A SENIOR doctor has warned of "unresolved serious issues" in hospital accident and emergency departments, despite investment of £50 million to try and improve the situation for patients.
Dr Martin McKechnie, the new chair of the College of Emergency Medicine Scotland, said the money had helped to curb a crisis but other parts of the system need urgent attention to make it pay off.
He also gave ministers credit for responding when the college told them 21 out of 24 A&Es were regularly unsafe because of the number of patients backing up on trolleys, waiting for ward beds.
However, in his first interview since taking up the post this month, Dr McKechnie said: "We still have unresolved serious issues.
"We have made major progress, but we need to press on."
His comments come after a number of A&E doctors said Scotland has fallen behind other countries in terms of offering doctors incentives to work in under-staffed emergency departments.
Concern about shortages of specialists in the field is running high, with NHS Grampian reporting five vacancies and NHS Lanarkshire drawing up plans to downgrade an A&E department in the event they cannot staff all three safely.
Dr McKechnie said there was no problem recruiting young doctors to the first years of emergency medicine training in Scotland, but they were not completing the course to become senior doctors or consultants.
He said: "In the last three years there is no doubt that we have lost significant numbers (at the later stages of training). They say they have had enough of it, because it is a slog, they do a lot of nights and anti-social hours for the same pay."
These doctors either move into different medical fields or go abroad where they say better staffing levels can make the job less onerous.
Dr McKechnie cited a study, worked on by a Glasgow doctor, that found 25 per cent of all emergency department medical registrars working in Australasian A&Es studied for their first medical degree in the UK or Ireland.
An A&E doctor himself, he stressed it was interesting, enjoyable work but the big problem faced by Scotland's A&Es - overcrowding because there is not enough space available to move sick patients onto wards - made it less satisfying.
Dr McKechnie said: "What a lot of trainees see is they are doing both emergency work and ward work in the emergency department at the same time and there is no doubt that concentrating all that risk in one place is dangerous."
The growing elderly population is one of the key factors causing this problem. Frontline staff say more patients are arriving in hospitals who have multiple health problems and require complex care.
Furthermore, there are also difficulties moving patients back to their own homes when they are well enough to be discharged because of issues obtaining care packages or care home places.
The Herald's NHS Time for Action campaign is calling for a review to ensure the right staff are in the right place at the right time to cope with the rising number of frail patients.
Dr McKechnie said: "There is no doubt we have to invest in all aspects of the patient pathway."
Social care, better resources for GPs and telemedicine are among the areas that he said needed more attention to help prevent patients backing up in A&Es.
He stressed sustaining investment in the frontline was also important.
A spokesman for the Scottish Government said: "As the chair of the College of Emergency Medicine Scotland has noted, the Scottish Government has more than doubled the number of A&E consultant posts across Scotland from 88.5 in 2007 to 184 in 2014."
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