National solution needed for Scottish A&E problems
Fixing the staffing problems that caused a crisis in Fife accident and emergency services will require a national solution, a new report by the country's public spending watchdog has claimed.
- By Stefan Morkis
- Published in the Courier : 12.08.10
- Published online : 12.08.10 @ 12.50pm
The Audit Scotland report on emergency care in Scotland calls on the Scottish Government to provide a clearer strategic direction for A&E departments, which are facing increasing pressure on their services because of a 9% rise in attendances and costs over the last decade.
Although the report, Emergency Departments, says overall patient satisfaction with services is overwhelmingly high, there is a widespread variation in the services on offer and confusion over where best to treat patients.
Last year there were 1.4 million attendances at Scotland's 30 emergency departments and 59 minor injury units, at a cost of £148 million.
Although the report acknowledges medical staffing in A&E departments has increased by 2% since 2007, the European Working Time Directive and the consultant contract have reduced the number of available hours for staff.
The report states, "There is a need for a strategic Scotland-wide approach to emergency care as there are emerging staffing difficulties that cannot be resolved solely at a local lever.
"NHS boards need central guidance on best practice to support their planning of clinical staff in emergency levels."
Although staffing levels are planned centrally in England, the report warned this will not be so easy to replicate north of the border because of the lower number of attendances and the country's geography.
Auditor general Robert Black said, "Emergency care is a vital part of the health service in Scotland and more people are attending these services.
"Patients are happy with the care they receive and the length of time they wait to be treated has been reduced with the introduction of a four-hour target — however, information about the quality and effectiveness of care provided is limited."
Emerging issues
He added, "The services available for vulnerable groups, including people with a mental health problem, vary across Scotland.
"There are also emerging staffing issues, such as shortages of junior doctors and the impact of the European working hours legislation, that must be tackled at a national level, not just locally.
"All of these factors highlight that there is a real need for a clear, national approach to emergency care so that we can get the best out of the resources available."
The report also calls for closer working across the health and social care system, but warns some patients are admitted to hospital just to avoid breaching the four-hour waiting times target.
Dr Brian Keighley, chairman of the British Medical Association in Scotland, said bad planning is to blame for the staffing crisis in the NHS.
He said, "I am pleased that levels of patient satisfaction for those attending emergency departments is high — that is a tribute to the hard work and dedication of the staff working in these services, often in challenging situations.
"There is no evidence quoted in the report to suggest that the new consultant contract, introduced in 2004, has had any bearing on workforce availability.
"Our own surveys report that the majority of consultants work an average of 48 hours per week and that the hours they spend directly caring for patients have not changed since transferring to the new contract."
He added, "The NHS had more than 10 years to prepare for the implementation of the working time regulations and it is a failure to effectively plan for changing working patterns that is the problem.
"There is also a reluctance to make difficult decisions on health service reconfiguration, and it may be that in some cases consideration will have to be given to service redesign for emergency departments in parts of Scotland, to ensure that services are fully staffed and safe for patients."
Waiting times
The Royal College of Nursing (RCN) said waiting times targets must be adjusted to ease the pressure on accident and emergency departments.
RCN Scotland director Theresa Fyffe, said, "The RCN is calling for a more realistic target of 95% of patients being seen within four hours rather than the current 98%.
"This would give A&E staff the flexibility and time to deliver the personalised, quality care patients deserve."
She added, "Health boards must listen to the concerns of nurses and other staff who work in emergency departments, and must collect proper data about the daily operation of emergency departments — such as the treatments that patients require, the level of care that they need and the frequency of readmissions.
"Only then can health boards actually ensure that appropriately skilled staff are available, and costs may be reduced as a consequence.
"While this report highlights some huge areas of progress, it is extremely important that as the NHS begins to tighten its belt, the skills of staff are better utilised and waste resulting from inappropriate self-referrals is minimised."
Health secretary Nicola Sturgeon said, "We are already taking action to address the issues raised by Audit Scotland.
"We've issued guidance and funded advisers to help NHS boards work within the European Working Time Regulations by implementing robust, sustainable services and rotas.
"The report highlights that there has been an increase in medical and nurse staffing in emergency departments since 2007."
She added, "We have also invested significantly in new ways of working, and the development of new and extended clinical and non-clinical roles which have helped to free up medical staff time and provide safe and stable cover within clinical areas.
"The creation of nurse banks has provided a real benefit, and the Scottish Government is working with employers and the BMA to explore the option of 'doctor banks' to manage the demand for temporary staff."
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