The snap inspection – which comes six months after a damning appraisal by health watchdogs – revealed the hospital failed to improve the ward environment for dementia patients and provided only limited activity other than TV sets and staff interaction.
Inspectors from Healthcare Improvement Scotland found ten under-performing areas at the hospital and six points of strength – including staff’s “compassionate and respectful” treatment of elderly patients.
But they also discovered patients dressed in hospital gowns that “did not maintain their dignity” and criticised lapses in patient confidentiality finding – on six occasions – health records left open and unattended on wards.
While there had been progress, the report said: “Assessment and screening of patients for dementia and cognitive impairment, nutrition and hydration and pressure ulcer care is still not taking place in the majority of cases. We also found there was limited personal care planning.”
Today, critics said NHS Lothian and the Scottish Government had serious questions to answer.
Jackson Carlaw MSP, health spokesman for the Scottish Conservatives, said: “This simply is not good enough for what is supposed to be one of Scotland’s flagship hospitals.
“There are serious questions here, not just about patient comfort and dignity, but also their wellbeing while in hospital. This shows the true picture when these inspections are carried out unannounced.”
Shadow health secretary Jackie Baillie said she was “extremely disappointed” that little action appeared to have been taken to improve dementia wards. “It is essential that any hospital environment is made suitable for people with dementia and for the health board to have failed to address this is unacceptable,” she said.
Alzheimer Scotland said the report showed care for dementia patients was “still nowhere close enough” to ensuring they receive the “best possible” quality of care in acute hospitals while Age Scotland said further improvements were “clearly necessary” but praised the progress made since last August’s inspection.
Norman Provan, associate director of Royal College of Nursing (RCN) Scotland, expressed concerns about staff shortages and nurses being “rushed off their feet” while pointing to capacity problems that leave patients “being treated in inappropriate wards”.
Melanie Hornett, nurse director at NHS Lothian, said a programme of improvements was being rolled out to make wards more dementia-friendly.
She said: “It is pleasing to note that significant progress has been made and, while we know there is always more to do, we are now regarded by Health Improvement Scotland as performing well in how we care for older people.
“There were some areas which the inspectors felt could be improved and we have already addressed these points.”
A Scottish Government spokesperson said: “This report shows that NHS Lothian has made considerable progress in improving care for older people. In the vast majority of cases older people were treated with dignity and respect, the A&E department has been adapting to the needs of people with cognitive impairment and ‘Dementia Champions’ are now used.
“However, further improvements can be made and NHS Lothian already has an action plan to make this happen.”