Call for '24/7' hospital expertise to tackle growing pressures

Senior hospital medics should be available round the clock and patients must be treated in the right wards in the shortest time, doctors have urged.

The recommendations came from the Royal College of Physicians of Edinburgh, during a conference on improving acute services under times of pressure.

A report to the conference highlighted growing demand, an ageing population and increasing complex conditions.

The Scottish government said the review backed work already taking place.

Health Secretary Alex Neil told the Sunday Politics Scotland programme the Scottish government was determined to eliminate the practice of "boarding" patients in the wrong wards. Mr Neil also set a target of moving the NHS to a full seven day operation, to better manage the flow of patients.

A £50m emergency care "action plan" introduced by the government earlier this year is running over three years to speed up admissions and create more options for community treatment.

Dedicated teams

Over the past five years there has been an increase of almost 7% in A&E attendances and these could increase 13.5% by 2020.

Recommendations from the Royal College of Physicians of Edinburgh include:

• an extension of seven-day working by clinicians and support services in hospitals and the community in order to meet demand

• working towards eliminating "boarding" - when patients are moved to wards inappropriate for their care when hospitals are busy

• patients must be seen immediately by the right, competent, clinical decision-makers

• there should be a named professional with responsibility for the patient's care

• every acute medical unit must have a dedicated multi-disciplinary team.

Research has indicated that being treated in the wrong ward can lead to patients being more likely to die and the senior clinicians at the College said hospital bed and staff capacity must be aligned to meet demand.

Nigel Edwards, chairman of the Royal College of Physicians of Edinburgh consensus panel, said: "Growing demand from an ageing population with increasingly complex care needs bring both challenges and opportunities for the NHS.

"It is clear that in seeking to respond to the urgent care needs of this population fundamental change is required.

"This will involve changing how the NHS configures and delivers acute medical services and, in this post-Mid Staffordshire era, encouraging the NHS to have the ambition to eliminate established practices which are known to have adverse effects on patients and their experiences."

A paper to the conference called for seven-day and extended hours working in hospital and across the system, with senior clinical decision-makers "available 24/7".

The Scottish government plan, announced in February, aims to improve the "flow" of patients through hospitals, ensuring clinical expertise is in place to support this at all times.

It is also designed to ensure senior doctors are always available at crucial points of assessment, treatment and transfer of patients.

Neglect legislation

Mr Neil told the BBC getting patients treated in the right ward at the right time was crucial.

He said: "I'm absolutely determined that this is one of the priorities - and has been a priority for the last year in particular - in improving the management of our bed capacity in hospitals.

"Let me say we've actually slightly increased the capacity in the last year and there are today 400 more beds in the National Health Service in Scotland than there were 12 months ago."

The health secretary also indicated he was "minded" to mirror legislation proposed for England and Wales, in the wake of Mid Staffordshire and other care scandals, which could see doctors and nurses found guilty of "wilful neglect" of patients facing jail.

Mr Neil said: "I think there's a lot of sense in extending the legislation that we already have for vulnerable adults to everybody in these extreme cases, so that if it did happen in Scotland, we would be able to do the necessary.

"But obviously we need to look at the implications but I am certainly minded to introduce that legislation in Scotland."