‘Simply unacceptable’: Western’s cleanliness standards slammed

Standards of cleanliness at The Western General Hospital have been severely criticized in a report (see below) by official watchdog The Healthcare Environment Inspectorate (HEI). NHS Lothian chiefs have said they have already acted to respond to concerns.

Chief Inspector Susan Brimelow said: “We carried out an unannounced inspection to the Western General Hospital on Tuesday 18 and Wednesday 19 November 2014. Due to significant concerns about the cleanliness of patient equipment and the environment, we escalated our findings to senior management in the hospital.

“We requested that NHS Lothian take immediate action to address these issues and produce an improvement action plan. We returned unannounced on Thursday 27 November 2014 to assess progress against the improvement action plan and found that significant improvements had been made. NHS Lothian must address the requirements and make the necessary improvements as a matter of priority.”

In a full statement issued earlier today the HEI said:

We previously inspected the Western General Hospital in February 2013. That inspection resulted in four requirements and five recommendations. The inspection report is available on the Healthcare Improvement Scotland website.

We carried out an unannounced inspection to the Western General Hospital on Tuesday 18 and Wednesday 19 November 2014. Due to significant concerns about the cleanliness of patient equipment and environmental cleanliness within the Western General Hospital, we escalated our concerns to senior management in NHS Lothian on 18 November and then again on 19 November 2014. On ward 52/53, we also raised concerns about the lack of working macerators and the procedures in place to reduce the risk of cross-infection to patients, staff and visitors. Macerators break human waste down into slurry so it can be sluiced effectively. We requested that immediate action be taken on these issues and an improvement action plan produced to show how these issues would be rectified.

We returned unannounced on Thursday 27 November 2014 to assess progress against the improvement action plan at ward and departmental level. Significant improvements had been made although we still noted some issues with the cleanliness of patient equipment and the environment.

We assessed the hospital against the NHS Quality Improvement Scotland (NHS QIS) healthcare associated infection (HAI) standards and inspected the following areas:

ward 2 (oncology)
ward 4 (oncology)
ward 15 (winter ward)
ward 20 (ICU)
ward 26 (general medicine)
ward 27 (colorectal)
ward 43 (regional infectious diseases unit)
ward 50 (stroke unit), and
ward 52/53 (gastroenterology).

Overall, we found evidence that NHS Lothian is not complying with the NHS QIS HAI standards to protect patients, staff and visitors from the risk of acquiring and infection.

In particular we found:

the standard of cleanliness of the patient environment was poor
the standard of cleanliness of patient equipment was poor, and
a lack of appropriate risk assessments, for example for out-of-order macerators.

The report highlights areas of strength and weakness as well as areas for further improvement, including requirements and recommendations.

This inspection resulted in eight requirements and one recommendation.
NHS Lothian must address the requirements and make the necessary improvements within the stated timescales.

Responding to the report, Melanie Johnson, executive nurse director at NHS Lothian, said staff had acted on the inspectors’ findings as ‘a matter of urgency’.

Ms Johnson said: “We recognise that some standards were below those we would expect and I apologise to any patients who may have been affected. I would also like to reassure them that those areas have been rectified – since the first of the visits in November, immediate changes were put in place to address all areas that were singled out for improvement.

“A detailed action plan was drawn up and all points have been completed. Many of these significant improvements were proven during the subsequent unannounced visit by inspectors as is detailed in the report.”

Commenting on the ‘extremely disappointing’ findings, Health Secretary Shona Robison said: “The report shows that standards have fallen well short of what the public and patients expect. The inspectors have uncovered simply unacceptable levels of cleanliness and infection control in certain wards, and I will be meeting the chair of NHS Lothian to reiterate my desire to see standards immediately improve. The improvement plan in place must be delivered urgently.”

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Health and social care integration plans unveiled

Edinburgh’s health and social care chiefs have unveiled details of how they will strengthen ties and improve people’s well-being through the integration of services.

Both organisations must integrate the planning and delivery of certain services through legislation set out by the Scottish Government relating to all Scottish local authorities.

Integrating adult health and social care services will allow the City of Edinburgh Council and NHS Lothian to:

Train and support staff to work together to meet people’s needs;
Improve health and reduce inequalities;
Give communities an active role in designing and delivering services;
Use shared resources in the most cost-effective way.

A Draft Integration Scheme will set out how the agencies will work together to deliver services through what will be known as a new organisation, the Edinburgh Integration Joint Board. A Shadow Edinburgh Health and Social Care Partnership Board has been operating since 2012.

A report recommending that the draft is approved to go forward for consultation will be considered by members of the Corporate Policy and Strategy Committee on 20 January.

A targeted and extensive consultation plan on the draft with relevant organisations and the public will run until 20 February, with the results set to be submitted to the Scottish Government for approval by 31 March.

Councillor Ricky Henderson, Health and Social Care Convener for the Council, said: “These are exciting plans and are the start of a new phase of development for health and social care in Edinburgh. I am confident that they will lead to an improved and more targeted service for everyone who needs it.

“It’s important to recognise that health and social care staff from the NHS and Council already work together very effectively to deliver integrated services, and the details will build on what is a very solid foundation.

“It’s vital that we engage with all the relevant groups so that everyone has the chance to have their say on how integration should work. They will be at the heart of the scheme’s decision making process and together we can shape a more streamlined service which will lead to improved health for citizens.”

Professor Alex McMahon, Director of Strategic Planning, Performance Reporting and Information, NHS Lothian, said: “We welcome and support these proposals on the integration of health and social care services for adults in Edinburgh.

“Having worked closely with our partners at the City of Edinburgh Council to develop this joint plan, this new approach will build on the integrated work and good relationships which already exist between health and social care colleagues and services.

“We look forward to continuing to work together on the development of these important proposals as we move forward.”

More money for Scotland’s health boards

NHS in Scotland to receive additional £65 million

The Scottish Government has today announced that an extra £65m will be made available to NHS in the next financial year. The funding boost for 2015/16 will ensure that all health boards will receive uplifts next year which are at least 1% above the rate of inflation.

This will bring all health boards to within one per cent of parity under the NHS funding formula, NRAC, a year earlier than planned.

Health Secretary Shona Robison (pictured above) said the funding increase demonstrates the Scottish Government’s commitment to protecting the NHS. She said: “This Government has not only protected the NHS budget, but increased it.

“Our NHS services faces challenges as a result of the increase in patients, with more complex illnesses, and the rising costs of expensive new drugs.

“This £65m additional investment increases the resources available to health boards will help alleviate these pressures and ensure our NHS can continue to deliver effective and sustainable care to all patients across Scotland.”

“We’re clear that all patients in Scotland should be treated as quickly and as effectively as possible, with the right care, in the right place, at the right time. With this increase in funding, health boards are being given more support to achieve this.

“Despite Scotland’s fiscal resource budget being slashed in real terms by 10 per cent by Westminster since 2010, we’ve increased the health resource budget by 4.6 per cent in real terms.”

Health Boards publish holiday A & E figures

More than 90% of Lothian A & E patients seen within four hours

Scotland’s core accident and emergency departments saw 88.8 per cent of patients within four hours over the challenging Christmas and New Year period. NHS Lothian outperformed the national average, recording a 93.4% figure.

The figures which have been reported to the Government by NHS boards, outline performance at A&E departments between December 22 to January 4.

Boards have also reported one of the key challenges over this period has been the number of admissions to hospital, reflecting the fact that more seriously ill people are presenting at A&E.

Health Secretary Shona Robison said:

“The winter months bring increased pressure on the heath service and these figures show that this year’s Christmas period was a particularly challenging time for our A&E services and across our NHS.

“It is clear we must improve our performance – both in winter and year round – which is why we’ll go on increasing investment, improving systems and protecting staffing levels.

“Health board staff across Scotland have been working extremely hard to meet this demand and ensure long waits in A&E are minimised – and for this they have our thanks.

“However, across many health boards, delayed discharge is having a significant impact on the flow of patients through hospital and boards have informed us there has been an increase in seriously ill people presenting at A&E, who need admitted to hospital.

“I have already stated that reducing delayed discharge is a top priority for this government and we are continuing to work with health boards and local authorities to ensure effective co-ordination so that these patients, who are often very frail, can either get home or into a homely setting as quickly as possible.

“While we have significantly reduced by two-thirds the number of patients who are delayed for longer than four weeks, we recognise that we must go further to ensure all patients are safely discharged as quickly as possible when they’re judged clinically fit enough.

“To help deliver this we’ve already legislated for the integration of health and social care from this April.

“Of course, more must be done to deliver sustainable change and we are working with partners to make sure this happens.

“We have also recently made £28 million available to support boards experiencing an increase in demand over the winter and ensure local plans are in place across Scotland, supported by this extra investment.

“This investment is enabling the creation of an extra 200 intermediate care beds across Scotland, expanding community capacity substantially. That means fewer people will be unnecessarily delayed in hospital, freeing up beds and easing the pressure on A&E.”

NHS England and NHS Scotland A&E core site/Type 1 performance Christmas period figures are:

4 Hour A&E Performance:

Country (2 Weeks Ending the 4th January 2015)

England (Type One Sites) 82.8%

Scotland (Core Sites) 88.8%

NHS Scotland A&E core site Performance Christmas period (unvalidated) figures are:

Scotland NHS Boards (Core Sites) – 2 Weeks Ending the 4th January 2015

Ayrshire & Arran 89.6%

Borders 89.0%

Dumfries & Galloway 96.3%

Fife 87.3%

Forth Valley 83.1%

Grampian 90.6%

Greater Glasgow & Clyde 82.6%

Highland 95.9%

Lanarkshire 89.4%

Lothian 93.4%

Shetland 97.5%

Tayside 98.1%

Western Isles 99.2%

Scotland (Core Sites) 88.8%

Seasonal health advice from NHS Lothian

Holiday Health Advice

Check you have cold and flu remedies

Many children and adults pick up common winter ailments such as a cold or flu-like illness. These can often be effectively treated at home with readily available medicine. Parents are reminded to restock their medicine cabinet with remedies suitable for children.

Use your local pharmacy

Your local pharmacy is an accessible resource for you and your family. Your pharmacist can offer advice or help if you have run out of any prescribed medication. You can also collect medicine for minor ailments or illnesses.

Make sure you have repeat prescriptions. Only order what you need and pick it up in plenty of time.

If you, or someone you care for, require medicines regularly, check that you have enough and if you need more remember to order and collect repeat prescriptions in good time to ensure you or your family have enough medicine to last over the Christmas holiday period. Only order what you need.

Know when your GP surgery will be open

Your local doctor’s surgery will be open on Wednesday December 24^th and will then reopen on Monday 29th December. This means there are four days when it is closed – Christmas Day, Boxing Day, Saturday 27^th and Sunday 28^th.

Doctors Surgeries will follow normal opening hours on Wednesday 31 December and will then reopen on Monday 5 January.

Have you heard about Healthy Start?

Healthy Start is a food and vitamin scheme scheme for families on low income (families on income support or Child Tax Credit recipients with household income less than £16,190). Pregnant women under 18 years old are also eligible, regardless of income.

Vouchers can be spent on fruit, veg, milk or formula feed. Supermarkets and many local shops and food coops accept them. They are worth up to £899 (if eligible all the way through from week 10 of pregnancy to 4th birthday).

A quarter of eligible families don’t currently receive vouchers so it’s worth checking your entitlement. Ask your midwife, health visitor or GP practice.

Watch a video about the vouchers here: http://vimeo.com/m/102126052

Check eligibility on website: http://www.healthystart.nhs.uk

Thanks to our friends at Dads Rock for passing on this information

NHS Lothian launches six-year plan for children’s services

Health and wellbeing services for children and young people in Lothian are set to be strengthened with the launch of a pioneering new strategy.

NHS Lothian’s Children and Young People’s Health and Wellbeing Strategy, which sets out a clear vision, principles and approach to services over the next six years, was unveiled by Aileen Campbell, Minister for Children and Young People at a conference organised by NHS Lothian last week.

The document sets out NHS Lothian’s vision and is the road map for reducing inequalities and improving the health and wellbeing of children and young people in Lothian.

Tim Davison, Chief Executive, NHS Lothian, said: “This strategy is crucial to children’s and young people’s services. It will underpin all the work we do over the next six years and will help to transform services to ensure that the interests and health of children are at the forefront of everything we do.”

The document outlines how the health board will work with children, young people, their families, public, the voluntary sector and local authorities, to improve the physical and emotional health and wellbeing of children and young people.

Sally Egan, Associate Director and Child Health Commissioner, NHS Lothian said: “Every child should have the best start in life and grow up being healthy, safe, confident and resilient. This new strategy puts children and young people at the centre of their care and makes it clear who is responsible for their welfare.

“It comes at a time when we are forming closer working relationships with local authorities to fully integrate health and social care and are also looking ahead to the new Royal Hospital for Sick Children (pictured above).”

Created with the help and input of children and young people and supported by the Children’s Parliament, the ambitious strategy is based around the principles of the United Nations Convention on the Rights of the Child and underpins the Children and Young People (Scotland) Act 2014.

It aims to tackle three key issues; how NHS Lothian engages with children and young people in their care and treatment, ensuring the health board recognises how children and young people feel, and improving access to health information and health services, which were all highlighted by children and young people during the extensive consultation period.

The strategy sets out plans to:

· Involve children, young people and their families in decisions that affect their health and wellbeing

· Improve the range and quality of healthcare services for children and young people

· Reduce the impact of social circumstances on health

· Ensure disabled children and young people will have their additional needs met

· Increase staff understanding of the needs of the younger population.

Minister for Children and Young People, Aileen Campbell said: “I’m delighted to help launch this ambitious new strategy. This successfully builds on the NHS services already in place, with a renewed focus on children’s rights and wellbeing to help ensure they and their families can get access to the right help at the right time.

“The Scottish Government’s aspiration is for Scotland to be the best place to grow up and this type of pioneering work will make a real difference to the lives of our children and young people, and ensure they have the best possible start in life.”

NHS Lothian launches six-year plan for children's services

Health and wellbeing services for children and young people in Lothian are set to be strengthened with the launch of a pioneering new strategy.

The document sets out NHS Lothian’s vision and is the road map for reducing inequalities and improving the health and wellbeing of children and young people in Lothian.

The strategy sets out plans to:

· Involve children, young people and their families in decisions that affect their health and wellbeing

· Improve the range and quality of healthcare services for children and young people

· Reduce the impact of social circumstances on health

· Ensure disabled children and young people will have their additional needs met

· Increase staff understanding of the needs of the younger population.

Minor Injuries Clinic is twenty years old!

The Minor Injuries Clinic will mark a major milestone this week when it celebrates its 20th anniversary. The unit, which was the first in Scotland, opened at the Western General Hospital in 1994.

It broke new ground when it was launched by becoming the first nurse-led unit of its kind. Now 20 years on, the unit continues to be one of NHS Lothian’s flagship services and treats around 25,000 people every year for a variety of aches, pains, cuts and sprains.

Fiona Churchill, lead nurse practitioner, NHS Lothian, said the unit was a one-stop shop for patients and provided a crucial alternative to busy Emergency departments which were dealing with life-threatening injuries.

She said the unit has ensured that patients are treated at the right time, by the right people in the right place.

She added: “We are delighted to be celebrating our 20th anniversary. The minor injuries clinic was pioneering when it was created and over the years it has continued to be at the forefront of quality care.”

The service has grown and evolved over the last two decades and paramedic practitioners and a physiotherapy practitioner are now attached to the unit.

One of the other major changes has been that all staff are, or are working towards becoming independent prescribers, which has helped enhance the patients’ journey and help the unit become the one-stop shop it was designed to be.

The number of patients attending the clinic has more then doubled since it was launched in 1994 because of its prompt and expert care.

It is estimated that on average 60 adults and children now attend the clinic every day – around 25,000 every year – for a range of injuries, especially to their ankle or wrist and for burns, cuts and sprains.

The clinic will continue to evolve and will soon move into a specially-designed unit on the same site as part of the work to re-design the Western General Hospital site to make it more effective and improve patient flow.

It will continue to be a walk-in service, so no appointment is required for treatment from a range of staff, including nurse, physiotherapy and paramedic practitioners.

Over the years, opening hours have been extended to make the clinic more accessible and in line with patients’ needs, meaning that it is now open every day of the year from 8am to 9pm, with last book in at 8.30 pm.

That seems incredible – can it really be that the Western General Action Group campaign was over twenty years ago?

Transport Hub to transform patient travel

Patient transport in NHS Lothian has been transformed after the health board became the first in Scotland to create a dedicated Transport Hub. The unique system, which is expected to save an estimated £1 million, organises all non-emergency patient journeys and has been designed to boost efficiency and improve patient flow.

With a fleet of ambulances, mini-buses with carers, volunteer cars and taxis at its disposal, the Transport Hub provides a single point of contact for staff seeking to arrange patient transfers or to take the patient home.

It means that when a patient, who requires transport, is due to leave hospital, ward staff simply have to make one call to the hub, which is open 365 days per year.

Specially-trained staff at the end of the phone will then organise the right kind of vehicle, depending on the needs of the patient and their clinical requirements.

In the past, ward staff would have contacted The Scottish Ambulance Service to arrange a journey or would have booked a private ambulance company directly.

Jim Crombie, Director of Scheduled Care, NHS Lothian, said: “The Transport Hub is a completely unique concept and we are really proud to be the only health board in Scotland to have taken this approach to planned patient transport.

“The Transport Hub is a much more efficient way of working. It improves the overall patient experience while also freeing up ambulances to be used for emergency transfers.”

The Transport Hub, which is based at the Astley Ainslie Hospital in Edinburgh, has become a crucial link in the discharge process, ensuring a smoother, smarter and more efficient way of working.

The team handle around 400 calls a day, from 24 of NHS Lothian’s Acute and Primary Care sites and also offers a level of support to a number of care homes within our boundary. Using a Patient Needs Assessment (PNA), the call handlers gain information from ward staff which allows them to arrange the most appropriate transport and equipment for the individual needs of the patient. This is done in real time so that each journey can be planned and logged and the caller advised immediately as to the transport option available.

By ensuring the correct mode of transport is in place, the system helps reduce clinical risk, allowing the patient to be moved safely from hospital to home. It also means hospital beds become available for new and emergency patients in a more timely and organised fashion.