Closed: Kirkcaldy's Victoria Hospital has been forced to close repeatedly because of staff shortages. Pic: © STV
Scotland’s accident and emergency departments are under growing pressure from a rise in the number of patients, according to a report published on Thursday.
A study by Audit Scotland revealed a 9% rise over the past 10 years, causing a £30m rise in NHS costs.
A survey of staff also found that patients are sometimes "inappropriately" admitted to hospital to meet Government targets.
The British Medical Association (BMA) described the finding as "scandalous" and called for ministers to investigate.
Around 1.4 million people attended A&E in Scotland during 2008-9, costing 1% of total healthcare spending at £148 million. That cost rose from £120m over three years.
Meanwhile, attendance levels increased from 1.39 million in 1999 to 1.52 million last year, despite a Scottish Government target to reduce attendance rates.
The study also found there was "inadequate information" to demonstrate the best use of care resources, leading to "emerging staffing difficulties".
A total of 55% of staff felt patients were admitted to hospital to avoid breaching a four-hour waiting time target.
However, despite the pressures, four out of five patients said the care they received was excellent or very good.
Dr Brian Keighley, chairman of the BMA in Scotland, said "a number of issues" must be addressed.
He added: "Reports that more than half of doctors and nurses surveyed by Audit Scotland believed that patients are sometimes inappropriately admitted to hospital to avoid breaching the four-hour waiting times target is scandalous and I would urge the Government to investigate this matter.
"They must also consider the issue of trolley waits, which can strip patients of their dignity."
Theresa Fyffe, director of the Royal College of Nursing (RCN) in Scotland, said: "The RCN is calling for a more realistic target of 95% of patients being seen within four hours rather than the current 98%. This would give A&E staff the flexibility and time to deliver the personalised, quality care patients deserve."
Audit Scotland has now suggested that NHS boards examine scope for GPs to refer patients directly to specialist units, bypassing emergency departments.
Auditor General Robert Black said: "Patients are happy with the care they receive and the length of time they wait to be treated has reduced with the introduction of a four-hour target.
"However, information about the quality and effectiveness of care provided is limited, for example there is little information about the medical condition of patients attending emergency departments.
"The services available for vulnerable groups, including people with a mental health problem, vary across Scotland.
"There are also emerging staffing issues, such as shortages in junior doctors and the impact of European working hours legislation, that must be tackled at a national level, not just locally."
In Kirkcaldy, staffing problems have led to the Victoria Hospital’s A&E closing on a number of occasions, meaning patients have to go to Dunfermline instead. NHS Fife blamed the closures on staff shortages and on the pressures of sticking within rigorous working time limits.
Following Thursday’s publication, Kirkcaldy Labour MSP Marilyn Livingstone said: "Health Secretary Nicola Sturgeon should take this warning from Audit Scotland very seriously. We have already seen the closure of the Accident and Emergency department in Kirkcaldy because of staff shortages."
Tory health spokesman Murdo Fraser said renegotiating GP contracts could help out-of-hours cover and reduce the number of people taking themselves to A&E.
He added: "Action is needed before the pressure on our services becomes too much in these difficult times."
Liberal Democrat health spokesman Ross Finnie said: "Audit Scotland found that in 2008-09, over half of those going to emergency departments had only minor illnesses or injuries.
"This is not the best use of expensive and often overstretched emergency departments."
IN DETAIL
- Kirkcaldy A&E closes for another week amid staffing crisis
- Fife emergency ward could be closed down on weekends
