Urgent injury patients have been asked to make appointments for care instead of turning up to A&E centres in Edinburgh and the Lothians. The new urgent appointment system was announced at the start of the month as health bosses warned of mounting pressure on NHS Lothian, including A&E departments.
The new system is specifically for patients with urgent injuries such as strains, sprains, suspected broken bones, wounds, burns, stings and bites. Urgent care patients in Edinburgh and the Lothians are asked to call NHS 24 on 111 to make an appointment with one of Lothian’s Minor Injuries Units instead of turning up to A&E centres.
Health bosses praised the news system for helping patients get the right care in the right place and help relieve pressure on hospitals. But some slammed the move as the consequence of "years of chronic underfunding."
“The new appointment system for urgent injuries is a reflection on how bad things have gotten,” said Miles Briggs, Scottish Conservative MSP for Lothian.
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"SNP and Green Ministers have utterly failed in alleviating A&E waiting times, putting patients and NHS Lothian staff at risk. The pandemic has undoubtedly impacted waiting times, but years of chronic underfunding from SNP Ministers has left NHS Lothian vulnerable.”
Scottish Labour MSP Foysol Choudhury for Lothian Region said the local waiting times at Lothian A&E departments have reached historic highs.
“The Scottish Government’s target of dealing with 95 percent of A&E patients within four hours has not been met since July 2020,” he said.
“The last year has seen a precipitous drop in compliance with this target within NHS Lothian, which currently sits at 65% of A&E patients being seen within four hours. At the Royal Infirmary, this figure is currently around 50%, one of the worst in the country.”
However, a spokesperson for the Scottish Government defended both the Scottish NHS and the new appointment system. The spokesperson claimed Scotland continues to have the best performing A&Es in the UK for six years running.
Additionally, the government spokesperson claimed the new appointment system will relieve pressures from hospitals and NHS staff as a new surge in Covid-19 continues to reduce hospital capacity and inflate staff absences.
“Our new Urgent and Unscheduled Care Collaborative programme, supported by £50 million, will support the implementation of a range of measures to reduce A&E waiting times and improve patient experience, including alternatives to hospital-based treatment,” a government spokesperson said.
“We encourage people to think carefully before going to an emergency department and for many A&E will not be the right place for their healthcare needs. People should consider whether their condition is an emergency, such as a stroke, heart attack or major trauma. NHS 24 is available for those who think they need A&E but it is not an emergency.”
Choudhury welcomed the new appointment system. However, he believes it will only have a significant impact on overall waiting times if the system – including the NHS 111 – is properly resourced and staffed to cope with demand.
“When I speak to NHS staff, they often feel overwhelmed by the stress of the pressures on the NHS, the fact that this and long waiting times often lead to them being abused at work, and the fact that staff absences are being compounded by repeated waves of Covid-19. NHS staff must be better supported by the Scottish Government to weather this storm before morale within the workforce collapses completely,” said Choudhury.
“The Scottish Government must get a grip on what is turning into a year-round crisis in our health service. The latest figures only make it more disappointing that they are taking their eye off the pandemic recovery they promised the Scottish people only last year to once again focus on constitutional arguments.”
Gillian McAuley, Acute Nurse Director of NHS Lothian, acknowledged that the NHS is currently under some of the most severe pressure it has ever endured, and patient waiting times have increased across the board — especially in emergency departments.
“We know that some of those patients waiting in A&E could be seen sooner in our MIUs. We want patients to get the Right Care in the Right Place which in turn will help to reduce the pressures at our A&E or ‘front door’, as we call it,” she said.
“Nobody thinks of their injury as minor, especially if it is painful. But our expert MIU teams treat a huge range of urgent injuries. By separating patients with urgent injuries and those in an emergency, we can make sure that everyone can continue to access high quality, patient-centred care when they need it most.”
When patients in Lothian call 111, a trained advisor will now take all of the details and refer them for a triage assessment with a clinical coordinator from NHS Lothian.
The patient will then be given a treatment slot for later that day or the following day at one of three MIUs – St John’s Hospital, Livingston, the Western General Hospital or the Royal Infirmary of Edinburgh.
Consultations are carried out via video call or during a face-to-face appointment in the MIU depending on the needs of the patient.
An NHS Lothian press release revealed local teenager Madison Maben, 15, as one of the first patients to use the new appointment system. Maben injured her ankle at her home in Livingston. To avoid A&E queues, Maben and her mother rang NHS 24 at 111.
Maben said a nurse phoned her back within 10 minutes to give her an appointment, and she was invited to a face-to-face appointment at MIU in St John’s Hospital.
“I would definitely recommend phoning 111, it was my first time using this process this morning and Madison was seen really quickly. I wouldn’t hesitate to phone them again if I needed them,” Maben’s mother said.
The appointment-based system made its debut on June 27 days after NHS Lothian warned of mounting pressure on hospitals and community services as increasing Covid-19 numbers once again create capacity issues across the whole system.
If people think they need to visit A&E, but it’s not life threatening, they should call NHS 24 on 111 first, day or night. If it is an emergency, always call 999 or go to the closest A&E.
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