The doctor will hear you now: Appointment by phone plan to ease ERI strain

NHS Lothian chief executive Tim Davison claims increased use of telehealth would free up medical experts and allow patients greater flexibility.

The proposal is just one plank supporting a wider blueprint aimed at getting the flagship hospital back on track.

Overall, the health chief wants to create room for up to 160 new beds at the ERI to ease the intense strain that the hospital has found itself under.

His proposals could see outpatient services shifted from the hospital to make room for inpatient assessment beds, which would be mainly used for the soaring numbers of frail and elderly.

Concrete plans to create 80 new beds by the summer in areas largely used for offices are already in place, and Mr Davison revealed that the same number again could be added in the coming years as part of a major redesign, which has been deemed necessary just ten years after the state-of-the-art facility opened its doors.

Outpatient services, offices and training rooms could be transferred to new permanent or temporary buildings on the hospital site or out of Little France entirely, while the health board could make use of space in the neighbouring BioQuarter. And the health service is also planning on increasing its use of telehealth services, which would see follow-up consultations with some patients carried out by telephone, rather than face-to-face, as part of an annual £20m year-on-year investment to boost the number of patients the health service can treat.

Mr Davison, who took over as permanent chief executive four months ago, said: “The fundamental issue is we have a lot of space that is only used part of the time in the hospital. Outwith Monday to Friday 8am to 5pm, we have acres of space in the Royal Infirmary that’s literally empty and the lights are turned off. If the hospital is under the pressure that it’s under, it would seem sensible to say is there another way of doing things that would allow us to use the space for inpatient services which are of a higher priority.

“We’ve got firm plans for the first 80 beds. We will also, during the next year, have a look at whether the potential for a further 80 beds is something we want to pursue.

“There is some thought being given as to whether we could displace more outpatient services which are in the main Royal Infirmary building and provide these elsewhere – either by building a new outpatient building on site, by moving outpatients to the BioQuarter next door, and potentially by reorganising how we do outpatient services, perhaps by using telehealth and telephone consultations rather than face-to-face consultations.

“You might come and see your doctor face-to-face, have tests, and be asked to come back in a month for a review. It’s not going to happen tomorrow, but it might well be that the consultation could be done over the telephone.”

Referring to the plan for 80 additional beds on top of those to be added next year, he said: “It may well be a medium-term plan over the next three to five years, but we have the in-principle view it might be possible.”

Mr Davison admitted that this year, the ERI has been the poorest performing major hospital in Scotland against a Scottish Government target, which states 98 per cent of emergency patients should wait less than four hours from arrival to admission, discharge or transfer for accident and emergency treatment. This month, NHS Lothian has hit the target just 77 per cent of the time, and on one day managed just 56 per cent.

Health Secretary Alex Neil last week told MSPs at Holyrood the hospital, which has around 1150 staffed beds, had been too small by one-fifth when it was built and criticised the original design.

Mr Davison said 630 patients per day use accident and emergency facilities at the ERI and St John’s Hospital, Livingston, 4000 outpatients are seen daily weekdays by NHS Lothian and an average of 200 people a day are admitted to Lothian hospitals as emergencies.

He said the pressure on services will not fall in coming years, with a rocketing elderly population who often have complex needs. The region’s population is predicted to rise by ten per cent in the next 
decade, while the number of over-75s will go up by 22 per cent by 2020. In 20 years, the number of patients with dementia will surge by 70 per cent.

NHS Lothian has already reopened the mothballed Royal Victoria Hospital this year to ease pressure, while extra beds at the Western General Hospital, Corstorphine and Liberton hospitals have also been found.

Mr Davison said: “Our capacity problems in unscheduled care – the ability of health and social care services to respond to emergency care for our citizens – are as great as our problems in elective care. It’s just that they weren’t as immediately apparent.

“The Royal Infirmary is under particular pressure and our ability to discharge patients quickly has really been compromised. We were criticised in the standards of care for older people inspection at the Royal. They [the inspectors] were generally witnessing older people not being treated with sufficient dignity or respect and it was clearly not good enough.

“But it is a manifestation of the fact the hospital is not designed to care for the numbers of frail older people with multiple conditions and complex social care problems, many with dementia, and that’s why we’re redesigning the Royal Infirmary to try and create extra general admission beds for these very frail older people.

“We have now begun to plan for long-term inpatient expansion. Over the next two to three years the expansion in waiting times and unscheduled care capacity will amount to £20m a year. That’s an enormous investment.”

The redesign will take place as work begins on the new Sick Kids building, which will also house the health board’s Child and Adolescent Mental Health Service the Department of Clinical Neurosciences, and will “plug in” to the ERI.

Initial construction work is due to start in the new year.

But Mr Davison admitted plans for the new beds will be complicated by the PFI contract with Consort, the company that built, owns and runs the ERI.

NHS Lothian, while having an above average funding increase compared with other health boards, must still make substantial budget cuts.

He added: “We are under a very austere financial cloud. We still require about three per cent per year cash savings. At the same time we’re investing these massive sums of money in our new things like new capacity, we also need to make efficiency savings of about £30m a year. It is difficult.”

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Early warning given over size

CONCERNS over the size of the Royal Infirmary are not new.

When the hospital moved in 2003, the number of beds was slashed from more than 1000 to about 900.

In 1999, prominent MPs had added their voices to warnings from the British Medical Association, which said it believed planners had overestimated how quickly patients would be treated and that they were adopting a “high-risk strategy”.

But regional bosses insisted they had their sums right.

In 2001, Allister Stewart, chief executive of Lothian University Hospitals NHS Trust, said the new ERI would be “the best thing to happen to Lothian health services in 50 years”.

MSPs give plan cautious welcome

THE prospect of new beds at the Royal Infirmary has been welcomed by MSPs today.

But Lothians Labour MSP Sarah Boyack said she would push the government to offer more financial support to the health board for it to carry out its plans.

She said: “There’s clearly insufficient capacity to deal with the massive pressures that NHS Lothian is currently facing. There are also challenges in relation to providing care for patients who are ready to be discharged so that they receive appropriate care when they leave hospital.

“But these changes will cost money which NHS Lothian clearly doesn’t currently have.”

Independent Lothians MSP Margo MacDonald added: “It seems to me that Tim Davison is on the right track. It’s great that the Royal Victoria is up and running again but we need a longer-term answer.

“I’m sure there will be a place for telehealth in the future but now I’m concerned about the basics – and that’s getting more beds in the right places.”