Following the report published by Healthcare Improvement Scotland this week, NHS Lothian said they had already launched a major improvement programme even before the inspections were conducted.
The health board also said there have been months of exceptional pressures, but they will react to the report demanding a number of improvements.
The inspectors made two unannounced visits, finding a number of issues falling below the high standards of patient care which should be expected.
Donna Maclean, Chief Inspector, Healthcare Improvement Scotland, (HIS) said: “At the time of the inspection, Royal Infirmary of Edinburgh, like much of NHS Scotland, was experiencing a significant range of pressures including increased admissions in the emergency department and admission units and reduced staff availability. The hospital was operating at over 100% capacity.
“During the inspection, our inspectors raised a number of serious concerns about the safe delivery of care in the hospital’s emergency department. We raised concerns about patient safety, care and dignity, leadership, the coordination of care and staff wellbeing. As a result, we wrote to NHS Lothian to formally escalate our concerns.
“Despite these concerns, our inspectors observed respectful and caring interactions between staff and patients in the majority of ward areas. Patients and relatives we spoke with in all care areas, including the emergency department, said they had received kind and compassionate care from staff, which was also witnessed by inspectors during their visits. Nursing staff told us that they felt well supported by senior nursing leadership.
“In order to prioritise the requirements from this inspection, an action plan has been developed by NHS Lothian and will seek assurance on progress with planned improvement actions.”
The inspectors observed other areas for improvement identified during the inspection included the management of intravenous fluids, medicine administration processes, locked doors policies and procedures, and feedback to staff following incident reporting.
Inspectors said that NHS Lothian senior managers responded quickly to concerns raised during the initial inspection. However, during their return visit on 14 March 2023, they 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 HIS writing a formal letter of non-compliance to NHS Lothian in accordance with level 1 of their 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. HIS will seek assurance on progress with planned improvement actions in accordance with their published inspection methodology.
This inspection resulted in five areas of good practice, three recommendations and 13 requirements. The full report is here.
Alison Macdonald, Nurse Director, NHS Lothian, 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 ED 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.
“It’s important to bear in mind that the inspection covered 13 wards, intensive care and the Emergency Department, and inspectors highlighted a number of areas of good practice relating to compassionate care, visible and supportive leadership, and a strong focus on patient care needs which we were encouraged to read.
“We recognise too that there is much work to be done. Safety and wellbeing of patients and staff are our main priorities, and I want to reassure them that we are doing everything possible to improve.
“We value and respect all of our teams and the hard work and dedication they bring. We are introducing new ways of working and reforming services to help better support our staff in their roles delivering patient care every day.
“There has been unprecedented pressure on our healthcare systems, which has been relentless in recent times, as the inspection team was able to experience first-hand.
“Occupancy of the hospital was over 100% when the inspection team visited, which has been a common experience in recent months. We are now focussed on our improvement and safety action plans.”
Lothian 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 .”
Scottish Labour Health spokesperson Jackie Baillie said: “This report is absolutely damning, but it is no surprise.
“After 16 years of SNP incompetence, our NHS is in crisis. Patients are being treated in unsafe conditions, with total disregard for their dignity and respect, whilst hardworking NHS staff – who are at the end of their tether – are crying out for help from the Scottish Government.
“Michael Matheson must take serious action to restore faith in our NHS and end this crisis once and for all.”
Foysol Choudhury MSP said: “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?”
The vital improvement work began in February at a time when the hospital had just endured the busiest winter on record, because of an increase in the severity and complexity of illness, higher rates of Covid infection for patients and staff, staff absences and vacancies, and high numbers of patients whose discharge was delayed.
The “front door” of the hospital, which includes the Emergency Department, Acute Medical Unit and Minor Injuries Unit, is currently included in a system-wide review of capacity and a redesign of services, while discharge processes are being streamlined to reduce waiting times to help prevent overcrowding and increase capacity.
Clinical and management teams from across the RIE hospital site have been brought together, under the Emergency Access Standard (EAS) Project Board, to address the significant pressures and identify solutions to prevent a repeat of similar issues this winter.
Patients will also continue to be reminded to seek the Right Care in the Right Place. If patients self-present at ED with a condition that is not a critical emergency they may be redirected to a more appropriate care service, such as Minor Injuries Unit, GP or local pharmacy.
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