We’ll pull together
NHS’S Dr Iain Wallace on the crisis in our A&ES
Dr Iain Wallace has this week answered questions on the crisis currently affecting the county’s three acute hospitals.
Staff have been pushed to the limit as A&E departments have been inundated with patients, non-urgent procedures were postponed and waiting times targets have been missed.
The Advertiser put a number of questions to Dr Wallace, NHS Lanarkshire medical director.
He reflects on events of the past few weeks and looks at what lessons can be learned for the future.
As a health board, what do you believe was at the root of the problems which have been experienced?
We, like every health board across Scotland and indeed the UK, have been challenged by the high number of very ill patients that we have seen.
Quite a lot of it is influenza but there is also adult Respiratory Syncytial Virus (RSV) and usual winter vomiting bugs, but mainly a lot of respiratory problems affecting more elderly people.
We have got the influenza vaccination ongoing and that is protective of some types of virus but not all. There was an increase in activity just before Christmas and East Kilbride was particularly affected by ice, so we saw quite a bit of pressure at Hairmyres just from people fracturing bones from slips, trips and falls.
Do you think the contingency plans in place for increased demand due to seasonal illness/injury were enough to meet demand for services?
We have a winter plan in place every year and we develop it and update it. We do have additional beds in place in hospitals over the winter, additional GP hours and we also step down our surgical activity, mainly routine surgical operations.
Apart from emergency operations, we obviously protect people with suspected cancer.
All of that had been put in place but because we faced a bigger challenge with the exceptional rise of activity over the festive period, we did open more additional beds to cope with that.
Over the last week we have managed to reduce these extra beds as we haven’t required them, but it’s a fluctuating thing and we just have to manage these peaks and troughs in demand as and when they occur.
Is there a funding issue/crisis at NHS Lanarkshire?
We are hoping to break even this year. Obviously additional funding is always welcome but, when it comes to dealing with pressure in the system, I wouldn’t call it a crisis.
Funding isn’t the first issue to look at, as we will continue to spend the money that is required to make sure that the service continues and patients are safe. The issues have not been caused by a lack of resource.
What is your message to patients who had their non-urgent procedures postponed?
We will work very hard to try and allocate patients their next appointment for surgery, and out-patients, as soon as we can. We obviously regret any cancellations that were incurred.
Why were backroom staff needed to take on jobs in the clinical environment?
When demand was as high as it was, people are thinking what can they do to help instead of office jobs and every little does help. We had a meeting and following that, got 130 volunteers to go out and help. Some folk were doing‘bed busting’which is cleaning of mattresses, etc. It was more about taking the pressure off. The staff who did it enjoyed doing something very practical and would certainly be willing to do that again, if necessary. It’s a good news story of everyone pulling together. Are there issues with staffing levels which could have contributed to problems and what is the health board doing to try and attract/retain staff? There are challenges affecting a lot of boards. We have got gaps in general and acute medicine, emergency department trainees are short on the ground and in other areas such as GPS and nursing staff.
We have had adverts showing the benefits of coming to work in Lanarkshire. We recently agreed partnership arrangements with two universities, Glasgow Caledonian and the University of West of Scotland.
Through that we have more students hopefully coming to work in Lanarkshire and when they come and get trained here, we know often people will stay.
More research at the cutting edge of new innovation helps with staff recruitment and retention but clearly the biggest thing is to have full staffing as where there are gaps, that can cause stress for people. We are trying our very best to fill all the vacancies we have and will continue to monitor that.
The measure of GPS opening on Saturday mornings in January, is this something which could become a permanent move?
We have plans to support general practice. GPS have been under strain for quite some time just with demand increasing and the number of GPS not rising.
But there are other practitioners that can take over some of the jobs undertaken by GPS. We have community pharmacists and pharmacists within practices. We have advanced nursing practitioners and we hope to train up more people to support general practice.
While the public would like that to happen on a more permanent basis [Saturday morning opening], with the particular pressures at the moment, I suspect that is not likely. We are working to try and expand what we can offer in primary care.
What have been the challenges at each acute hospital and how do you feel each individual site has performed?
Each site is different and are specialists or centres of excellence. In Wishaw we have neo-natal and maternity services, Monklands has renal and MAT oncology and Hairmyres has vascular surgery and intervention radiology for example.
The catchment areas are different and certainly there is a larger elderly population in Hairmyres catchment and also its proximity to Glasgow has seen an increase in the number of attendances.
That is not the case at the other two sites. They have all had their challenges but we work as a system of three hospitals so we have conference calls between the sites and discuss where pressures are greatest from one day to the next and we can divert demand accordingly if one site is busier than the other.
We try and manage it is a whole system of three hospitals and deal with peaks and troughs through that.
Hairmyres is still performing below the other acute hospitals in terms of waiting times for A&E. What are the specific reasons for this?
It does have a different catchment area so it has probably been hit more than the other sites by older people affected by the respiratory virus, who then have a longer recovery period.
It does have a smaller bed base than the other two hospitals historically and that is partly down to the increased activity coming from the neighbouring area in south Glasgow.
We have also got some key vacancies that are needing filled in terms of position numbers and are looking to put additional consultant positions into Hairmyres.
The thing about the four-hour standard performance is that, while it is important, it’s a quality marker – probably the biggest quality marker we look at is the hospital standardised mortality ratio.
That measures the overall safety in the system and Hairmyres is slightly below the Scottish average which is good and has seen a larger reduction than the Scottish average as well over last few years. That shows the hospital is performing well in terms of patient safety.
Ambulances were spotted on two occasions queuing outside Hairmyres. What were the reasons leading to this and could they have been prevented?
A&E has been very busy because of what we call acuity of illness of patients. Moving patients through A&E if quite seriously ill when arriving, we need time to manage putting in drips, central lines and getting x-rays done.
There can be times at peak demand where ambulances don’t offload patients quite as quickly as they may otherwise do. We have had, I’m sure, days where transfers might be slower than we would expect but generally the focus is moving patients out of the emergency department to the hospital if they require to be admitted.
If you don’t move people home or to community care or care in nursing homes, that’s when hospitals can slow admissions at the‘front door’. We have been working really hard with the local authority to make sure patients are ready for discharge and can go home as soon as they can.
Will there be a review of the last few weeks and what lessons can be learned?
Very much so. We are capturing information from staff about things that worked well, things that could have worked better and we will always review that before we do our plan for next winter. There are always lessons to be had in these situations.
What tribute would you like to pay to NHS staff?
I really feel very passionately about our staff who have pulled out all the stops; people have come in from holidays to help. I would like to thank all the staff for their hard work.
They have worked extremely hard since before Christmas, making sure patients get the treatment and care they require and I am proud of how staff have worked together, also with local authority and social work staff too, in order to do all we could for patients at this challenging time.
Our staff have pulled out all the stops; people have come in from holidays to help...