THE NHS in Scotland is on its knees, according to one of the country’s top doctors.
Martin McKechnie warned that there there are serious concerns across the board.
He said a major shake-up of services both in and out of hospitals is needed.
McKechnie, who is vice president (Scotland) of the Royal College of Emergency Medicine, pinpointed a wide range of problems which have to be addressed. They include:
● A shortage of space which means staff have to carry out consultations with patients in cupboards.
● Traditional winter pressures are now affecting A&E all year round.
● A “brain drain” of disaffected highly-trained staff to other countries means shortages in Scotland.
McKechnie praised hard-pressed staff for performing “heroics every day”. But he said more action is needed to prevent the NHS facing breaking point for a decade to come.
He said: “We are doing the damn best we can. But it is awful for patients and families and awful for staff.”
McKechnie said a lot of attention has been given to problems in A&E units because that’s the first port of call for many people coming to hospital.
He claimed patients get stacked up in casualty units because of shortages elsewhere.
McKechnie said: “It is a hospital and medical service crisis.
“A&E is at the sharp end because everyone is coming to this area.
“Because of a mismatch between demand and capacity, it backs up into our department because we can’t stop people coming.”
McKechnie added: “There is no big magic wand to wave imminently.
“But four things need to be addressed – a better integration of services, safe and sustainable staffing of emergency departments, a better working environment and a better use of the money that already exists in the health service.
“What some of our patients need is improved access to GP and medical, dental or social care.
“But these services are in not-as-easily-accessible supply as they could be, so they come to A & E.
“We reckon between six and 15 per cent of patients coming to emergency departments could be seen by another health care provider like nurse practitioner services and minor injury-type units.
“We need to provide a better core (GP) element. If that’s not available outwith 8-6 Monday to Friday, patients tend to come to emergency for care.
“There needs to be a bit of a debate and discussion between Government and GPs and hospitals and social care.
“Getting rapid change in how these services are provided needs resources.”
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McKechnie said the simple explanation for failing waiting times in hospitals is “exit block” – the inability to move patients on.
He added: “Older people come into hospital and may need ongoing care while they are waiting to go into a ward.
“The flow into a ward and out is what we are aiming for, but that is delayed because of delayed discharge into social care.
“A lot of people are living a lot longer, which is great, but older people tend to have morbidity problems – perhaps heart, kidneys and diabetes. So when they get ill, they get really unwell.
“We have patients backing up and on trolleys along corridors because an old person, who needs ongoing care while we wait for a bed in a ward, is in a cubicle for hours.
“The minor injury stuff, the
walking wounded, we can see quickly if there is a place to see them. I could see 10 patients in an hour in a cubicle, but I can’t because there is a patient waiting in there for a bed.
“We are seeing patients in cupboards and offices. It is appalling.
“The fact we are reaching 89 per cent (of target times) is still pretty amazing in these circumstances. But one per cent of one million is still a lot of patients not receiving care in this time. We could and should be able to deal with these people in good time.”
McKechnie added: “People don’t stop coming. It used to be a winter phenomenon but now it’s all year round. They see a light is on and they need to be seen.”
A problem with brain drain means there is a lack of specialists in emergency medicine.
McKechnie said: “It is difficult to retain people because it is hard work and people do not think it is a sustainable career.
“We need to keep these people but we need to improve the working conditions – and by that I mean the working environment.
“Quite a lot of doctors who are trained by the UK taxpayer after a while go abroad – a lot of them to Australia – and then come back after a few years. But increasing numbers are not coming back.
“We know there are 450 UK and Ireland graduate emergency registrars in the Australian state of Victoria alone. If they were back here working, a lot of our difficulties would lessen.”
McKechnie said conditions have improved – but not enough.
He added: “We were pretty much at death’s door three years ago. But what the SNP Government have done, to their credit, is help us with the number of consultants, which has gone from 120 to 190.
“Our aim is to get 230 so every department in Scotland provides a 24-hour, 365-days-a- year service. People don’t just get ill depending on the time of day.
“That is what we think would be a safe and sizeable resource for the current health care demands.
“Because of the problem in retaining registrar middle-ground doctors, consultants not only do a consultant’s job but a middle-ground job as well.
“But it will take 10-12 years to reinvigorate the levels. We will have to go through two cycles of recruitment to bolster that because it takes six years to train a doctor.”
McKechnie said a set-up where other health workers are based alongside casualty staff would improve working conditions in A&E.
He added: “Some people come to hospital emergency departments thinking a child has meningitis, but it is actually an ear infection.
“Instead of coming to A&E, they would see a triage nurse and if there is a GP co-location right next door, you could go through a door and be sent one way or another so you would be seen by the right type of doctor or nurse for your condition.
“The Royal College of Emergency Medicine would never blame a patient for coming to A&E when a GP would suffice because they don’t know what is wrong with them. That’s why they come to see us.”
McKechnie said NHS cash should be used more efficiently.
He said: “There is a lot of money in the health service but it just needs to be used a bit better. We don’t have enough substitute training posts but we are spending £80million a year on locums.
“Staffing hasn’t ever in my lifetime been up to what is required.
“But staff need to have acknowledged that they are doing pretty heroic stuff every day.
“I personally believe A&E should have fish tanks and reclining chairs and waiter service.
“Ideally, people will get straight to a ward quickly. But if they have to wait, they shouldn’t have to wait in squalor.
“Everyone I know is working their damnedest. Nurses need support because they are trying their best.
“Yes, sometimes we get it wrong. But given the conditions, it is incredible how often we get it right.”