Concerns were formally raised by senior clinicians with management three months ago about the “intolerable” risk level within NHS Grampian.
Last week, the health board, which covers Aberdeen, Aberdeenshire and Moray, declared a “critical incident”, which saw some patients diverted to neighbouring areas, including Ninewells Hospital in Dundee.
This was due to the demand at NHS Grampian’s flagship Aberdeen Royal Infirmary (ARI), which was later stood down on November 30.
According to BBC Scotland, a letter in August from members of the Medicine and Unscheduled Care (MUSC) leadership team warned that not enough was being done to meet the expected increase in demand over winter.
It said: “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.
“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.
‘Continuous deterioration’
“We are aware that these concerns have been escalated previously and despite reassurances, this has not resulted in any significant improvement.
“The current trajectory of performance and occupancy across MUSC in recent months suggests continuous deterioration.
“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 winter period.
In response, NHS Grampian said MUSC’s points had been considered and “enormous challenges” were being faced by its teams.
It said it had to take the “significant step” on November 28 to declare a critical incident after sustained and continuing demands at ARI, which as well as Ninewells, saw some patients taken to Dr Gray’s in Elgin where “clinically appropriate”.
Despite this, life-saving treatments still took place at the Foresterhill hospital, although some elective procedeures and appointments were cancelled, but not for cancer treatment and diagnostic tests.
NHS Grampian interim chief executive Adam Coldwells told BBC Scotland he and another senior manager had considered the points raised in the letter and they had both written to and met its authors.
He said: “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.
“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.
‘We continue to look at ways to improve’
“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.
“The hard work and dedication of our teams cannot be understated in such difficult times.”
Speaking today, First Minister John Swinney said ministers were in discussions with NHS Grampian about the incident, who said they would be reviewing what happened last week.
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