Edinburgh Royal Infirmary struggles to cope with 50 per cent patient overload in A&E

The emergency department at Edinburgh Royal Infirmary is having to cope with 50 per cent more patients than was originally planned for with one doctor saying “the whole system is very hot”.

Hospital bosses say that crowding not only affected the department’s ability to cope but had been shown to lead to more deaths.

Rebecca Miller, the hospital’s strategic programme manager, issued the stark warning at a meeting of the East Lothian Integration Joint Board (ELIJB).

She told the board the hospital was likely to see 400 patients come into the emergency department every day and said that “front door services”, which refers to unscheduled care at the hospital, were under pressure.

The emergency department, which was opened in 2003, was designed to manage 80,000 patients a year, but in 2018 it saw just under 120,000.

Her views were echoed by Dr Drummond Begg, chair of the British Medical Association’s (BMA) Lothian local medical committee and a GP in Penicuik, who said there appeared to be a gap in the system between demand and capacity.

He said: “Demand across the whole system is very high.

“One practice in Lothian in one day had the same demand – people phoning or coming to the surgery – as the entire A&E department of the Royal Infirmary.”

He said the BMA backed the call for 11 per cent of total NHS spend to go to general practice – a move Nicola Sturgeon has pledged to deliver by the end of the current parliament.

But he said the reasons behind the growing demand were multiple and complex, including changing demographics and people living longer with more disease.

Dr Begg added: “All points of contact with the NHS are under pressure.

“The whole system is very hot.”

Hospital bosses have warned they expect the number of annual cases coming through its doors to go up to 150,000 by 2033.

The capacity issue is the latest problem to hit NHS Lothian with the new £150m Sick Kids hospital not due to open for another year after health secretary Jeane Freeman ordered a last-minute halt to the planned opening in July.

More failings were identified last week after a review of the building’s fire and electrical systems.

Experts found smoke dampers had not been fitted in corridors serving sleeping accommodation, creating a risk that smoke could travel through the ventilation system and affect escape routes.

And they said more must be done to guard against the loss of electricity supply to critical services such as life support.

GP and Out-of-Hours issues causing A&E problems

The report told ELIJB members at a meeting last Thursday that “crowding is a key barrier to providing safe and effective care within RIE Emergency Department (ED)”.

It added: “Within the publication Crowding in Emergency Departments, the Royal College of Emergency Medicine cites published evidence which demonstrated that ED crowding is linked to increased mortality.

“Front door services have been under continual and growing pressure for a number of years.”

The board was asked to give its support in principle to an application from NHS Lothian for more capital investment, although no figure has been produced, and to agree to ask East Lothian Health and Social Care Partnership to look at providing more “community-based alternatives” to acute hospital care. The appeal came as the board met in the new £70 million East

Lothian Community Hospital, which was built without an accident and emergency or minor injuries unit.

Lothian MSP and Tory health spokesman Miles Briggs claimed difficulties in getting GP appointments and problems with the out-of-hours service were part of the reason so many patients were going to A&E.

He said: “People are often just going to A&E when that’s not the most appropriate place to be.

“You can’t blame the public if they have a concern.

“Often the only access they see is to go to A&E, even though it might not be an accident or an emergency, its just them trying to access health services. A lot of people are not able to get an appointment, what are they going to do?

“Sadly the GP crisis has had a knock-on effect of people looking to access services wherever they can and it just so happens there’s a big shiny ‘Accident and Emergency’ sign above the door 24 hours a day and you know you can walk in.

“If it wasn’t for the GP crisis more people might be able to be treated in their own community.

“But because we’ve seen GP closures and shortages that work’s often not being carried out in the community and people end up in A&E units.”

A Scotland-wide problem

Dr Tracey Gillies, Medical Director, NHS Lothian, said the health board in common with others in the central belt was experiencing rapid and rising levels of demand in emergency departments.

She added: “A huge amount of work is under way across the country to understand the complex problem and the contributing factors to provide solutions.

“Statistics show the numbers of people treated in the ED in the Royal Infirmary of Edinburgh between 1 and 19 September increased from 6,491 in 2018 to 6,910 in 2019.

“Health boards are working with Health and Social Care partnerships to shift the balance of care from hospital to community care to provide necessary services closer to home. This has already given rise to pioneering initiatives, such as Hospital at Home in East Lothian. Out of hours services and GP surgeries are also changing the ways they work by changing the ways patients can access care and advice, increasing availability of appointments and in some cases offering Minor Injury services to help prevent admissions to hospital and attendance at the ED.”