Staff shortages and stretched resources means healthcare services are facing their “most challenging” winter ever, NHS Fife’s chief executive has warned.
Carol Potter, who took up her role just as the Covid-19 pandemic began in January 2020, says the whole health and care system has been under “exceptional and relentless” pressure for the past 20 months, with that unlikely to show any sign of letting up over the next four to six months at least.
That, in turn, has led to pre-pandemic targets and standards in areas such as emergency access, delayed discharges and waiting times not being met.
Staff are reporting feeling exhausted and working in an environment of increasing demand, sickness absence and, despite best efforts to recruit, high vacancy levels.
The grim picture has been painted in an update to NHS Fife‘s board this week, although board members have been assured that all necessary actions to minimise risk to patients and staff were being taken as far as possible.
Ms Potter said: “We do not underestimate the extent to which the pressure could have a detrimental impact on patients and staff.
“Many of the issues are not new – the health and care system was under pressure before the pandemic – however, the situation has been exacerbated by Covid-19.”
What are the challenges?
Ms Potter says challenges facing NHS Fife and Fife Health and Social Care Partnership include:
- High numbers of Covid hospital admissions
- High volume of attendances at A&E
- Continuing high emergency admissions
- Capacity and sustainability challenges within primary care
- Difficulties in the flow of patients through the health system
- Physical constraints of many buildings that were never designed to enable the spacing and infection control aspects of Covid-19
A report to the board confirms that unscheduled attendances and admissions to hospital have increased, long waits in the emergency department have gone up “dramatically” in recent months, and elective activity is becoming “increasingly difficult” to maintain – running at just 79% of pre-pandemic activity.
The stepping-up of the combined flu and Covid-19 booster programme, described by Ms Potter as “arguably the most significant public health intervention in a century”, has not helped either.
And she added: “This is a political and public health priority and is viewed as the key route out of the pandemic and, whilst it has been delivered and continues to be delivered successfully in Fife, it is a significant logistical exercise which has required significant movement of staff to deliver.”2
Staff sickness absence has risen from 5.7% in October 2019 to 6.34% in October this year, and an estimated four out of every five absentees are off long-term.
Ms Potter continued: “It is evident within the current climate that we face staff shortages across many professions; with recognised acceptable staffing ratios often being difficult to maintain.
“This increases workload and places a level of personal pressure on individual members of staff in their commitment to fulfil their role to the best of their abilities.
‘Everything possible being done’ to address staff concerns
“NHS Fife recognises that listening to staff voices and dealing with concerns and issues in partnership is core to our ability to meet the current challenges and ensure everything possible is being done to address the difficulties being faced on a daily basis by our staff.”
Figures comparing October 2019 to October 2021 show that the percentage of people being seen at the emergency department within four hours has slumped from 90.2% to 70.3%, while delayed discharges stood at 121 last month compared to 92 two years2 ago.
A new operational escalation plan has been drawn up and will be implemented in the next 10 to 14 days in a bid to improve workforce capacity and patient flow.
“It’s about supporting decision making and having clear roles and responsibilities for staff at all levels,” Ms Potter concluded.
NHS Fife chair Tricia Marwick has hailed the “whole system” approach in the plan and thanked each and every member of staff for their ongoing efforts.
She said: “It shows that what we do in one area impacts on another and it’s important we get this whole system approach right.
“This is a moving feast – there’s no set point where we can say ‘this is it’ and there will be changes to be made, so we need to be able to react when circumstances change.”
