The health board was criticised last June in a review that blasted the leadership team, highlighting a breakdown in trust between medical and nursing staff in the A&E department, with senior management’s attempts to resolve the issue proving “unsuccessful or detrimental”.
The report, ordered by former health secretary Shona Robison after a whistleblower raised concerns, was carried out by the Academy of Royal Colleges and looked into the emergency departments at St John’s, the Royal Infirmary of Edinburgh and the Western General hospitals. It said staff at all levels felt there was “limited focus” on emergency care from the board and found evidence of bullying and harassment, lack of leadership and a failure always to prioritise patient safety and quality of care. The Scottish Government has now commissioned a troubleshooting team, chaired by Jim Mackey, CEO of Northumbria Healthcare NHS Foundation Trust, to support NHS Lothian with the implementation of the recommendations in the report. They will look at the four-hour A&E waiting times performance across the health board as a key priority.
Last December, the Royal Infirmary suffered the poorest performance of any hospital in Scotland, seeing less than two-thirds (64.1 per cent) of patients on time as winter pressures took their toll. A more transparent culture within NHS Lothian allowing staff to air concerns was also among a number of recommendations made.
A Scottish Government spokesperson said: “Performance at the Royal Infirmary in Edinburgh has been challenged over the last few months, therefore we have commissioned the help of an external team to support the board with the implementation of the recommendations. This approach of learning and mutual aid is commonly used to enable the NHS to improve, and continue to provide high quality care. Drawing on clinical and operational expertise from across NHS Scotland and NHS England, the team offers support to NHS Lothian to implement a programme of continuous improvement. The team is chaired by Jim Mackey, CEO Northumbria Healthcare NHS Foundation Trust who brings a wealth of experience in quality improvement and delivery of safe high quality care.”
However, Kezia Dugdale, Labour MSP for the Lothians, criticised the decision to draft in an English expert to “fix the mess”.
She added: “The performance of NHS Lothian has been unacceptable for several months, despite the best efforts of dedicated staff who have been put under far too much pressure. Sending in a taskforce is a welcome decision and suggests that SNP ministers are finally waking up to the fact that they have starved NHS Lothian of cash and resources for too long. With winter likely to put hospitals under even more pressure, patients and staff in the ERI and across Edinburgh deserve better from this failing government.”
NHS Lothian had carried out its own internal report after concerns were raised about under-reporting of A&E waiting times. It concluded staff acted with the best of intentions in developing local guidance on recording waits because national guidance was vague and ambiguous. It said staff were under “intense pressure” beyond that of working in a busy department, but said none of those interviewed felt bullied or harassed.
Tim Davison, Chief Executive, NHS Lothian, said: “We welcome the expertise of this group and for their contribution and helpful advice to our improvement programme of work. NHS Lothian continues to be committed to both our patients and our staff in delivering high quality and effective services and we are explicit this programme of work is framed by that principled objective.”
A spokesperson for Northumbria Healthcare NHS Foundation Trust said: “We support NHS organisations from across the UK and, following a request by the Scottish Government, Jim Mackey has been working with NHS Lothian on their journey of improvement. This is a time-limited piece of work with Jim currently spending one day per fortnight to support this. All costs are reimbursed.”