Recent Concerns regarding the Galloway Community Hospital.
There are two issues that have attracted public concern:
- The Emergency Department
The Emergency Department (ED) handles approximately 12,000 cases per year. It is staffed by a suitably qualified doctor and experienced ED nurses. In addition to that, the ED doctor can call on the services of an on-call anaesthetist if he is faced with a need to ventilate a severely ill or injured patient. Alternatively, the ED doctor can seek help from the Emergency Medical Retrieval Service based in Paisley: This service is manned by consultant level staff 24 hours a day and has a helicopter on stand-by able to rapidly transfer medical staff to the Galloway and transport seriously ill patients to Glasgow Hospitals.
The Emergency Department has good working relationships with Scottish Ambulance Service paramedics based in Wigtownshire, who are often faced with critical decision making, deciding whether to transport patients to the Galloway Community Hospital for stabilisation, or to transport them direct to Dumfries & Galloway Royal Infirmary where definitive treatment is available.
Anaesthetic on-call cover used to be provided by two anaesthetists who lived in Stranraer. One retired several years ago and the other last year, and it has not been possible to recruit replacement anaesthetists. As a result, the 12 hour shifts in the rota have been staffed by locum consultants and by consultant anaesthetists from Dumfries & Galloway Royal Infirmary.
We have had increased difficulty recruiting locum anaesthetists to the Galloway, which reflects a national shortage of locum consultants. In addition, with 3 vacant posts in the anaesthetic department in Dumfries & Galloway Royal Infirmary we have had difficulty in rotating consultants out to the Galloway Community Hospital. Obviously sending an anaesthetist out to the Galloway Community Hospital could result in theatre sessions in Dumfries & Galloway Royal Infirmary being cancelled – causing distress to a number of patients (some of whom could have come from Stranraer.)
In the last month there have been 3 occasions where an anaesthetic shift has not been covered as a result of failure to recruit locum doctors. In these cases the impact has often been reduced by a doctor staying on longer after his shift ended, or a doctor agreeing to arrive earlier for the start of the next shift. The dates when there was no anaesthetic cover were overnight were 4th July, 5th July, 6th July and 11th July 2017.
I would like to stress, however, that at no stage has the Emergency Department been closed. It has not been “downgraded to a Minor Injuries Unit” – the usual doctors and nursing staff were present and seeing patients normally. Children with asthma or patients with fractures for example could still be treated normally. While we regret that we were not able to provide the fall-back cover of an anaesthetist it should not be concluded that this was from lack of trying – we have spent a total of £1.5million on providing medical locum cover for the hospital in the year to April 2017 and will continue to maintain a rota for the foreseeable future.
Being truthful, I cannot give an absolute guarantee that we will never have this situation again. We will, however, continue all efforts to recruit anaesthetists both to Dumfries & Galloway Royal Infirmary and to the Galloway Community Hospital and it is likely the situation will ease as locum availability improves after the holiday season. However, we do face a very difficult medical workforce market. I can confirm that we have a working group led by the Deputy Medical Director working on efforts to improve our recruitment and retention in a highly competitive market.
- The In-Patient Wards
You will be aware that there are two in-patient wards in the Galloway Community Hospital. One ward, the Garrick Ward, deals with more acute medical cases, whilst the other, the Dalrymple Ward, tends to deal with rehabilitation cases and care of the elderly.
Arranging a safe level of nurse staffing in the wards has been made difficult recently by 4 longer-term vacancies, and more recently by 3 nurses forced to take sick leave. The nursing staff have worked exceptionally hard and flexibly providing extra shifts to help maintain the full service. However, a decision was taken to move all patients into one ward (the Dalrymple Ward) for the period 5th – 12th July 2017, in order to allow for safe nursing levels to be maintained and for patients to be treated with dignity and compassion. This was achieved by declining admissions to the Dalrymple ward for a week prior to this to allow the numbers of in-patients to decrease as patients were discharged. During the period when the two wards were combined it was possible to admit acute patients to the ward from both ED and from GPs.
I am glad to say that following a very intensive weekend recruitment drive we have now managed to appoint to nursing posts and the new staff will start in September 2017, easing the pressure on ward staffing.
A statement from the General Manager was emailed to Councilors in Wigtownshire on Tuesday 4th July 2017 informing them of the situation.
A Senior Manager is carrying out a review into the Galloway Community Hospital at the request of the Chief Executive. The remit is to look at how services can be made more resilient and sustainable and to consider what services could be increased in the hospital, particularly out-patient appointments, diagnostic investigations and day-case surgery. Increased services in the Galloway Community Hospital may, however, be delayed if we remain unable to recruit consultants to the region.
The Health Board is committed to the Galloway Community Hospital. This is evidenced by the fact that we have budgeted for routine renovation and equipment upgrade of the theatres and a renovation of the dialysis unit later this financial year. In addition, further money will be spent in the Galloway Community Hospital on equipment for endoscopic examinations.
On a personal level, I feel that ultimately, the stability of services within the hospital relates directly to medical recruitment in a very difficult recruitment environment where we are forced to compete with hospitals across the UK. The Board will continue to work hard to recruit to what are unfortunately
perceived as professionally isolated and clinically challenging posts. I believe that there is a role for community leaders of all persuasions in helping to promote very positive messages about the hospital, the community and the environment to help us attract the best possible staff to the area.
Again on a personal, and professional, level I feel it is extremely important that none of us unnecessarily promote avoidable anxiety or confusion in patients and the public. I think it is, therefore, important that the language we use in public fora is accurate at all times. The Emergency Department has not been closed and patients should attend there as normal. They will be treated by suitably qualified doctors and trained nurses. They should not be led to believe that they are required to travel to the Emergency Department in Dumfries & Galloway Royal Infirmary. Patients who are mistakenly led to believe that may make seriously inappropriate decisions to delay seeking help or travelling to Dumfries – decisions that could have significant adverse effects on their health.
Dr Angus Cameron is Board Medical Director for NHS Dumfries and Galloway