LOTHIAN MSPs have spoken out following a critical report on safety issues at the Royal Infirmary of Edinburgh at Little France. Inspectors reported safety concerns following visits to the hospital’s A & E Department in February and subsequent follow-ups.
Conservative Lothian list MSP Miles Briggs said: “These are very serious concerns in regards to overcrowding at Royal Infirmary of Edinburgh and the fire safety risk it creates.
“The A&E department at the hospital has been running over capacity for a number of years now, with SNP Ministers showing an ability to make any progress.
“Patient and staff safety must be the number one priority at the RIE and urgent improvements must be made.
“I have written to NHS Lothian to ask for further details and a timetable for when these improvements are being made .”
Labour list MSP Foysol Choudhury added: “It is incredibly disappointing and worrying that inspectors raised numerous serious concerns about safety in the A&E department at Royal Infirmary Edinburgh (RIE).
“Constituents in Edinburgh need to be sure that they can safely attend hospital for care and treatment. Instead, patient safety, care and dignity were called into question.
“This is terrifying for those patients in the region who need to be able to rely on and trust the A&E department should they ever need it.
“I’m very concerned that our hardworking NHS staff may also be put in danger by this crisis in the NHS, with concerns raised over staff wellbeing at RIE. Our hospital staff work incredibly hard to provide the best service possible.
“Patients at RIE and their relatives spoke highly of the compassionate care they received from staff. “This makes it all the more disappointing that staff and patients alike are being affected by 16 years of SNP incompetence.
“Staff and patients are crying out for help. Will the new Health Secretary answer their call and reverse years of damage done by Humza Yousaf when he held the post?”
NHS Lothian says the concerns expressed in the report are already being addressed. Alison Macdonald, nurse director at NHS Lothian, told the BBC the HIS visit came at a time of “unprecedented pressure” on the hospital.
She said: “We accept and acknowledge the findings of the HIS report and we sincerely apologise to patients for longer than usual waiting times in the emergency department and a poorer experience of care.
“We had already begun our own improvement work when the inspectors carried out their first visit.
“When they returned for their follow-up, it was clear to see that improvements had already been made, but more was required. We are now focused on our improvement and safety action plans.”
HEALTHCARE IMPROVEMENT SCOTLAND’S REPORT
HEALTH watchdog Healthcare Improvement Scotland carried out an unannounced inspection to the Royal Infirmary of Edinburgh, NHS Lothian on Monday 20 to Wednesday 22 February 2023 using our safe delivery of care inspection methodology.
During our inspection, we:
- inspected the ward and hospital environment
- observed staff practice and interactions with patients, such as during patient mealtimes
- spoke with patients, visitors and ward staff (where appropriate), and
- accessed patients’ health records, monitoring reports, policies and procedures.
As part of our inspection, we also asked NHS Lothian to provide evidence of its policies and procedures relevant to this inspection. The purpose of this is to limit the time the inspection team is onsite, reduce the burden on ward staff and to inform the virtual discussion session.
On Tuesday 14 March 2023, we carried out an unannounced follow-up visit to the Royal Infirmary of Edinburgh to establish if concerns we raised during our initial visit had been addressed.
On Thursday 16 March 2023, we held a virtual discussion session with key members of NHS Lothian staff to discuss the evidence provided and the findings of the inspection.
As a result of serious concerns about patient safety within the emergency department identified during this inspection we wrote to NHS Lothian to formal escalate our concerns in accordance with level 1 of our escalation process in the Healthcare Improvement Scotland and Scottish Government: operating framework.
A copy of the letter has been published with this report.
Summary of our findings
At the time of inspection, the Royal Infirmary of Edinburgh, like much of NHS Scotland, was experiencing a significant range of pressures including increased hospital admissions, increased pressures in the emergency department and admission units and reduced staff availability. During our onsite inspections the hospital was operating at over 100% capacity.
In ward areas, senior managers were visible, wards were generally calm and well organised and we observed good leadership and care being delivered. Patients and relatives spoken with described a good experience of care and helpful staff.
During the safety huddles we attended, we observed a strong focus on patient care needs across the hospital. However, serious patient safety concerns within the emergency department were identified during this inspection.
Inspectors raised a number of serious patient safety concerns regarding the emergency department during both our onsite inspection and return visit regarding the delivery of fundamental care for patients, patient safety, care and dignity, the current operating environment, leadership and coordination of care in the emergency department, as well as concerns about staff wellbeing.
Other areas for improvement identified during the inspection include the management of intravenous fluids, medicine administration processes, locked doors policies and procedures, and feedback to staff following incident reporting.
NHS Lothian senior managers responded quickly to concerns raised during the initial inspection. However, during our return visit on 14 March 2023, we remained concerned that the immediate actions put in place by NHS Lothian did not lead to significant improvements in the delivery of safe and effective care within the emergency department.
This resulted in us writing a formal letter of non-compliance to NHS Lothian in accordance with level 1 of our escalation process, setting out the serious patient safety concerns that required immediate action.
NHS Lothian promptly responded to this escalation, providing a detailed plan of improvement action to address each of the concerns. We will seek assurance on progress with planned improvement actions in accordance with our published inspection methodology.
This inspection resulted in five areas of good practice, three recommendations and 13 requirements.