HOSPITAL staff in the Scottish capital have been working in a pressure-cooker environment with too few employees to cope with demand, according to the health board's new chief executive.
Tim Davison, who was given the top job at NHS Lothian earlier this month, said he is planning to hire more than 200 new staff, including nurses and doctors, in order to look after the growing population.
He listed inadequate staffing and a problematic relationship between health board managers and the high- profile university hospitals as the major issues he has uncovered since he arrived at the board.
Mr Davison was parachuted in to run NHS Lothian on an interim basis last year when it was rocked by a scandal over the fiddling of waiting times and allegations of bullying. Officials were caught wrongly categorising patients as unavailable for treatment to make it look as though Scottish Government targets were being met, when thousands of people were actually queuing for treatment.
In one of his first interviews since he was given the position of chief executive on a permanent basis, Mr Davison said: "It was a real pressure- cooker environment. I can understand why people felt under enormous pressure to deliver when demand is growing and your capacity to deal with your demand is not."
Like all health boards, NHS Lothian has had to cope with rising public expectations of treatment and the needs of a growing elderly population at a time of shrinking budgets and shorter working hours for doctors. However, Mr Davison said on top of that, the number of people living in the region had grown 10% in 10 years, but the hospitals had not been given 10% more services or 10% more beds.
Asked why, when NHS Lothian had been allocated extra money to reflect inward migration, capacity had been allowed to fall behind demand, Mr Davison said he could only guess.
He added: "I think probably there was an expectation that you could drive more efficiency out of the system than we have managed to achieve." However, he also said in some hospital departments "over a period of years" the real number of patients who needed treatment was being withheld, concealing the size of demand.
He continued: "Because in a number of specialities the information was being manipulated, it was not apparent until the lid got lifted on the thing that actually what got exposed was a very significant problem."
Now he says, although the percentage of patients who have waited longer than they should have done for consultations or treatment is just 2% of the total workload, it will take years to solve the problem. Recruiting the extra staff to increase capacity so the hospitals can cope with ongoing demand, even once the backlog is dealt with, may not be straightforward.
Mr Davison, previously chief executive of NHS Lanarkshire, said: "We cannot recruit enough theatre nurses locally in Scotland.
"We have a recruitment campaign throughout the UK trying to attract theatre nurses to come and work in Edinburgh."
Restrictions on hiring medical staff from countries outside the European Union was also a "real problem", he said.
Mr Davison added: "I want to talk confidently that this thing will get fixed and I do genuinely believe that we will fix it, but I do not want to be heroic about how quickly we will fix it."
Two independent reports have been published on NHS Lothian's waiting times scandal: the first spoke of a culture which involved the suppression of information and an "oppressive management style"; and the second revealed a "blame culture" where the board's anti-bullying policy was breached, bad news was buried and a "gloss" was put on reports.
The previous chief executive, Professor James Barbour, 59, announced he was stepping down from his post with immediate effect days before the interim findings of the second report were released.
Audit Scotland is investigating whether the practice of manipulating waiting times figures is more widespread, and its report will go to the Scottish Parliament after the summer recess.
More details about Mr Davison's plan to invest in 200 extra staff will be presented to NHS Lothian's board members in September.
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