'Deficiencies' at Aberdeen Royal Infirmary

Serious concerns about staffing levels and leadership at Aberdeen Royal Infirmary have been highlighted in a damning report.

A review by Healthcare Improvement Scotland (HIS) found significant deficiencies'' in the management of Aberdeen Royal Infirmary (ARI) and called for NHS Grampian to take urgent action.

There is also widespread disengagement'' of medical staff at the hospital, with responsibility for that resting with both managers and doctors.

The report further pointed to considerable staffing'' difficulties, particularly surrounding medical staffing in the emergency department, and branded one of the surgical unitssignificantly dysfunctional''.

HIS has issued 13 recommendations for improvement for NHS Grampian.

The health board said it took the findings seriously and accepted the recommendations.

The detailed independent review was announced in June. The newly-published report concluded that the board was insufficiently aware'' of several of the problems facing the hospital.

The review praised the actions of talented and dedicated'' frontline staff to mitigatea range of issues that considerably reduce quality and safety''.

But it also spoke of low morale in a number of departments and very poor relations'' between some senior medical staff and managers.

We found a number of issues relating to leadership and culture which reduce the quality and safety of care,'' it stated.

There is an urgent need for NHS Grampian to address these in order to ensure safe care.''

On staffing, the HIS found dedicated and hard-working individuals throughout the ARI and Aberdeen Maternity Hospital.

But it went on: However, there are considerable staffing difficulties, mostly relating to medical staffing within the emergency department at Aberdeen Royal Infirmary, that require urgent attention to maintain safety.

These have been repeatedly raised by consultants in the department and to date the plans to address these have not been adequate.''

HIS found no direct evidence of patient harm and it noted that patients achieved similar outcomes to those at other Scottish hospitals.

But the report's authors voiced concern that many aspects of the current working arrangements, particularly those dependent upon goodwill, will be unable to meet future demands on the system.

The potential for patient care and safety to be further compromised is overwhelmingly evident in the findings of this report.''

Dr Angus Cameron, chair of the review team and medical director at NHS Dumfries and Galloway, said: The issues are serious, and I recognise that the report will in many respects make sobering reading.''

In autumn, the then NHS Grampian chief executive announced his intention to take early retirement and it emerged the chairman would also be stepping down.

NHS Grampian said it accepted all the recommendations in the review of ARI and a separate HIS report into services for older people in acute hospitals.

It also accepts the recommendations made by the Royal College of Surgeons of England following its review of general surgery.

New interim chief executive Malcolm Wright said: These reports highlight issues with leadership and management, culture and behaviour, accountability and governance within NHS Grampian.

We take these reports extremely seriously and we accept the recommendations that the reports make.''

He went on: The board absolutely accepts the recommendations made and detailed action plans have been drawn up to address these issues.

We have committed to improving leadership, management and engagement between clinicians and managers at Aberdeen Royal Infirmary and across the organisation.''

Mr Wright expressed disappointment at serious concerns raised in the older people's report and apologised to patients and their families.

He said: This is undoubtedly a challenging time for NHS Grampian. These three reports have highlighted a range of issues requiring immediate attention.

I am confident in the ability of my colleagues throughout this organisation to address these issues and deliver a sustainable, high-quality health service for the future.''

Niall Dickson, chief executive of the General Medical Council (GMC), said the report raises very serious issues'' about aspects of medical care at the ARI.

The GMC will now consider whether it needs to take any immediate action beyond that already taken, he said.

The individual behaviours and the systemic failures described in the report are completely unacceptable,'' he stated.

Ellen Hudson, associate director at the Royal College of Nursing in Scotland, said the report lays bare the failings of leadership and management at NHS Grampian''.

The Conservatives said it is time for the Scottish Government to step in and sort out the issues at the troubled health board once and for all.

Labour said it is a clear demonstration of the failure of successive SNP health ministers'' to act, while the Liberal Democrats said ministers had failed to heed a series of warnings about the challenges facing the health board.

Health Secretary Shona Robison said NHS Grampian must fulfil its commitment to making urgent improvements across a range of areas''.

She said: While it is important to note that the Healthcare Improvement Scotland report finds that care delivered at the ARI is safe, there are clear failings highlighted that are simply not acceptable in our NHS.

Not least of these is a failure of leadership, a breakdown of relations with clinicians and the resulting pressures this has placed on frontline staff.''

She said the Scottish Government acted swiftly in response to concerns raised by staff at NHS Grampian.