Hospital staffing crisis forcing drop in surgeries
Caithness General Hospital has been experiencing significant difficulties in providing sustainable 24-hour emergency surgical cover.
The situation has now become so acute that NHS Highland is moving to implement planned contingency arrangements, as from 15 December, which will see an end to overnight and weekend surgical procedures.
NHS Highland claim these arrangements will ensure that the majority of surgical services will be maintained in the hospital and that all services provided are safe.
It will mean, however, that a small number of patients may have to be transferred to Raigmore Hospital in Inverness for surgery required overnight and at weekends.
Senior clinical back-up and support for local medical staff will be provided by the surgical team at Raigmore utilising existing telemedicine facilities, which will minimise any disruption and provide additional support for local clinical management of patients.
Dr John Macleod, consultant anaesthetist and clinical lead for the hospital, said: “Our ongoing problems with recruitment and reliance on locums won’t be a surprise to anyone.
“We have tried very hard to keep everything going but it’s now become so fragile that it’s not reasonable to continue as we are.
“We have therefore taken the decision that it is better to put in contingency arrangements on a planned basis rather than have to react to the next crisis. This means there will be no out-of-hours local consultant surgical cover in Caithness General but it will allow us to protect the vast majority of our surgical services.”
The situation has become acute with a recent retirement and resignation of two surgeons.
This leaves only one substantive consultant general surgeon in the hospital.
Dr Macleod added: “It’s a difficult time for all concerned because we realise that as well as managing our immediate difficulties we will have to agree a sustainable plan for the future.
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“I am grateful to all clinical colleagues and managers for agreeing an immediate plan that allows us to retain both local emergency and elective surgical services.
“This is in no small part thanks to the Raigmore consultant surgeon colleagues for agreeing to provide back-up. Had this not been possible to agree then I fear we would have had to suspend the emergency service altogether.”
The key change is that from 6pm-8am on weekdays and all weekends, the on-call surgeon will be based at Raigmore Hospital and, although available for telephone advice and direct review of blood test results, X-rays and scans, will not be able to attend Caithness General Hospital in person.
Patients requiring admission or assessment will still attend Caithness General and receive immediate care.
The initial assessment of all patients made by the junior doctor and nursing team will be reviewed by the local on-call medical and anaesthetic consultants, with advice on the management of patients with potential surgical problems provided by the on-call consultant surgeon at Raigmore with telemedicine available if required.
If immediate emergency surgery is thought to be required, or if there is any other cause for concern, the patient will be transferred to Raigmore Hospital for further treatment.
Otherwise, the patient will receive local treatment as agreed between the local physician and the surgeon in Inverness, pending further assessment by the local on-site surgeon in the morning.
Dr Rod Harvey, interim medical director for NHS Highland, met local clinicians in Wick this week, and has been overseeing the contingency arrangements.
He said: “We came to a collective view that we need to put in safe and stable arrangements until we work out a more sustainable plan.
“This plan maximises the use of all our local skills and resources, including junior doctors, experienced nurses, physicians, anaesthetists, laboratory and X-ray facilities, to assess people presenting with a possible surgical emergency on site but with the back-up of a consultant surgeon in Inverness.
“I believe it is a solid and safe plan which, through capitalising on increased co-operation between the two hospitals, enhances the resilience of our local provision.
“It’s clear that everyone wants to retain local surgical services but continuing with short-term locums is not the solution.
“This is definitely not the start of removing surgical services from Caithness but I do see it as a first step on the way to making changes for the future to ensure that local services remain of a high standard and are safe and sustainable.
The exact shape of these changes needs to be discussed by the local communities and staff and solutions agreed that are first and foremost safe but that NHS Highland can also staff and afford.”
NHS Highland insisted there is already considerable work under way looking at services in Caithness General Hospital.
It is likely that this will involve the reconfiguration of in-patient services to consider a combined medical and surgical assessment unit, an enhanced daycase and elective surgical unit, improved capability of medical inpatients and rehabilitation services and a fit-for-purpose emergency and out-patient departments.
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