NHS Grampian received ‘intolerable risk’ warning before critical incident

BBC Scotland News has learned that senior clinicians within NHS Grampian formally communicated concerns to management regarding an “intolerable” level of risk three months before a critical incident was officially declared. Last week, NHS Grampian declared a critical incident, which resulted in certain ambulance patients being redirected to hospitals beyond its geographical area due to high demand at Aberdeen Royal Infirmary (ARI). The incident was subsequently stood down. A letter originating from members of the Medicine and Unscheduled Care (MUSC) leadership team in August cautioned that insufficient measures were in place to address the anticipated rise in demand during the winter period. NHS Grampian stated that the issues raised in the letter had been taken into account and that its teams were confronting “enormous challenges.” The health board indicated that it was compelled to take the “significant step” last Thursday following persistent and ongoing demands at ARI. Patients were redirected to facilities in Dundee and Elgin when deemed “clinically appropriate,” though life-saving care continued to be provided at ARI. Following the standing down of the incident, health officials announced that the hospital had entered a “recovery phase” and that a review of the incident would be conducted. The August letter addressed to senior management stated: “Over the past 12 months multiple risks have been reported and recorded from all areas of the portfolio, both formally and informally. “Despite this, we are experiencing a deterioration in the performance against most measures and targets and the quality of care we are able to deliver to patients.” It continued: “We are increasingly concerned about the impact this sustained pressure and risk is having on our staff. We see regular evidence of individuals and teams who are experiencing harm from the required workload and inability to deliver effective care for patients with the resources available.” The letter further added: “We are aware that these concerns have been escalated previously and despite reassurances, this has not resulted in any significant improvement.” Among the critical issues highlighted were staff wellbeing and the need for longer-term improvement. The letter noted: “The current trajectory of performance and occupancy across MUSC in recent months suggests continuous deterioration.” It also stated: “There is no evidence to support any planned improvement work or capacity changes that will meet the impending increase in demand seen over October and sustained over [the] winter period.” The authors of the letter indicated their awareness of the financial pressure affecting NHS Grampian and the magnitude of the projected overspend. Adam Coldwells, NHS Grampian’s interim chief executive, informed BBC Scotland News that he and another senior manager had reviewed the points presented in the August letter, and that they had both corresponded with and met the authors. He stated: “Continuous discussion with, and hearing the challenges of all our colleagues, is an integral part of both understanding the issues and finding the right solution.” Mr. Coldwells added: “There are enormous challenges facing our teams, not only in medicine and unscheduled care, but in other parts of acute care, in community hospitals, and working out in the community itself. The past week has shown those challenges play out in real time.” Mr. Coldwells mentioned that there was no “single solution” to these difficulties and further noted that NHS Grampian possesses the lowest number of hospital beds per head of population in Scotland. He also stated: “We continue to look at ways to improve flow within the footprint across the whole of health and social care in Grampian. In addition, our colleagues in Scottish government have committed to support that work as necessary.” He concluded: “The hard work and dedication of our teams cannot be understated in such difficult times.” On Monday, First Minister John Swinney confirmed that ministers were engaged in discussions with NHS Grampian concerning the incident. He stated: “The government will continue to work with NHS Grampian, listening at all times to the clinical workforce, to make sure that we design services, that we put the resources in, and that we take the correct approach to make sure that we have sustainable health services that meet the needs of people in all parts of the country.” NHS Grampian reported that the average occupancy at ARI last week stood at 111%. The hospital’s occupancy has not fallen below 100% since September. Similarly, at Dr Gray’s in Elgin, occupancy reached 124% and has also remained above 100% since September. The critical incident resulted in the postponement of some elective procedures and appointments, though not for cancer treatment and diagnostic tests. BMA Scotland expressed that it was “extremely concerned” by the timing of the incident, occurring before the busy winter season. Copyright 2024 BBC. All rights reserved. The BBC bears no responsibility for the content of external sites. Details regarding its approach to external linking are available.