HOSPITAL emergency services that became the focus a public campaign are now facing such staffing shortages that plans have been drawn up to divert patients elsewhere.

With the future of the NHS at the centre of the independence campaign, official NHS Lanarkshire papers warn that ongoing ­vacancies and skills gaps mean frontline medical staffing in the region - which has three A&Es - is "fragile".

Contingency arrangements have been designed that would divert some of the sickest patients away from one of the A&Es for up to two days in the event there are not enough experienced doctors to look after them safely.

"Medium-term" contingency plans, to be introduced in the face of a deepening staffing crisis, are also being discussed.

NHS Lanarkshire previously tried to cut the number of A&Es from three to two, agreeing to downgrade the service at Monklands Hospital in Airdrie after a long consultation that also investigated closing the A&E at Hairmyres in East Kilbride.

Nut when the SNP won the Holyrood election in 2007 they saved Monklands and declared a presumption against centralising hospital departments.

Campaigners welcomed this, but last year an investigation into high death rates at Monklands raised concerns about the quality of care in Lanarkshire hospitals.

The latest papers raise grave concerns about shortages of ­medical staff, with the consultant rota for Wishaw A&E described as "exceptionally fragile". The number of trainee ­specialists is said to be "under considerable strain". While there is a shortage of emergency medicine specialists UK-wide, according to the report NHS Lanarkshire faces extra recruitment difficulties as other health boards can offer doctors the chance to work in a larger team, with more training ­opportunities and a better work-life balance.

An advertising campaign seeking emergency medicine staff in Australia and New Zealand failed to yield any candidates and a second search in Europe is under way.

A spokesman for NHS Lanarkshire said: "Within Lanarkshire we routinely operate as an emergency clinical network, so that when a hospital is experiencing an exceptionally high rate of emergency admissions, we have the opportunity to redirect patients between our hospitals to ensure that patients receive the treatment they require without delay. This is usually done for a period of hours during peak demand.

"However, due to the national difficulties in recruiting medical staff to A&E departments, there may be an occasion where a hospital is experiencing high levels of activity and there is a shortage of senior clinical staff on site which would create sustained pressure within that hospital.

"In order to ensure that patient safety would not be compromised in such a circumstance we have undertaken a piece of work to develop business continuity plans to manage the redirection of some emergency patients for up to 48 hours.

"In the unlikely event that such a plan is implemented we would like to stress that an A&E department would never close its doors and would continue to provide a service for self-presenters, patients with minor injuries, and GP out-of-hours care".

A spokeswoman for the Scottish Government said NHS staffing and consultant numbers had reached a record high under the current administration and action was being taken to address pressures in A&E.

She added: "These are sensible contingency plans which we would expect all boards to have in place to ensure that patient safety and the quality of care can be maintained at all times."