Threat to accident and emergency cover at Victoria Hospital
Kirkcaldy's Victoria Hospital could be without accident and emergency cover overnight and at weekends over the next year.
Victoria Hospital.
- By Craig Smith
- Published in the Courier : 18.11.10
- Published online : 18.11.10 @ 04.37pm
NHS Fife's operational divisional committee heard on Wednesday how staffing shortages which saw the hospital's A&E department downgraded to a minor illness unit on several occasions this year are likely to rear their head again in the coming months — prompting the board to draw up options to deal with the situation until its new wing opens in January 2012.
While no decision has yet been taken, The Courier understands the favoured option is to repeat the contingency plans from this year on a fixed rather than intermittent basis, meaning full emergency services are likely to be offered at Queen Margaret, Dunfermline, 24/7 and at the Vic only during the day.
A minor illness/injuries unit would therefore again operate at the Vic between 8pm and 8am Monday to Friday and at weekends, with more serious cases taken to Dunfermline.
The possibility of prolonged action follows a 23-day period this year when the contingency plans were put in place, sparking anger from many politicians who felt patient safety could be put at risk.
However, medical director Dr Gordon Birnie said the contingency had "little impact" on patient activity, highlighting the need to ensure the "clinical safety and stability" of services before the planned integrated A&E service begins at the Vic's new build.
Although stressing the staff position is currently "stable" after an August intake of junior doctors, he warned there was every likelihood that more gaps would appear in rotas due to illness, maternity leave and progression into consultant posts.
Dr Birnie said, "In other words, the type of gap which required the operation of the contingency plan in 2010 could re-appear at any time."
He said that "quite dramatic" falls in trainees were difficult to predict, although the expectation is that a contingency will have to be in place from early 2011 for patient safety.
That is partly due to "insufficient" numbers of middle grade staff, as junior staff are not qualified to run a service out of hours unsupervised.
Dr Birnie said, "Since August 2010 one more gap has already appeared in the middle grade emergency medicine rota and one in the middle grade medical rota due to the progression of trainees through their programmes.
Deteriorating
"Trainees who leave in-year are not replaced and therefore the situation is always a deteriorating one."
He added, "When gaps appear then the requirement for locum cover will increase and if supply fails then the only option to maintain safe clinical services will be the operation of the contingency plan."
Three options are being considered — either the status quo will remain with intermittent contingency operation, a full reconfiguration of A&E services to Queen Margaret or a partial reconfiguration with see out-of-hours A&E provided solely in Dunfermline.
The latter has received strong support according to Dr Birnie, who suggested the ad hoc use of contingency leads to "mixed and confusing" messages to the public and increases clinical risk.
Whichever option is chosen, elected board member John Winton urged health chiefs to ensure the public is well informed.
"The open-then-shut situation left the public not knowing what's going on," he said, suggesting more permanence was needed.
"It's far better to bite the bullet so everybody knows where they stand."
A review of the contingency plans suggested 85% of the expected emergency medicine attendances at the Vic were still dealt with by the minor injuries service, while just one patient on average had to be transferred to Dunfermline each time the contingency operated.
The average number of patients with east Fife addresses admitted to Queen Margaret on the nights of the contingency was 3.5, although it ranged from none to eight.
It was stressed that, for now, emergency and acute medicine will be delivered in both Kirkcaldy and Dunfermline 24 hours a day, seven days a week.
NHS Fife is not alone in the problems it faces as European working time regulations and changes in clinical practice have led to increasing specialisation, while legislation has cut the recruitment of locums from abroad.
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