Problems with patients being discharged from Forth Valley Royal Hospital without proper follow-up notes is just one sign of the incredible pressure the NHS is now under, a senior doctor has said.
Speaking at a meeting of Falkirk 's Integrated Joint Board (IJB), Andrew Murray, Forth Valley NHS's medical director, said he was in no doubt that the experience for many patients was not what it should be.
But he defended the quality of care and the NHS staff who, he said, are "trying to do the absolute best they can every day to care for the people that come and see them".
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Mr Murray said: "We have pressure in our unscheduled care that we have never experienced before. I have been doing this job for 35 years and I have never seen these pressures.
"What does that actually mean? It means we have treatment rooms that were never meant to have a patient staying in them overnight - every single treatment room now has a patient.
"We've got extra beds in four-bedded bays - fifth patients have to go into those bays. The dignity and quality of care that people have to experience is nowhere near where it needs to be and the staff who are trying to look after everybody in that situation are completely frazzled by that experience."
Mr Murray was attending the IJB to present a report looking at why re-admissions to hospital within 28 days of discharge had seemed particularly high in Forth Valley.
An investigation found that there had been a change in the system used to collect the data and the high figure was an anomaly.
He reassured members that the figures are actually in line with Scotland's average rate of around nine per cent.
However, the board's GP representative, Dr David Herron, said he felt there was still an issue with patients leaving hospital without an immediate discharge letter (IDL), which tells the GP and pharmacy about what follow-up treatment is needed.
He said: "Within primary care we very, very often have to manage patients who have come out of hospital with no immediate discharge letter."
He suggested that the number of patients leaving hospital without IDL's was something the IJB should look at again as "readmissions are often a result of us in the community having no idea what's going on with the patient and having to send them back into hospital for that specific reason".
He acknowledged that Mr Murray in particular was aware of the issue and had been keen to look at it but added that "we are not making much progress".
Dr Herron's remarks were picked up by all three of Falkirk's councillors who sit on the IJB who said that their personal experience suggested that the transfer out of hospital "was not as smooth as it should be", as Councillor Anne Hannah said.
Mr Murray said he fully accepted that the patient experience was not good - but he strongly denied the suggestion that the re-admission rate was high because of it.
He said: "I am going to state categorically, for the record, that the quality of care that generates these readmissions is not in doubt."
He agreed fully with Dr Herron that there is a need for improvement but said that a lack of progress did not mean a lack of effort.
SNP Councillor Stacey Devine, recently elected to the board, said that the disconnect between hospital care and follow-up care from the GP is "one of the number one thing that flags up time and time again" in conversations with constituents.
She said: "I experienced it in the summer with my daughter in hospital and there was no discharge letter, the doctors didn't know what was going on and it created just such an inconvenience, not only for myself but for the GPs."
Cllr Devine added: "Speaking to constituents, I know I'm not the only one.
"We need to be a lot more transparent about why this is happening and what steps we can take to improve it."
In reply, Mr Murray said he agreed "the experience is nowhere near what it should be" but he urged members to understand "what it's like to be in health care" at the moment.
He said that there is "a perfect storm of pressures on our system" with staff shortages everywhere and extremely high admission rates.
But he defended the people on the frontline saying they are "trying their best to cope with what we're going through".
He said the answer to the problems facing health and social care will come from the IJB, the health board and the council all working together to come up with solutions.
"I'm not shying away from what I'm hearing and seeing - that's not how we need to respond to this but we need to respond to this with collaboration that's going to transform and allow us to make some progress because at the moment - and I'll be very honest - the situation is very gradually, but week by week, getting worse."
