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HEALTH MATTERS: Hospital pressures are also affecting Raigmore's A&E

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Mike Rennie is Service Clinical Director Accident and Emergency.
Mike Rennie is Service Clinical Director Accident and Emergency.

As is being frequently reported, emergency departments (A&Es) across the country are under significant pressure, and the department at Raigmore Hospital is no different.

Covid provided us with a lot of significant challenges, even when our attendance numbers dropped during the lockdowns. With everyone, quite rightly, returning to all their normal activities, A&E attendances have steadily climbed – continuing a trend that was in place before Covid – such that we’re now seeing more patients than ever before.

We’re also seeing patients with a greater complexity and severity of illness. Factors contributing to this include the ageing and at times frail population often presenting with conditions for which they may have postponed seeking assessment during Covid.

Unfortunately, many patients requiring admission face lengthy waits in A&E for a bed in the hospital. In A&E we call this ‘access block’ due to lack of movement (flow) of patients into appropriate wards and ultimately out of the hospital and back into the community. In common with other health boards, there are national shortages of staff, making it difficult to recruit colleagues to staff beds and to provide care in the community.

As a result, we can, at times, have all of our clinical spaces for seeing patients occupied with patients backing up in our crowded waiting room and others waiting in ambulances outside. Having said that,it should be appreciated that a quiet waiting room does not mean the department is not exceptionally busy dealing with a lot of very sick patients.

This is a situation none of us want to see and are sorry for the impact this has on both patients and staff. We have been highlighting our concerns for some time. Action has and continues to be taken, including reconfiguring wards and launching a recruitment drive, to try and tackle these flow problems.

When flow problems exist we have to try and prioritise those patients with greatest need or risk of immediate harm. Unfortunately, therefore, some other patients will be subject to extensive waits. We understand the frustration that long waits generate but would ask for your understanding. Please be patient and kind to staff who are working hard in very challenging conditions. Staff members are and have been remarkably resilient so it may not be apparent just how much stress they are actually under when looking after you, your relative or others.

One of the most significant ways you can help is to consider if your attendance at the emergency department is really required or if there are alternatives that you might use, such as pharmacy, GP, minor injury unit or advice from NHS 24 on 111. Indeed calling 111 may mean they can direct you to alternatives or, if they feel you do need to be seen in the emergency department they may be able to schedule a better time for you to attend – minimising A&E crowding and your wait.

This is another reason why you might see patients in the waiting room who appear to be seen sooner than you might have expected: they may have called 111 and been given a specific time to arrive. It is perhaps also worth pointing out that A&E is not designed or set up to be an alternative to GP services – even though we know those services are under immense pressure too.

If you need emergency care, please be reassured that A&E staff will give their best to deliver that care. The challenge ahead is restoring flow to the whole health and social care system.

n Mike Rennie is service clinical director at Accident and Emergency.

Raigmore Hospital ambulance health locator...Picture: Gary Anthony..
Raigmore Hospital ambulance health locator...Picture: Gary Anthony..

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