Health bosses have warned there are “very, very difficult times ahead” for Dumfries and Galloway.
Services across the region are currently under “significant pressure” as staff battle with an increase in emergency admissions and rising numbers of delayed discharges.
And a combination of an ageing population, lack of staff, budget cuts and a reduction in the number of people of working age means issues are set to continue for years to come.
Health board chairman Nick Morris told members on Monday: “There are very, very difficult times ahead and the public needs to understand that issue in order to have a realistic conversation about expectations and needs.”
The meeting was told by NHS Dumfries and Galloway’s chief operating officer, Julie White, there had been “consistently high occupancy levels in all our hospitals” for several months.
She said: “That’s been a result of increased urgent, unscheduled and emergency admissions and that’s been affecting our ability to plan our electives accordingly. We have seen a number of elective operations cancelled.
“We are a system under significant pressures at the moment.
“Our clinical and operational teams from primary through to secondary care, mental health and community services are working incredibly hard to respond to those challenges and increased demand.”
She admitted some operations were being cancelled at short notice – often on the day they were scheduled – as staff tried to carry out as many procedures as possible.
She said there had been higher than expected levels of emergency admissions, as well as higher than expected levels of delayed discharge – when someone is deemed clinically well enough to leave but cannot go home, often because a social care plan isn’t in place.
In some instances, patients who were fit to leave were being asked to go to cottage hospitals across the region – even if the facility was were nowhere near where they live. The only Stewartry cottage hospital currently operating is in Castle Douglas.
Ms White explained: “This is us balancing the risks we’re experiencing in the system. If we do have an available bed in a downstream hospital and we can move a patient from DGRI into that bed while they await their care and support package, that helps us mitigate the risks that we’re facing around that next emergency admission at the front door of the hospital.
“Whilst these are really difficult decisions for us to take, they are really vital decisions that we take and they are likely decisions we have to take more and more as the system is under increasing pressure.”
Chief executive Jeff Ace warned that the demographic problem was likely to continue until 2040.
He said: “The World Health Organisation would say, with the demographics we’ve got, you would normally be looking for a three to four per cent real terms increase in health and care spending year-on-year.
“We are not going to see that. We are going to see a reduction in real-terms resource.
“We’re dealing with this very intense performance problem in the context of having far, far less resources to deal with that over the next three or four years.
“This is an extraordinary position for the board to be in and one probably this board has not been in before.”
Mr Morris warned the demographic problem “isn’t going to go away” and it would take “many, many years to get on top of actions to address those”.
And he also feared the potential for a “vicious cycle” when it came to workforce challenges.
“We may not just have a problem of recruitment, we may have a long term problem with retention.”
