An NHS Grampian boss today warned that patients could be left waiting in “significant pain” this weekend after the health board declared another “critical incident”.
Ambulances carrying people who do not need “immediate life-saving care” are being steered away from Aberdeen Royal Infirmary today – and possibly into the weekend.
NHS Grampian declared a “health board critical incident” as it continues to struggle with “very large pressure over a prolonged time”.
It means they are no longer able to deliver emergency care and are asking for help from the Scottish Government and other NHS boards, in this case Tayside and Highland.
One of those involved in that decision, on-call medical director Dr Hugh Bishop says health chiefs are sorry and “uncomfortable” the months of strain have led to this.
“None of this is what we want to be doing but what we’re seeking to balance all of the risk across the whole population and try and come up with measures to get through this period.”
What’s happening at Aberdeen Royal Infirmary?
Last night they asked NHS Tayside and NHS Highland for help, and now all but the most serious casualties in ambulances will be taken to Dundee and Inverness instead of ARI.
Operations and other appointments are also being postponed for some patients, who will be contacted by the health board.
What patients will be diverted from Aberdeen Royal Infirmary?
Dr Bishop, who was the on-call medical director last night, made it very clear that this is not what he wants to be doing, as he explained who will be diverted elsewhere.
He said the ambulance team will assess patients and phone what’s called the flow navigation centre, which offers guidance on whether the patient needs to go to any hospital at all.
If they are in need of hospital treatment, crews will phone up the other nearest health board and arrange a drop-off.
But Dr Bishop is clear: “Patients with life-threatening conditions such as heart attacks, strokes, and even more extreme things like cardiac arrest…
“They are all going to be brought to ARI and treated here, as would be expected and we are really grateful for the expertise of the frontline paramedics in helping to determine the right location for each individual patient.”
An ambulance spokesperson tells us the service is “working collaboratively” with NHS Grampian to manage the pressures – but also “strongly encourages” people to call NHS 24 instead.
What operations and appointments could be cancelled by NHS Grampian?
Decisions on scheduled operations and day treatments will be made day-to-day “in the coming days”.
Cancer treatment and diagnostic tests will not be affected, we’re told.
Dr Bishop’s guidance is that appointments will only be postponed if it is safe to do so – and those affected will be contacted.
However, the health board is still working to catch up on urgent surgeries waylaid by the Covid pandemic.
Those are unsuitable for any further delay.
He said: “It goes without saying that I am extremely sorry that may have to happen for any patient.
“And I’m also extremely sorry that some of our patients will be diverted to other health boards, that’s not the care that we want to be providing and we are very sorry this is happening.”
NHS Grampian’s critical incident will leave people ‘frightened’ and in ‘significant pain’ for longer
He added: “Uncomfortable though it is for me to say, it is possible some patients suffering significant pain might have procedures put off.
“And that is something that I regret and want to apologise for to any patient that is in that circumstance.
“Anyone who’s experiencing pain, and has been expecting to have their problem dealt with, where that has to be deferred… it’s a really, really unpleasant position for a patient to be in.
“And any patient that’s accessing emergency healthcare is frightened. It’s a frightening thing to do.
“And it’s more frightening if they are going to be then taken to a different place than they were expecting to go.”
How long with NHS Grampian being diverting ambulances?
Dr Bishop said it’s difficult to say how long ambulances will be diverted.
“We don’t know yet,” he admits.
” We’ve done lots of other things that are less visible and perhaps less newsworthy than the diversion of ambulances.
“What I want to reassure everybody – patients, primarily but also colleagues – is that this will be the first step to be reversed.
“As soon as we have created enough capacity to safely allow a reversal of that step, it’ll be the first thing that we change back to normal from all the other things that we’ve done.
“I can’t give you an exact number, but we don’t think that it will be longer than a small number of days before we’re able to reverse that step.”
Has ambulance stacking at Aberdeen Royal Infirmary caused this?
Aberdeen Royal Infirmary has been “under very large pressure for a prolonged period of time”.
For months, The Press and Journal has reported on the queues of ambulances at A&E, unable to transfer their patients to hospital.
Dr Bishop said there were ambulances “stacked” at ARI yesterday at the emergency department and the key medical assessment unit.
“While that is a source of concern it’s not the only factor – it’s something we deal with most days,” he adds.
It’s worth flagging that outside experts acknowledge NHS Grampian as having one of the “most efficient unscheduled care systems on mainland Scotland”.
The Centre for Sustainable Delivery Discovery reports the health board achieves its “middling performance” despite operating with a “significantly smaller” number of beds compared to the population.
Delayed discharges and number of patients the primary causes
Dr Bishop continued: “It’s not an issue with staffing.
“We’re not currently able to deliver care for the patients in the right place every time.
“Delayed discharges are a large part of the issue causing pressure – that’s patients who are ready to go to an alternative place for their ongoing care, but where we’re not able to provide that place.
“But that’s combined with just the overall number of patients that are presenting. It’s those two things together.
“There’s no individual incident that happened. It’s an accumulation of the high levels of pressure that has been in place for a long time and we’ve not been able to identify any particular trigger for this extra pressure that’s got us to the point where we’ve needed to take steps we have taken.”
The straining health board is making a plea for friends and family to be more prompt in picking up loved ones due for discharge though – hoping that might free up some beds.
Things Dr Bishop wanted to make clear:
- No patients are being asked to change how they access healthcare. If you are sick, continue to call NHS 24 on 111, your GP, or go to the emergency department if necessary.
- No patients transporting themselves to hospital will be sent to Inverness or Dundee – these diversions are only in place for the Scottish Ambulance Service.
- Patients affected by cancellations will be contacted – so if you don’t hear anything, go to your appointment as arranged.
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