A damning report has criticised patient care at Victoria Hospital for still failing to meet the required standards in many areas.
A Healthcare Improvement Scotland study last December threw up a catalogue of issues surrounding the care of older patients in the NHS Fife hospital.
In one frightening case, it was revealed a frail elderly patient had received no food for 10 days because staff couldn’t fit a feeding tube.
Following that visit the organisation highlighted 11 areas where the service could be improved, and one area of strength.
But despite a detailed action plan being drafted by NHS Fife, an unannounced follow-up visit last June found there were still many areas where care was inadequate. The watchdog has now added a new area where the health board must pull their socks up.
The news has prompted MSP Claire Baker into demanding a robust NHS Fife plan to ensure confidence in the health service is maintained.
And she is calling on additional Scottish Government funding for the under fire NHS in Fife.
“Healthcare Improvement Scotland identified areas for improvement as far back as May last year, yet over a year later we are still waiting for all the recommendations to be addressed,” said the Mid Scotland and Fife Labour MSP.
“We have a state-of-the-art hospital in the Victoria but as the inspections highlight we are continually seeing weak areas, particularly around older people’s personal care.
“We must see a robust plan brought forward by NHS Fife management to address these weak points and ensure confidence is maintained.”
Mrs Baker added: “This must be backed through full funding from the Scottish Government and I’ve written to the health secretary calling for the money NHS Fife deserves.”
The latest visit was staged because of the concerns inspectors had about the routines at the hospital last December, particularly when it came to patients’ nutritional care and hydration.
Inspectors wanted to focus on the four areas for improvements relating to this aspect of care and took into account information supplied by the NHS in its 16-week improvement action plan submitted last April.
The team watched staff at work in three wards 13, 42 and 44 as well as care of the elderly and rehab, the stroke unit and general medical respectively.
They also interviewed patients and reviewed 14 patient records.
While it discovered there were areas where NHS Fife was performing well when it came to nutritional care for older people and was aware the board was committed to addressing the four areas of concern, inspectors said: “This was not reflected in our findings from this inspection.
“We found an inconsistent approach to nutritional care and hydration across the wards inspected.”
In one case a patient had not been nutritionally screened until 17 days after being admitted to the hospital.
Another patient, who was screened six days after arriving in hospital, did not get an updated care plan for another 20 days. Weighed while inspectors were on the ward, the patient had lost 6kg, meaning they were now classed at high risk of malnutrition.
And another patient was seen by a dietician, at the request of staff, 24 days after admission by which time a 19% weight loss was calculated.
Following inspection, recommendations are:
* Recording all patients’ weight and height and assessing them for possible malnutrition within 24 hours of admission;
* Developing personal nutritional care plans which must include information about help patients may need to take their meals;
* Monitoring food and fluid intakes and taking action if their intake is inadequate.
After the visit they also identified a new area to be improved.
This involves NHS Fife putting in place a multi-disciplinary and coordinated decision-making process which includes a clear plan of treatment and care for those with complex needs.
Such was the inspectors’ concern that they asked for NHS Fife to carry out an immediate review of all patients in ward 13 to provide assurance the correct care was in place. That has been carried out.
They also asked for a review of ward 42 where concerns were raised about the care and management of a patient with a feeding tube. NHS Fife accept there were issues but was satisfied the patient’s care met accepted standards.
One area which had improved was protected meal times, where non-essential interruptions had been reduced.
Acute services director Heather Knox said: “NHS Fife has been working hard to address the issues raised and progress is being made. We are pleased that the report highlights the improvements made to the management of patient mealtimes, the calm and organised manner of lunchtimes on our wards, and the positive input of our dietetic services and speech and language therapists.
“We acknowledge that at the time of the inspection there were inconsistencies of approach in certain areas these are being actively addressed through a number of initiatives. An action plan has been developed and agreed with Health Improvement Scotland.
“We are committed as an organisation to building further on the work currently under way and I am grateful to our staff for their tireless efforts.”