Concern over NHS equipment decontamination service

Units that sterilise surgical equipment in Scotland's hospitals do not have enough capacity to deal with major breakdowns, health officials have warned.

Support from a service in Liverpool was recently needed to maintain part of NHS Scotland's sterilisation service.

And NHS Lothian has warned there is not enough contingency in the system.

NHS Scotland said decontamination services were facing "capacity challenges" and a review was under way.

Last year, the majority of scheduled operations in NHS Lothian had to be postponed for nearly a week because of a leak in its Hospital Sterilisation and Decontamination Unit (HSDU).

The HSDU is based at the Royal Infirmary of Edinburgh and processes about 400 trays of surgical instruments a day.

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An internal NHS Lothian report released to BBC Scotland shows there is a "very high" risk that the HSDU is unable to meet current or future capacity demands for theatre equipment due to physical space limitations of the current department and lack of staff, leading to the possible of closure of operating theatres.

The report also adds that, "it is not anticipated that external providers alone would be able to provide enough contingency in the event of an outage, to cope with the volume of trays to be processed".

Minutes from two recent meetings of the NHS Lothian's finance committees state the board's HSDU challenge "was similar" to other health boards, adding, "particularly larger boards where there was not enough capacity elsewhere in case of failure".

The minutes also note, "there appeared to be a lack of resilience within NHS Scotland which had been demonstrated by the recent need to seek support from Liverpool to maintain critical HSDU services".

The hospital decontamination and sterilisation unit at the Royal Infirmary of Edinburgh provides sterile equipment for 60 theatres across all of NHS Lothian's hospitals.

A spokesperson for NHS Scotland Assure, part of NHS National Services Scotland, said the strategy for decontamination arrangements across the health service was currently being reviewed at a national level.

They said: "A dedicated decontamination collaborative programme was set up to address capacity challenges, identify opportunities to increase resilience and optimise service.

"Health boards have a contingency and resilience plan. This includes the use of neighbouring NHS facilities as priority and alternative available facilities when necessary."

Part of the challenge facing many boards is the labour-intensive processes around sterilising used hospital equipment and staff shortages.

'Much more to do'

Morag Campbell, director of estates and facilities at NHS Lothian, said: "There are significant issues with physical space limitations in the current [HSDU] department and a shortfall in staff to maintain and repair key equipment.

"A detailed plan is in place, overseen by robust governance processes, to make the necessary upgrades.

"Although we've made important progress in recent months, this remains an ongoing process and we recognise there is much more to do to ensure both the short and long-term functionality of the HSDU."

NHS Lothian is putting in a bid for Scottish government money to build a new HSDU facility but it is thought it will be at least 2026 before this is completed, if approved.

The health board has replaced some of the machinery in the existing HSDU to increase its resilience.