Health Board Fears Over U-turn On A&E Closures

The cost of saving Scottish accident and emergency departments came under the spotlight yesterday with warnings that the move will cost millions and require hundreds of extra doctors.

Executives at NHS Lanarkshire and NHS Ayrshire and Arran have been tight-lipped since their plans to downgrade A&Es were overturned by the SNP-led government.

At separate health board meetings yesterday, however, both authorities debated revised proposals for the future of hospital services.

Different ways of keeping the threatened A&Es open were discussed along with the impact they would have on budgets and other front-line care plans.

NHS Lanarkshire had agreed to downgrade Monklands Hospital in Airdrie amid concern about staffing. The board has the highest number of consultant vacancies in Scotland and there were fears that services could collapse if they did not plan to concentrate specialists on fewer sites.

Tim Davison, chief executive, told the board some of the options now proposed for keeping a full A&E at Monklands would require 240 extra trained doctors.

He questioned how they would recruit them when they might not be keen to work for an authority with services spread across three hospital sites.

Lanarkshire consultants are on call one weekend in four because they work at several hospitals. In other areas, the health board was told, specialists are on call one weekend in 10.

The importance of securing more trainee doctors over the coming years to support Monklands was emphasised by board members.

Concerns about the bill for the plans were also raised. It is estimated some of the options for emergency care now on the table in Lanarkshire would cost more than £300m to set up. Yet the health board spoke of receiving a relatively small budget compared with other health boards and there are fears of squeezes following the government spending review.

Staff, represented by NHS Lanarkshire’s area medical committee, also expressed reservations about the shake-up in a letter.

The plan to downgrade Monklands was part of a package of changes called Picture of Health which included developing community medical services. Anything less than this plan, the letter says, may be regarded as “sub-optimal”.

As yet it is unclear which community developments in Lanarkshire could be jeopardised by preserving Monklands A&E, though improvements to adult mental health services to meet new legislation are said to be at risk.

This question is due to be thrashed out over the coming weeks.

NHS Ayrshire and Arran is embarking on a similar process regarding the reversal of its plan to downgrade Ayr Hospital A&E.

This too was part of a package which would have created new community treatment facilities.

Now that a full A&E is to be preserved, the board meeting talked about the threat to the other projects.

Members raised concerns about what the proposals would mean for plans to have new casualty departments in Irvine, Cumnock and Girvan.

Professor William Stevely, chairman of Ayrshire and Arran NHS Board, said: “Ayr and Crosshouse A&E is the priority. Irvine is in every model except the status quo and to change its status would impact on the handling of patients elsewhere. The bottom line is A&E services.”

Both boards are due to submit reports outlining their revised plans for emergency services to an independent panel by the end of this week.

Final solutions will be agreed by the boards in January with the ultimate decision on what emergency services look like in the two board areas to be taken by Health Secretary Nicola Sturgeon.