of staffing shortages. But they went to the Scottish Terms and Conditions Committee just last month and it was agreed that they would receive 20 per cent on top of their wage because they were short staffed. They got what they asked for.”

NHS Lothian said that no cardiac surgery operations which required perfusionists had been planned between Friday next week and 8am on the following Monday. Emergency patients are almost certain to be treated in Glasgow that weekend, unless an agreement is reached – although a last-gasp deal is not anticipated.

Patients suffering chest traumas, potentially due to stabbings or car accidents, are among those that could be affected. Medical patients who suffer aortic dissections could also be sent to Glasgow when they would otherwise be treated at the Royal Infirmary.

Typically, three patients every month are admitted to Lothian emergency departments with chest trauma or aortic dissection.

Dr David Farquharson, NHS Lothian’s medical director, said: “NHS Lothian are working around the clock to ensure that we are able to provide on-call cover within the cardiac perfusion team over the weekend of April 26th.

“Contingency plans are being drawn up to ensure that any emergency patients requiring perfusion services are able to be treated in another health board area over that weekend.

“We are currently recruiting for positions within the perfusion team but have so far been unsuccessful”.

“We will continue with our efforts to recruit new staff to these positions and hope to make appointments in the very near future.”

A Scottish Government spokesman said: “We are aware of a range of issues in relation to recruitment of the perfusionists and are working with NHS Scotland employers to address them. We have been assured that contingency arrangements are in place”.

LATEST CRISIS TO ENGULF NHS LOTHIAN

THE staffing shortages among perfusionists are only the latest to hit NHS Lothian.

Although they have made efforts to recruit new staff to the roles, a UK-wide shortage has meant posts have gone unfilled.

Children’s services have also been hit due to staffing issues, with the paediatric ward at St John’s Hospital in Livingston closing for three weeks last summer.

A search for specialists in the area has extended across the globe, due to a lack of numbers in the UK.

Initial results have proved positive, but long-term doubts over the future of the service remains.

And Lothian health chiefs recently warned that they are struggling to fill posts in emergency medicine, surgical specialities and gynaecology and obstetrics.

NHS Lothian’s chief executive Tim Davison has admitted that shortages in some areas were creating difficulties across the UK.

He said: “We are all fishing in a small pool [for staff]. The generality of the risk is real and we don’t have all the answers yet.”

MAINTAINING THE VITAL SPARK

CLINICAL perfusionists are vital members of open heart surgery teams.

They use highly technical, mechanical and electronic devices to ensure that oxygen reaches a patient’s body through the blood, when the lungs and heart are not functioning.

An NHS Lothian advert for perfusionists, posted last year, warned the role is “emotionally extremely demanding” and that routine decisions could mean

life or death.

‘Resolution needed soon’

Sally McPhail is preparing for her third open heart surgery operation.

Although her upcoming valve replacement is planned, rather than an emergency procedure hit by shortages in out-of-hours cover among perfusionists, she expressed shock that more than half of the roles are unfilled in Lothian.

The 25-year-old from Colinton said: “I hope there will be some sort of resolution to this as soon as possible. I am surprised by it. They need to do anything they can to stop things like this happening.”

Sally’s surgery should take place this summer at the Golden Jubilee Hospital in Clydebank. She was just hours old when her parents learned she had heart problems.

Medics found she had been born with two holes in her heart and problems with her pulmonary valve.

She had open heart surgery aged five and eight, to repair the holes, and her upcoming procedure will repair the valve.

She hopes the operation will give her a new lease of life, and has vowed to take up running once it is over. “I’m feeling confident about it, probably because I’ve had open heart surgery twice before,” she added.