Overcrowded ERI struggling with patient care THE full extent of the crisis facing the Capital's Royal Infirmary has been laid bare after an investigation revealed that on some days there are more patients than beds at the flagship hospital. An internal audit report by NHS Lothian, which has been obtained by the Evening News, showed that the bed occupancy rate hit a staggering 101 per cent over the two-hour period in which an inspection was carried out. Across 25 wards, there were 694 inpatients to fit into 689 beds, leaving some to sit in side rooms while they waited for spaces to become free. It is widely accepted that occupancy rates in major hospitals should remain at around 85 per cent to ensure there is the capacity to cope with emergencies or an unexpected surge in patient numbers. Despite the hospital being effectively full, it was also revealed that more than one in five patients did not need to be in the ERI but were stuck there as the places they should have been sent, such as care homes, were not available. They are the latest in a series of damning revelations to hit the ERI, and come after the Evening News revealed that the number of people waiting half a day or longer in its accident and emergency department has hit unprecedented levels and NHS Lothian chief executive Tim Davison admitted the hospital is "uniquely compromised in its ability to care for patients coming through the front door." Pressure has mounted further in recent days due to a major norovirus outbreak which has left much-needed beds out of action and led to a ban on visitors in affected areas. One NHS Lothian insider said there was no doubt that the ERI was running at "breaking point" and claimed hard working doctors and nurses were "scunnered" at the state of affairs. The senior source added: "The fundamental problem is that demand is far exceeding the supply of beds. This figure really is very bad. It means there's absolutely no slack in the system. If wards need to close, as they have done recently because of the norovirus outbreak, it causes major issues. If there's a flu outbreak in the community or the weather gets cold, leading to more fractures, the beds just aren't available. There's a complete lack of flexibility and if there's problems in the community or in the hospital, it becomes dangerous. The day of care audit ordered by NHS Lothian, which was carried out between 8am and 10am on January 18, revealed that 24 patients were being "boarded" - meaning they were placed in inappropriate areas because of pressure over capacity. The NHS source added: "For argument's sake you could have someone with a severe chest infection in a gynaecology ward where there just isn't the skill-mix for that patient." NHS Lothian is currently trialling two initiatives in a bid to prevent unnecessary admissions to the ERI. More senior doctors have been introduced at the "front door" of the hospital to improve decision-making, while a phoneline has been set up so that GPs can receive advice from elderly care specialists before referring patients to emergency departments. Plans are in place to create around 70 new beds at the hospital, and although it was originally hoped they would be available by the summer, they are now not expected to become available until the end of the year at the earliest. MSPs said more needed to be done to ease pressure at the ERI and called on the Scottish Government to intervene. Labour's shadow health secretary Jackie Baillie said: "These figures, frankly, are shocking. It is extraordinary to have a 101 per cent occupancy rate. It demonstrates the pressure that is on NHS Lothian and its staff and the lack of capacity available in the hospital. NHS Lothian has reversed some cuts in nursing staff and it's about time the Cabinet Secretary gave the resources to reverse cuts in bed numbers. Conservative health spokesman Jackson Carlaw said there were clearly "major operational problems" at NHS Lothian. He added: "Every day seems to bring another revelation of patient care being compromised. First, it was major problems over waiting lists and meeting A&E targets, now we hear there is a bed shortage and patients not being sent to the correct departments for treatment. If they are unable to sort themselves out, then perhaps it is time for the health secretary to intervene. The British Medical Association Scotland also expressed concern over the high bed occupancy rate at the ERI - which opened in 2003 as a replacement for the old infirmary - which had in excess of 1000 beds. A spokesperson said: "NHS staff are working flat out to provide care to the number of patients in the wards. However, in order to provide the highest quality of care it is important that patients are admitted to appropriate wards. Hospital occupancy levels should be on average around 85 per cent to ensure flexibility for the service to cope with emergencies. There is evidence that high rates of bed occupancy contribute to healthcare- associated infections. Efforts to reduce such cases of HAI will be undermined if the high turnover of NHS beds is not addressed. Melanie Hornett, NHS Lothian's nurse director, said that more care at home packages had become available and that a substantial increase in the number of care home places in Edinburgh were set to become available within the next six months, which is expected to result in a reduction in the number of people becoming stuck in hospital. Provision of care home and homecare services is the responsibility of local authorities, rather than NHS Lothian. She added: "Working collaboratively with the Scottish Government and our local authority partners, this important piece of work provides us with vital information about how our hospitals are operating on a daily basis. Although the findings of this audit are not unsurprising, they do give an important snapshot of our activity, allowing us to properly focus on developing our services and staff systems to best meet the needs of our patients. No-one should have to stay in hospital any longer than is necessary and we are working closely with our community health partnerships and local authority partners to ensure patients are able to move to the most appropriate setting for ongoing interventions and support. A spokesperson for the Scottish Government said it was providing NHS Lothian with expert clinical and managerial advice and supporting its efforts to implement real-time demand and capacity management systems. With high occupancy, there's no slack DR Ian McKee, former SNP MSP for the Lothians, said: "We are reaping the rewards of bad decisions that were made 15 or 20 years ago. The number of beds dramatically reduced when the new Royal Infirmary was built under the PFI contract. The theory was that there would be more care in the community, but it only works if the community is geared up to receive people who would otherwise be in hospital. It is a great waste of money and resources to have these really expensive teaching hospital beds taken up by people who could be in much less expensive beds, at Liberton Hospital or a care home for example, but that's the position we're in. If you have someone who doesn't need that standard of medical care but has nowhere to go, you can't just chuck them on the street. The issue with these occupancy rates is that there is no slack in the system. The reason 85 per cent is seen as a good number is because you have the resources to take in someone who needs it and you can make sure they are in the right place. If you have a high degree of occupancy, the beds available might be totally inappropriate. You could have someone with blood poisoning on an orthopaedic ward where they struggle to look after them properly. I feel very sorry for the staff in the hospital. They're doing their level best to treat people effectively and well. They do a great job overall but they are working under very, very difficult conditions. That's not their fault - it's the fault of the planners and the system. The population in Lothian is increasing, meaning they have more and more people to look after every year and I expect the money isn't catching up as quickly as it should. Norovirus outbreak adding to pressure LOTHIAn health bosses have admitted that the current norovirus outbreak at the ERI has led to a "challenging situation." Last night, bans on visitors remained in place in four wards to prevent the spread of the bug, which has been more prominent this winter. Nurse director Melanie Hornett said: "This is always a busy time of year for our hospitals and the higher prevalence of winter illnesses has exacerbated the situation. Whilst this has inevitably had a slight impact on the number of free beds we have available and the number of patients who may have had to wait longer for a bed, the current situation is not unprecedented and there are thorough procedures in place to manage these situations.