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A&E On High Risk


A major staffing crisis has forced a health board to place several of their services – including casualty treatment - at “high risk”.

In NHS Lanarkshire there are 129 vacant posts at consultant, specialist and junior doctor level. About half are filled by locums – leaving 65 posts empty.

Politicians and campaigners for patients voiced their concern at the move and called for action.

From accident and emergency and general surgery to medicine/care of the elderly, orthopaedics and urology, there are concerns there are not enough consultants, specialists and junior doctors to cope with the demand in NHS Lanarkshire.

And where the health board do not consider specialisms at high risk, in all but a handful of services they do consider them to be a medium risk.

Now, in a report to the board on medical staffing, the NHS trust have admitted there are real problems.

A&E at Monklands and Hairmyres is considered high risk with Wishaw labelled “very high risk”.

In the most recent weekly A&E figures, NHS Lanarkshire were the second worst performing health board, with only 91.4 per cent of patients seen within four hours. Only NHS Shetland were worse.

The health board also had the highest number of patients waiting more than eight hours and were the only one where anyone waited longer than 12 hours. Three patients in the last week waited more than 12 hours at Hairmyres.

The medicine/care of the elderly at all three is also high risk as is general surgery at Hairmyres and Monklands. Wishaw’s general surgery is medium risk.

Orthopaedics in all three are high risk as is urology at Monklands. Anaesthetics, ENT, dermatology, neonatal, paediatrics, sex and reproductive health, and family planning and psychiatry are all medium risk.

MSP Margaret McCulloch has written to health Secretary Shona Robison over the “severity of the medical staffing crisis”. She said: “There are serious problems with staff recruitment and over-reliance on locums which is an on-going and escalating risk to services in the communities I represent.

“NHS Lanarkshire graded the staffing position in a number of specialisms at Monklands, Wishaw and Hairmyres hospitals as ‘high risk’. Staffing in emergency medicine at Hairmyres and Monklands has been assessed as high risk for some time and now, for the first time I’m aware of, staffing at Wishaw A&E has been ranked ‘very high risk’.

“There continue to be vacancies at consultant level in all of Lanarkshire’s A&E departments – a long-standing problem which partially explains slow progress towards the four-hour waiting time standard.”

And she insisted that even at full strength, staffing levels in specialisms such as orthopaedics are failing to meet the needs of the service. She said: “In other specialisms, risk levels have been upgraded because of absences, vacancies and the high number of locum staff.”

The MSP urged Robison to take “immediate action” to resolve the crisis.

Scottish Patients Association chief executive Dr Jean Turner said: “These are all major specialisms and, with an ageing popuation, there will be an even greater demand for these services.

“It is clear we’ve not been trying to recruit and retain medical staff.

“We should have been doing something about this years ago because it takes so long to train doctors and surgeons and even longer to become a specialist.

“People are not wanting to stay in medicine or go abroad after training because of the conditions they find themselves working in and that makes me a bit upset.

“In my day, people wanted to do the job even though conditions were not good. The work/life balance is not good. People have to get holidays and time for training and time to go off sick which puts a strain on other doctors.

“We have not had enough slack in the system for years.”

Turner said she does not believe Lanarkshire NHS are the only health board who were suffering this kind of crisis. She added: “ I believe there will be a certain degree of this throughout Scotland.”

Labour public services spokesman Richard Simpson said: “This is one of the biggest health boards in the country saying they are facing a staffing crisis. The Government need to get their act together.

“This admission from the health board shows ministers boasting about extra staffing is a load of hot air. They are barely meeting requirements.

“There seems to be a total lack of joined-up thinking in workforce planning. This is a warning the SNP need to take seriously, and fix, before winter bites.”

BMA consultants committee chairwoman Dr Nikki Thompson said: “This is a clear demonstration of significant problems caused by shortages of doctors.

“More and more often, doctors are having to cover gaps where vacancies go unfilled, increasing the strain on the health service even further.

“We need to make medical jobs in Scotland attractive, so that we have the staff to deliver the high standards of care that patients rightly expect.”

NHS Lanarkshire acute divisional medical director Dr Jane Burns said: “In the last few months we have been successful in recruiting consultants in areas including paediatrics, orthopaedics, anaesthetics, ophthalmology, care of the elderly, acute medicine, general surgery, breast surgery, urology and rheumatology. Some individuals have still to start in post.

“Where vacancies remain, medical and managerial staff work closely to manage periods of peak activity in our hospitals and to fill any gaps to ensure we have the right combination of medical staff.”

The Scottish Government said the number of A&E consultants had almost trebled under the SNP, while overall NHS Lanarkshire staffing has gone up by more than 1000, an increase of 12.8 per cent.

They added: “NHS Lanarkshire have assured us that safe and sustainable services will be maintained.”