The accident and emergency unit at Victoria Hospital, Kirkcaldy, is soon to be downgraded to a minor injuries/illness unit at nights and at weekends due to staffing shortages.
Members of NHS Fife’s operational division committee gave the green light to plans to concentrate out-of-hours A&E services at Queen Margaret Hospital in Dunfermline at some point in the next few weeks, with the Vic’s A&E effectively becoming a minor injuries/illness unit from 8pm to 8am Monday to Fridays and on Saturdays and Sundays.
The arrangements mirror those put in place on several occasions last year after NHS Fife experienced a major headache in drawing up out-of-hours rotas at both the Vic and Queen Margaret largely caused by EU restrictions on working hours and problems finding locums to cover.
With gaps again expected to appear later this year, health chiefs have decided to switch out-of-hours A&E services to the Queen Margaret until the new wing at the Vic opens in January 2012 rather than implement the contingency plan on an ad hoc basis.
Around 85% of the emergency medicine attendances at the Vic are still expected to be dealt with by the minor illness/injuries service there, although those who present with more serious injuries will be taken the 13 miles along the A92 to be treated at the Queen Margaret.Normal day operationCommittee chairman Dave Stewart believes the decisive move, which is expected to come into force in the next few weeks, will remove any uncertainty patients and staff have about what is provided where and at what time. He also took great pains to stress the department at the Vic was not closing, with the A&E still operating as normal during the day.
“One of the problems that we had when we had to implement the contingency plans last year was that it always came as a surprise to people and there was this kind of shock reaction,” he said.
“That’s one of the reasons we won’t be implementing it immediately because we want to make sure the staff are in place, well aware of what they are doing, but more importantly we want to make sure the public are well aware of what we’re doing and why we’re doing it. The service isn’t closing and that’s the message that we need to get out.
“If someone turns up at the A&E at the Vic, there will be someone here to treat you, no matter what’s wrong with you, and depending on the severity of the injury you’ll either be dealt with or we’ll arrange transport to take them along to the Queen Margaret.”
The staffing situation has improved in recent months due to a fresh intake of trainees, but medical director Dr Gordon Birnie said the current situation was “safe but fragile” with a deterioration expected in the run-up to July as a number of trainees are due to leave the programme.
An option to continue with the status quo was dismissed by the committee, with members agreeing the intermittent use of the contingency had caused confusion and mixed messages for patients and staff.
A complete switch of all A&E services to the Queen Margaret was also ruled out after it was felt such a move could “overload” the Dunfermline site.
Mr Stewart accepted there was likely to be some political concern about the move but stressed the option selected provides the “safest set-up” for all concerned.
“As the chairman of the operational division, that’s all that counts for me, ensuring the safety of the patients in my charge, and that’s first, second, third and last,” he said. “That’s my priority and always will be, and at the end of the day the politicians have to recognise that we’ve done our very best and it’s only right that we choose the safest option.Clinical advice”Our clinicians are giving me this advice and telling me that this is the right way to go, and I’ll always accept my clinicians’ advice irrespective of what politicians might think because it’s my role to look after the safety of the patients.”
Operational division chief executive John Wilson stressed the change would only involve a small number of patients, with on average one person requiring transfer from the Vic to the Queen Margaret each time the contingency operated last year.
“We don’t want to wait until things fall apart and that’s why we had the contingency plan last year,” he said. “It (the contingency) did demonstrate that the number of patients who were affected by the change were in single figures on any given night and it has to be recognised that this is a small change during the night for a small number of patients.
“I think we’ve acted correctly in addressing what the concerns are.”
No date has been given for the changeover but Mr Stewart said the public should be given plenty of notice.