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Urgent need for review of NHS emergency care

NHS staff are good at dealing with stress and underfunding - they have had plenty of practice.

Even so, yesterday's scathing report by Healthcare Improvement Scotland (HIS) into the quality of hospital care in NHS Lanarkshire starkly illustrates how inadequate staffing can impact on patient care.

The report reveals how at weekends in Monklands at-risk patients are often reviewed solely by medical trainees in the early stages of training, how patients on medical wards could potentially go up to two weeks without seeing a senior doctor if their consultant is on holiday and how problems with staffing are regarded as so difficult to solve, that variable care is simply tolerated. Inadequate checks on deteriorating patients and nurse shortages were all highlighted.

Is NHS Lanarkshire alone in experiencing these problems? Apparently not. Dr Neil Dewhurst of the Royal College of Physicians in Edinburgh believes the commendably frank HIS report will strike a chord with other clinicans around Scotland.

What can be done? The health secretary Alex Neil insists that the issue is not the overall number of consultants or nurses, but the management of the resources that already exist. Improving that should of course be the priority and experts are to be sent in to help.

Nevertheless, NHS staff are likely to find the health minister's response inadequate. Pressures on the NHS are increasing as the population ages and the cracks are already starting to show, as The Herald has highlighted in its NHS: Time for Action campaign. Experts in health and social care from organisations across Scotland who recently came together to discuss the problem in a summit hosted by The Herald declared that an honest debate was required as a priority about how to fund the NHS. There is clearly a need for better management of resources that already exist, but it is wishful thinking to imagine that staffing and resource problems can be solved independently of a debate on funding.

Politicians must not shy away from considering the underlying causes of the problems affecting NHS Lanarkshire. The SNP Government's decision to block the closure of Monklands A&E after the election in 2007, a decision The Herald backed, was based on public opposition to the closure plan and the notion of travelling further to A&E, and concerns about how other A&Es could become overloaded if Monklands shut.

Keeping all three open may still be the right approach, but the view of emergency consultants cannot be ignored and they say they cannot continue to run three A&E departments around the clock. Tempting as it may be for politicians and indeed newspapers to ignore that warning, they must be prepared to listen even when what is being said is difficult to hear. It may be that the way existing A&E services are run in the area can be improved; an increase of funding would no doubt help; but the first step should be a review of unscheduled care which is undertaken with an open mind, in the best interests of patient care. Quick fixes will only defer problems, not solve them in the long term.

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