MEDICAL LEADER’S DEPARTING WARNING: CRISIS MANAGEMENT MUST NOT BECOME THE NORM IN SCOTTISH HOSPITALS, AS STAFF AND BED PRESSURES BECOME INTOLERABLE
The outgoing President of the Royal College of Physicians of Edinburgh (RCPE) has warned that coping strategies intended for crisis management are in danger of becoming the norm in Scottish hospitals, that the pressures experienced by some medical and nursing staff are becoming almost intolerable and that standards of acute medical care for patients in the NHS in Scotland risk falling behind those in England.
Dr Neil Dewhurst, who steps down as President of RCPE at the end of this week, said,
“There is much to be proud of in the NHS in Scotland and we are lucky to have a highly committed workforce which strives to provide high quality care for patients. However, in recent years a variety of pressures have built up in our hospitals which are now seriously impacting upon our ability to deliver the quality of care that patients require and should expect. Most recently, this was evident in the problems experienced in NHS Lanarkshire, but this could just as easily have happened in any other part of the UK. Reductions in the numbers of acute beds while medical admissions have continued to rise, in parallel with workforce shortages, have placed almost intolerable pressure on our doctors and nurses.
“In response to this situation, the NHS has had to deploy a series of coping strategies which were only ever intended as crisis management tools. These are in real danger of becoming accepted daily practice. Moving medically ill patients to other wards was only intended for times of severe pressure, such as during ward closures and outbreaks of norovirus or flu, but has become established practice in many Scottish hospitals on a year-round basis. We welcome the Scottish Government’s recent commitment to eliminating this discredited practice but “boarding” continues in our hospitals and efforts need to be accelerated to reduce it. In parallel, bed occupancy in Scottish hospitals now commonly exceeds 85% nationally. Evidence has shown that this is the maximum safe level at which we can treat patients and that it is essential to leave spare capacity within the system to cope with an increasing number of emergency admissions [1,2]. Above this level, the risk to patient safety also increases. Despite this, bed capacity of up to 124% was recorded in Scottish medical units last year. Personally, I believe it essential that we commit to the UK-wide adoption of a maximum ward capacity of 85%.
“Following the events in Lanarkshire, there is also a pressing need to implement more stringent standards for the quality of acute medical care provided to patients in Scotland. In late 2013 the NHS in England adopted 10 specific new standards of care in response to the events in Mid Staffordshire and to support the delivery of 7-day acute medical services [3]. The standards to be implemented in England over the next 5 years have the support of the medical profession and these could be adapted for use by the NHS in Scotland. We are not short of standards and the four clinical quality indicators from the Society for Acute Medicine would be a good starting point [4]. What is needed is national adoption of an agreed set of manageable standards to drive up the quality of care for medical patients. Without this the NHS in Scotland risks falling behind England.
“As a College, we shall continue to work with the Scottish Government and NHS Healthcare Improvement Scotland in developing standards for use in acute medicine in Scotland. Importantly we urgently need effective systems for measuring and monitoring their implementation in practice.
“I am a strong advocate of the NHS in Scotland and throughout the UK, and believe passionately that we owe it to patients to provide the highest quality of care that we can. This is why I believe that, collectively, we need to be honest about the challenges which we face, to step back from crisis management, to develop more sustainable strategies for managing hospital services and to improve the standards of acute medical care provided to patients. Our patients deserve nothing less”.
ENDS
Contact: Graeme McAlister on 07733-263453 or 07808-939395
Notes to Editors
[1] Dynamics of bed use in accommodating emergency admissions: stochastic simulation model, BMJ1999;319doi: http://dx.doi.org/10.1136/bmj.319.7203.155
[2] Shaping the Future NHS: Long Term Planning for Hospitals and Related Services, Consultation Document on the Findings of The National Beds Inquiry, Department of Health, 2000, http://www.nhshistory.net/nationalbeds.pdf
[3] NHS Services, Seven Days a Week: Clinical Standards, NHS England, December 2013. http://www.england.nhs.uk/wp-content/uploads/2013/12/brd-dec-13.pdf
[4] Clinical Quality Indicators for Acute Medical Units (AMUs), Society of Acute Medicine http://www.acutemedicine.org.uk/images/stories/pdf/clinical_quality_indicators_for_acute_medical_units_v18.pdf
