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Aberdeen Royal Infirmary

Healthcare Improvement Scotland (HIS) review†

NHS Grampian has accepted all the recommendations in the reviews of Aberdeen Royal Infirmary and services for older people in acute hospitals published today [December 2] by Healthcare Improvement Scotland. We also fully accept the recommendations made by the Royal College of Surgeons of England following their review of general surgery. We are publishing these today, along with the terms of reference of the review.

Malcolm Wright has been appointed as interim Chief Executive and will spend the next six months supporting the executive team and NHS Grampian Board in implementing the recommendations. He acknowledged that the reports make stark reading for the organisation and that plans for tackling the issues they raise require robust implementation. Extensive plans have already been drawn up to take forward all the recommendations, but he emphasised that people in the north east can have confidence in the quality of care provided.

He 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.†

"They do not raise any consistent or widespread concerns about patient safety or about the quality of care across NHS Grampian.† The detailed case note review carried out by HIS confirms many areas of good practice, including patients being seen by consultants and experienced trainees early in their admission, evidence of good communication with patient relatives and clear care plans. It also confirms that infection rates at Aberdeen Royal Infirmary do not differ from the Scottish average.† MRSA, MSSA and c.difficile rates are the second lowest of mainland Boards in Scotland.† The reports also confirm that our patient outcomes are consistent with those in other parts of Scotland.† Our hospital standardised mortality ratios (HMSR) are also consistent with other parts of Scotland.†

"Our own work on patient experience tells us 96% of patients rate the care they have received as good, very good or excellent.

"We believe that our staff are amongst the best working in NHS Scotland and as a Board we are committed to doing all that we can to support them.† We take our role as a teaching hospital seriously and we will ensure that this support is extended to all staff and to trainees in all disciplines."

Mr Wright emphasised that NHS Grampian has invested and will continue to invest in world class facilities - the Matthew Hay building, the Aberdeen Health and Care Village, the refurbishment of Chalmers Hospital, the Forres Health and Care Centre and the planned Women's Hospital and Cancer Centre all point to the Board's ambition to be the best in Scotland.

"Aberdeen Royal Infirmary is a first class hospital with world class facilities," he said. "The people of the North East can have trust in the care offered and the in the staff providing it. Over £1 billion is spent on NHS services in Grampian every year, or £2.8 million a day, and major investment in infrastructure continues, with investment last year of £54 million on new developments."

Mr Wright was grateful for the recognition the report gives to the challenging environment in which the Board has been operating, but acknowledged NHS Grampian is at present falling short of its ambition to be the best healthcare system in Scotland.†

"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.† We will establish a system of management at Aberdeen Royal Infirmary with clinicians and managers working together at the heart of the care that we provide with clear roles and responsibilities, ensuring that all staff understand what is expected of them.† This will include all consultants having job plans.

"The report highlights real concerns over staffing levels and we will bring forward further proposals to recruit and retain both medical and nursing staff in what is a challenging labour market environment.† In 2014/15, more than 200 additional clinical staff were employed at a cost of £9.9 million.  

"We are committed to the training of junior doctors and it is vital that NHS Grampian further develops as an attractive place to train and build a medical career.† The views and contributions of junior doctors in training are essential to the delivery of high quality patient care."

NHS Grampian is also investing in nursing staff. Between March 2013 and March 2014 an additional 100 nurses were recruited, 60 working in the acute sector (theatres and emergency care). Between March and June 2014 another 36 nurses were employed, with investment concentrating on critical care and cancer care. From June 2014 onwards, close to 60 posts have been created, almost all in the acute sector. Looking ahead, the organisation has earmarked funding in 2015/16 for between 30 and 40 additional nursing posts. NHS Grampian is committed to working with our local universities and offering all newly qualified staff a post on graduation.

Mr Wright acknowledged there will have to be changes to way in which the Board works. "We will improve the operation and performance of the Board.† We will also bring a new rigour and focus to the work of the executive team.† We acknowledge that the issues highlighted in the reports do not reflect well on governance and accountability in the organisation and we are committed to addressing these issues rigorously."

Mr Wright was also disappointed by the serious concerns raised in the older people's report. He apologised unreservedly to patients and their families.

"People should have confidence in the standard of care they or their loved ones receive, and I want the examples of good practice in this report to be shared and become the standard throughout.

"It is vitally important to learn from this inspection and act swiftly on its recommendations. We have developed a detailed action plan and work is already underway to address the concerns raised. In the longer term we want to appoint a consultant nurse to focus on care for the elderly and ensure that there is an appropriate focus on leadership, development, training and support for staff in terms of implementing best clinical practice."

Also published today are the recommendations and the terms of reference for a review of General Surgery undertaken by the Royal College of Surgeons of England. The College found no evidence of clinical safety concerns within the General Surgery department. Specifically the Hepatobiliary (HPB) Service has been found to be safe and fully engaged with national audit process and all the cases examined in detail are under appropriate follow up as per the recommendations. A number of other General Surgery cases were mentioned in the report but not fully examined by the review team and as per the recommendations we will complete a full review of these patients.

The report describes areas of poor team working and organisational issues that have the potential to reduce the effectiveness of the general surgery service. We have already started addressing these with a comprehensive improvement plan.

Mr Wright 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."

The reports can be found at†

Improvement Programme 2014/15 - Immediate Action Plan (December 2014) (pdf)

Further information about this review is available at the HIS website.