Doctors and nurses under 'almost intolerable pressure'
- 25 February 2014
- From the section Scotland
Doctors and nurses are being placed under "almost intolerable pressure", a leading medic has warned.
Dr Neil Dewhurst said this was due to cuts in hospital beds, growing admissions and staff shortages.
The outgoing president of the Royal College of Physicians of Edinburgh called for an agreed set of manageable standards to be adopted nationally.
Health Secretary Alex Neil said there were pressures on the NHS but it was not all "doom and gloom".
Dr Dewhurst's comments came as the Scottish government released its latest series of health statistics, which covered areas including waiting times, staff levels, drug and alcohol treatment and bed blocking.
The figures, published by the Information Services Division (ISD) of NHS Scotland, suggested that:
- The number of cases of "bed blocking" - where patients cannot be discharged from hospital after their treatment has been completed - has risen. In January this year, there were 254 people still in hospital four weeks after they could have been discharged - about 50% more than in January 2013.
- Fewer patients are spending long periods in hospital accident and emergency departments. The government has demanded 98% of all patients are treated within four hours of arriving in A&E. In December 2013 the figure was 93.5%, an increase on the 90.3% recorded the previous year.
- Across Scotland the NHS has met the waiting times target of treating patients within 18 weeks of referral. In December 2013, 90.8% of patients were treated within the target.
- The number of people being treated in Scottish hospitals for alcohol-related problems has continued to fall. In the year to March 2013 almost 36,000 people were treated.
- More than 4,400 people were admitted to hospital in Scotland last year diagnosed with drug misuse - a fall on the previous year. Three-quarters of them were in their early 30s and had overdosed on heroin or methadone. Patients in their eary 20s were most likely to have suffered symptoms relating to cocaine use.
- The NHS workforce is increasing. At the end of 2013, the health service employed more than 158,000 people - without taking into account GP and dental practices. The figure was up 1.5% on the previous year.
Dr Dewhurst, who stands down as RCPE president later this week, claimed the number of hospital beds being occupied now "commonly exceeds" what is regarded as the maximum safe level.
He said occupancy rates in some areas had reached as high as 124% last year.
He said it was "essential" for the health service to commit to having a maximum occupancy rate of 85%.
The consultant cardiologist went on to call for the introduction of "more stringent standards" for the quality of care, as happened south of the border following the problems identified in Mid Staffordshire.
While Dr Dewhurst stressed there was "much to be proud of in the NHS in Scotland", he added that 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".
Dr Dewhurst said problems in the health service had most recently been seen in NHS Lanarkshire - which was last year told a range of improvements must be made at three hospitals following a review into patient safety prompted by higher than average mortality rates.
But he said these problems "could just as easily have happened" elsewhere.
Dr Dewhurst said: "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."
Dr Dewhurst said the practice of moving patients between wards because of overcrowding - known as boarding - was "only intended for times of severe pressure, such as during ward closures and outbreaks of norovirus or flu".
But he said this had now become "established practice in many Scottish hospitals on a year-round basis".
While he welcomed a recent pledge from the Scottish government to end this "discredited practice", Dr Dewhurst said efforts to do this must be stepped up.
"Boarding continues in our hospitals and efforts need to be accelerated to reduce it," he said.
He warned that the occupancy rate for hospital beds in Scotland "now commonly exceeds 85% nationally", with Dr Dewhurst saying evidence had shown this was "the maximum safe level at which we can treat patients".
He said: "Above this level, the risk to patient safety also increases.
"Despite this, bed capacity of up to 124% was recorded in some 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%."
He pointed out that in late 2013 the NHS in England had adopted 10 specific new standards of care in response to the events in Mid Staffordshire and to support the delivery of seven-day acute medical services.
"The standards to be implemented in England over the next five years have the support of the medical profession and these could be adapted for use by the NHS in Scotland," he said.
"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."
He added: "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."
Speaking on BBC Radio's Good Morning Scotland programme, Scottish Health Secretary Alex Neil said: "I'd be the last person to deny there are pressures in the National Health Service but it's not all the doom and gloom that's being painted.
"For example, Neil Dewhurst said the number of beds have been cut. That's not true.
"Over the last year we have increased the number of beds in the NHS by over 400. We have the highest ratio of beds to patients in the UK.
"We are investing in additional capacity, additional staff, additional beds and additional support for frontline staff."
Addressing the issue of boarding, Mr Neil said: "Across the whole system there are fewer than 10% of patients who will be boarded and we are trying to reduce that significantly."
He said the NHS Lanarkshire report had shown that up to 30% of the hospital patients did not need to be there.
"One of the ways we are tackling this is by trying in future to make sure that people who do not need to be in hospital are not admitted or referred to hospital," he said.