Doctors call for major incident as hospital 'unsafe'

Patients had to wait outside the Queen Elizabeth University Hospital in ambulances

Senior doctors working at a Glasgow hospital have asked for a 'major incident' to be called this week but had their request declined, BBC Scotland News understands.

Emergency medicine consultants described conditions in the Queen Elizabeth University Hospital (QEUH) as "grossly" unsafe with no room to take in new patients on Monday evening.

NHS Greater Glasgow and Clyde said it has a "robust system" in place to deal with additional pressures which were implemented.

Last week, NHS Grampian declared a 'critical incident' because Aberdeen Royal Infirmary was full.

A critical incident sees a level of disruption to services at a local level that may put patients and staff at risk of harm.

In comparison, a major incident has a range of serious consequences that present serious threat to the health of the community, where an emergency responder's ability to respond is constrained.

'Considerable pressure'

Documents seen by BBC Scotland News describe the whole hospital site at the QEUH in Glasgow as being "completely overwhelmed" on Monday evening.

The emergency medicine consultants said a lack of capacity in accident and emergency left one patient waiting almost six hours in the back of an ambulance with a fractured hip.

At the same time five ambulances were on route and a further 19 expected to attend the hospital.

The document states that NHS Greater Glasgow and Clyde chief executive Jane Grant was involved in discussions about whether a major incident should be called, but it is believed she declined the request.

The health board say the situation was resolved without involving the chief executive.

NHS Greater Glasgow and Clyde said all of its services are under "considerable pressure" with the arrival of winter bringing additional challenges.

In a statement, the hospital's board said: "The A&E department at the QEUH has experienced particular pressures in recent days, and we would like to apologise to anyone who had to wait longer than they would have expected.

"NHS Greater Glasgow and Clyde has in place a robust system of escalation policies to help mitigate additional pressures, and these were implemented yesterday.

"The possibility of declaring a major incident was raised during a discussion around pressures on the department and hospital capacity, but given the mitigations that had been put in place that discussion was taken no further."

What is a major incident?

A health-related major incident is described as any occurrence presenting a serious threat to the health of the community.

It is defined in the Joint Emergency Services Interoperability Principles (JESIP) as: “An event or situation with a range of serious consequences that require special arrangements to be implemented by one or more emergency responder.”

It is likely to involve disruption of services and require the implementation of special arrangements by multiple agencies such as hospitals, ambulance, and primary care trusts.

All hospitals are required to have plans in place in the event of a major incident being declared. This might include measures such as non-urgent procedures being cancelled or ambulances being diverted.

Health boards can also declare business continuity incidents and critical incidents.

Last week, NHS Grampian said it had taken the "significant step" of declaring a critical board incident due to sustained and continuing demands on Aberdeen Royal Infirmary (ARI).

Patients requiring immediate life-saving care were still dealt with at ARI but other patients were diverted hospitals in Dundee and Elgin when it is deemed "clinically appropriate" to do so.

Some elective procedures and appointments were also postponed.

Health Secretary Neil Gray said "patient safety is paramount" following the critical incident.

He added: “This type of sustained pressure that services are facing is not unique to Scotland, similar challenges are being felt across the UK.

“While Scotland continues to have the best performing core A&E departments in the UK, performance is not of the standard we all expect."

Hospitals in Scotland have been facing growing pressures in recent years.

A review by Audit Scotland said fundamental change in how NHS services are provided in Scotland is "urgently needed" to cope with growing demand.