The outgoing president of the Royal College of Physicians of Edinburgh (RCPE) has warned that coping strategies intended for crisis management are in danger of becoming the norm in Scottish hospitals:
A variety of pressures have built up in our hospitals which are now seriously impacting upon our ability to deliver the quality of care that patients require and should expect. Most recently, this was evident in the problems experienced in NHS Lanarkshire, but this could just as easily have happened in any other part of the UK.
Reductions in the numbers of acute beds while medical admissions have continued to rise, in parallel with workforce shortages, have placed almost intolerable pressure on our doctors and nurses.
In response to this situation, the NHS has had to deploy a series of coping strategies which were only ever intended as crisis management tools. These are in real danger of becoming accepted daily practice.
Moving medically ill patients to other wards was only intended for times of severe pressure, such as during ward closures and outbreaks of norovirus or flu, but has become established practice in many Scottish hospitals on a year-round basis.
We welcome the Scottish government’s recent commitment to eliminating this discredited practice but “boarding” continues in our hospitals and efforts need to be accelerated to reduce it. In parallel, bed occupancy in Scottish hospitals now commonly exceeds 85% nationally.
Evidence has shown that this is the maximum safe level at which we can treat patients and that it is essential to leave spare capacity within the system to cope with an increasing number of emergency admissions. Above this level, the risk to patient safety also increases.
Despite this, bed capacity of up to 124% was recorded in some Scottish medical units last year. Personally, I believe it essential that we commit to the UK-wide adoption of a maximum ward capacity of 85%.
Following the events in Lanarkshire, there is also a pressing need to implement more stringent standards for the quality of acute medical care provided to patients in Scotland. In late 2013 the NHS in England adopted 10 specific new standards of care in response to the events in Mid Staffordshire and to support the delivery of 7-day acute medical services. The standards to be implemented in England over the next 5 years have the support of the medical profession and these could be adapted for use by the NHS in Scotland.
We are not short of standards and the four clinical quality indicators from the Society for Acute Medicine would be a good starting point. What is needed is national adoption of an agreed set of manageable standards to drive up the quality of care for medical patients. Without this the NHS in Scotland risks falling behind England.
As a college, we shall continue to work with the Scottish government and NHS Healthcare Improvement Scotland in developing standards for use in acute medicine in Scotland. Importantly we urgently need effective systems for measuring and monitoring their implementation in practice.
Collectively, we need to be honest about the challenges which we face, to step back from crisis management, to develop more sustainable strategies for managing hospital services and to improve the standards of acute medical care provided to patients. Our patients deserve nothing less.