Fife’s clinical director for emergency care has admitted the region’s A&E departments have a challenging year ahead but firmly believes that the changes agreed will represent the safest option for patients.
During an interview with The Courier, Dr Robert Cargill confirmed staff have been put under immense pressure in recent months because of shortages and that the problem is not just confined to Fife but extends to hospitals across Scotland.
However, he hopes the move to a minor injuries unit at Victoria Hospital in Kirkcaldy overnight and at weekends will relieve some of that pressure as well as giving the public clarity about what is provided where for a more prolonged period of time.
Dr Cargill said both Victoria Hospital and Queen Margaret Hospital in Dunfermline sees between 100 and 150 patients in a 24-hour period, although a significant proportion of those between 80% and 85% have what are classed as minor injuries.
He said, “The staff feel under pressure for two reasons and one is the volume of patients coming in, particularly when there is an unpredictable surge of patient numbers that can be the weather, the flu, that sort of thing.
“The other is the uncertainty when we’ve had to close the A&E department at Kirkcaldy at short notice, which led to higher attendances at the Queen Margaret you are less well prepared for. You can deal with anything except uncertainty so at least this gives us a degree of certainty about what’s available on each site at what time.
“The last contingency was helpful and it showed this model could work. It is much preferable than deciding on Monday ‘this is what we’re going to have to do this weekend.’
“The staff are uncertain, the public are uncertain, so if we can get a degree of certainty up front it will be beneficial in terms of who we need on the ground to receive certain categories of patients.
“Staff will still be doing the same job but they’ll be doing it, I hope, in an environment where they are better supported, in an environment where the public know what to expect and I hope that they’re able to do the job better and enjoy the job they are doing.”
Dr Cargill accepts there is some degree of controversy around the move, with critics of the measure suggesting the safety of patients living in central or east Fife could be put at risk due to the extra journey time involved.
He maintained, “I think what we’re doing is the safest option.
“There is an option to leave services unchanged but that leaves us exposed to the difficulties we’ve had over the last year, trying to keep two departments adequately staffed and manage the volume and seriousness of the patients who come in to each site.
“I think all aspects of medicine include risks of some sort or other, and minimising risks is what we’re in the business of doing, whether it’s by configuring services or configuring a hospital. It’s all about trying to make healthcare safer for patients. I think people want a good local hospital and they also want access to the best services they can get for what they need at that time.
“I also get a feel from the frontline teams that patients in general are appreciative of good healthcare and where that’s delivered is probably secondary to that experience of healthcare.”
Dr Cargill believes that the biggest challenge facing A&E is adequately staffing both departments.
“We started building the new wing at Victoria partly to anticipate the challenges with staffing coming down the line for some years but they are being compounded just now by some posts being unfilled and we anticipate a number of further unfilled posts in the next few months making it extremely difficult to staff two departments,” he said.
“It is a national problem, particularly with trainee doctor numbers, and that is the legacy of a number of policy changes and the Working Time Directive as well which limited the available hours for medical staff.
“There are some long-term sickness and other leave issues that are predictable but do inevitably leave us short, and then it just needs an unpredictable or short notice absence for various reasons to put the pressure on.”
As for who is to blame for the national problems in relation to staffing, Dr Cargill reckons it is not about apportioning blame.
“I think a lot of the changes that have been made have been made for good reason protecting the employees, trying to balance the number of doctors in training with the number of posts available. I think those have been done with good intentions but in terms of blame, the challenges we face are the challenges that every healthcare system has to rise to.
“This particular one has a challenge with staffing, we’ve got the challenges coming with an ageing population, we’ve had the challenge this week because of swine flu, and next week it’ll be something else.
“I think it will be a challenging year but moving to a minor injuries unit overnight gives us a good opportunity to test how things are going to work, but I don’t doubt there will be some challenges ahead.”