ERI cries for help

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THE man in charge of running Lothian’s hospitals today warned he feared for the "welfare" of patients as a result of the region’s bed-blocking crisis.

Around 100 operations have had to be cancelled at the Edinburgh Royal Infirmary this year because of the city’s chronic problem. And the hospital is so severely overstretched because of blocked beds that this week it was forced to open a day ward overnight.

Planned operations have had to be cancelled because there are no beds for patients to go into, as they are occupied by people waiting to be discharged.

David Bolton, chief executive of Lothian University Hospitals Division, which runs the ERI, said he was worried about the effect the crisis was having on patients. Council and health chiefs are to hold a crisis meeting with deputy health minister Rhona Brankin, where they plan to demand extra cash from the Scottish Executive to deal with the problem.

Mr Bolton said measures brought in by the council to ease the problem had yet to have an impact on the hospital.

"The Royal is feeling great pain at the present time. For the last four months it has been very difficult," he said. "We are unable to move our patients as we would wish from the ‘front door’ of our hospital - the emergency departments - to discharge or downstream beds like Liberton or the Astley Ainslie because of the number of delayed discharges.

"When we moved to Little France there were just under 50 delayed discharges, and we were able to manage the flow of patients. Once you get over 70 it becomes very difficult. We have been running with that for many weeks and there is no sign of that falling."

Seventy of the operations cancelled have been in orthopaedics - hip and knee operations.

Cancellations prove extremely costly for the health board as patients have to then be treated at other NHS hospitals or in the private sector.

Mr Bolton also revealed that on Monday night, the medical day bed unit had to be opened for the third time this year to cope with the number of admissions and agency doctors and nurses brought in to staff it. "When it does get as bad as it got [on Monday], I have personal concerns about the welfare of patients," he said.

"We are pleased with the proposals which will augment care home places, but at the Royal we are seeing no signs of that having an impact."

Mr Bolton added: "Of the patients not included in the orthopaedic figures, there were small numbers of patients in each of general surgery, vascular surgery, ENT, neurosurgery and cardio-thoracic. We endeavour to re-book as many patients as possible within the waiting time guarantee here at the Royal Infirmary.

"In the very few cases where we cannot, they are referred on to the Golden Jubilee Hospital in Clydebank, an NHS Hospital in Darlington or the Murrayfield Clinic in Edinburgh."

Earlier this year, the council and NHS Lothian agreed an extra 400,000 to be spent on buying extra care home places and topping up the rate per week paid to the private sector to move people out of hospital more quickly.

But council chiefs admitted that just six patients have been moved out of the ERI and into care homes in the last two weeks, although 99 people were sent back home with support from care workers.

They say they have been focusing on discharging patients into care homes from rehabilitation beds at the Astley Ainslie and Liberton hospitals.

Latest figures show there were 302 people in hospitals in Edinburgh awaiting discharge at the end of December last year.

The concerns about the ERI’s ability to cope with the bed-blocking crisis were raised at a specially-convened meeting to discuss the issue.

At the summit, council chiefs faced demands to increase the amount of money paid per person every week to private sector care homes. They claimed upping the sum would reduce the number of private care home places they were able to buy.

Mr Bolton said: "At the Royal Infirmary, which is our major emergency hospital, the benefits of extra funding are still to be seen.

"Here and now as I see it and where I work, we need to have movement on care homes.

"We would see much more benefit in getting 48 places immediately rather than 58 places at the current rate in several months.

"This is really important - we are vastly overspent because of this and we don’t have the money we are spending."

Although the council has agreed to pay private care homes 450 per resident per week from the start of the next financial year, this is still well below the rate demanded by many private sector establishments.

Acting director of social work Duncan MacAulay said: "There is no doubt that delayed discharge is a huge problem for the city of Edinburgh.

"We believe good progress is being made towards building four new care homes and achieving the objective of 600 additional care at home packages.

"To reach the target set by the Scottish Executive for April, we will need to purchase around 100 places in care homes."

Meeting convener Marilyne MacLaren said: "This is a desperately serious issue facing both the council and the health authority, and the poor people who are suffering from this situation, especially the elderly.

"It is one of the most serious issues the council has had to confront. If the weather continues to be bad, then it is going to get worse, not better."

A Scottish Executive spokes-woman said: "We recognise there are specific problems in Lothian. That’s why the deputy minister has agreed to meet NHS Lothian and Edinburgh City Council to discuss these issues."