Medical chief to visit Ninewells over waiting times claims
The chief medical officer is to visit Dundee's Ninewells Hospital after whistleblowers claimed that surgeons are prevented from seeing A&E patients to speed up waiting times.
The doctor at Dundee's Ninewells Hospital told BBC Scotland that surgical teams were barred from seeing patients to manipulate figures.
And a second whistleblower said the system was putting patients at risk.
NHS Tayside said patient safety was its "overriding priority".
The issue was raised during a health debate in the Scottish Parliament, after Scottish Labour and the Conservatives had each called for an immediate government investigation into the "very serious allegations".
Health Secretary Shona Robison said the Scottish government had been assured by NHS Tayside "that their ways of working are effective and safe", but said she had asked the chief medical officer to visit Ninewells and speak to staff.
For several years, NHS Tayside has boasted the lowest accident and emergency waits in Scotland, with 99% of patients treated in four hours.
However the whistleblowers, who want to remain anonymous, said surgical teams were being bullied and prevented from seeing potentially seriously ill patients in order to manipulate the figures.
One doctor, a member of the general surgical team at Ninewells Hospital, said patients were not allowed to be assessed by surgeons until they were moved to the surgical department. This, they claimed, is so hospital managers could tick a box saying the patient had been discharged from accident and emergency, and the waiting time 'clock' stops.
"On paper, it would seem that the patient was in the A&E department for a short time," the doctor told BBC Scotland.
"The surgical service is often actively barred from assessing sometimes critically ill patients in A&E, as this would increase the time spent by the patient in A&E.
"Patients presenting to A&E with abdominal pain - the bulk of surgical patients - are not treated there in any way. They are quickly seen by a junior doctor, who then discusses the case with a consultant.
"The patient is then referred to the surgical ward where actual assessment, investigations and treatment takes place."
It is claimed surgical specialists are not allowed to order blood or imaging tests on the patient in the emergency department, as they would normally do, in case this causes delays.
This is despite the fact that the department which carries out the imaging tests is next to A&E, and patients often have to be transported back again.
A second doctor told BBC Scotland that they had been physically prevented by consultants from going to A&E.
The doctor said some critically unwell patients had been sent up to the surgical ward, which is not the appropriate place to care for them.
The doctor added: "Ward 15 is basically the dumping ground for accident and emergency patients, where they are left to languish and the doctors on Ward 15 have to pick up the pieces.
"I have worked in other hospitals and I have never experienced emergency care which is so aggressive in terms of getting patients out of the department."
The doctor also said there was an "utter fixation to the four hour target, sometimes to the detriment of the patient."
Across Scotland, the NHS is still not meeting the Scottish government's interim target for 95% of people to be treated and discharged within four hours. The last figures, published on Tuesday, suggested that 93% of people were seen and treated within this time frame.
Staff at NHS Tayside raised the alleged manipulation of waiting time figures with the General Medical Council (GMC) last year.
The GMC is carrying out visits to hospitals following a rise in the number of trainee doctors reporting bullying or undermining.
A report of a visit to Ninewells in October stated: "We heard from all groups that we met that there may be issues with interaction with other departments such as emergency medicine. We also heard that doctors in training feel unable to attend the emergency medicine department unless they are explicitly asked to do so by staff in that department.
"Additionally when they do attend we heard examples of when they were undermined and/or bullied."
It was raised again earlier this year, this time in a report on the quality of surgical training at the hospital by NHS Education.
Dr Alan Cook, NHS Tayside's medical director for the operation unit, said the Ninewells emergency department "operates a safe and clinically appropriate model" which has been in place since 1998.
He said: "There is absolutely no truth in the claim that surgical teams are prevented from assessing patients in the emergency department to have a positive effect on waiting times.
"Anyone who comes to the emergency department is reviewed by a senior clinician. This senior decision-maker is, in the vast majority of cases, an accident and emergency consultant who is the best person to make decisions about the patient in the first instance.
"No consultants or surgeons are banned from the emergency department as is claimed, and senior clinicians from all specialties are encouraged to attend if this would benefit the immediate management of patients."
Scottish Labour health spokeswoman Jenny Marra led a Holyrood debate on the health service, in which she highlighted the Ninewells case and called for a discussion about changing the way targets work to encourage positive behaviour.
She said: "I would expect the Health Secretary to establish an immediate investigation into these claims in order to restore confidence.
"We believe there is a place for targets in driving up standards and maintaining accountability for performance within our health service, but without adequate resources we cannot allow targets to drive perverse behaviours.
"I would support the Cabinet Secretary in looking to revise targets so they are smarter, more sophisticated and drive the right behaviour, and that should be part of the debate we have on the future of the NHS."
Ms Robison replied that she had asked chief medical officer Dr Catherine Calderwood to visit Ninewells on Monday to investigate the claims about waiting times.
She said patient safety was "absolutely key", and said she wanted to make sure the concerns raised were investigated.
She said: "When any concerns are raised with me I always want to make sure that we have asked all of the questions and that we have seen for ourselves, so that is why I have asked the chief medical officer to visit Ninewells on Monday and to see for herself, to investigate, to ask questions and speak to staff and report back to me.
"I think we have to be very careful here in making sure that one of our best-performing emergency departments in the country is not undermined.
"It is important to put on record that patient safety is not affected by any of these concerns because I think that patient safety is absolutely the key to what they do in that fantastic hospital."