HEALTH chiefs who rejected calls for East Lothian’s new £70 million community hospital to provide accident and emergency (A&E) services are now appealing for ‘community-based’ alternatives after admitting Edinburgh’s flagship hospital cannot cope with demand.

The Royal Infirmary of Edinburgh’s emergency department is operating at 50 per cent over-capacity and is expected to see nearly twice as many patients than planned in the next 15 years.

Its emergency department, which opened in 2003, was designed to manage 80,000 patients a year but last year it saw just under 120,000.

And hospital bosses have warned they expect the number of annual cases coming through its doors to go up to 150,000 by 2033.

East Lothian’s MSP and the chairwoman of Haddington’s community council, where the new East Lothian Community Hospital is located, have both criticised the decision not to include A&E services at the new county facility as a “missed opportunity”

Rebecca Miller, the Royal Infirmary of Edinburgh’s strategic programme manager, told a meeting of East Lothian Integration Joint Board that crowding not only affected the department’s ability to cope but had been shown to lead to more deaths.

She told the board that the hospital was likely to see 400 patients come into the emergency department every day this year.

And she warned that front door services, which refer to unscheduled care provided from the emergency department, minor injuries and ambulance service, were under severe pressure which was only going to continue.

The board was asked to give its support in principle to an application from NHS Lothian for more capital investment, although no figure has been produced, and to agree to ask East Lothian Health and Social Care Partnership to look at providing more “community-based alternatives” to acute hospital care.

The appeal came as the board met in the new £70 million East Lothian Community Hospital, which was built without an accident and emergency or minor injuries unit.

NHS Lothian ruled out a minor injuries unit because it said there was not sufficient demand for the service to justify its inclusion, with 3,000 patients a year needing to be seen to make it viable.

East Lothian MSP Iain Gray, who backed campaigners who lobbied for the new hospital to have an A&E department, said health chiefs had missed a real opportunity to deal with the problems.

He said: “I have long believed that the new hospital in Haddington was a real missed opportunity to provide some sort of A&E or at least minor injuries service in the county, to reduce the number of East Lothian residents who have to travel to the infirmary for attention.

“I have been to A&E a few times in the past year and, while staff there do their best, it is clearly under huge pressure, as these figures confirm.”

The report told board members at a meeting last Thursday that “crowding is a key barrier to providing safe and effective care within RIE Emergency Department (ED)”.

It added: “Within the publication Crowding in Emergency Departments, the Royal College of Emergency Medicine cites published evidence which demonstrated that ED crowding is linked to increased mortality.

“Front door services have been under continual and growing pressure for a number of years.”

Calls for A&E services to be included at the new East Lothian hospital were made at a series of public meetings as the construction got under way but NHS Lothian ruled it out, saying there was not enough demand.

The board was told a working group had been established and was working on developing proposals for the development of the Royal Infirmary front door; health and social care partnerships across the Lothians have been invited to take part.

Councillor Fiona O’Donnell, board chairperson, pointed out that community services were already well used in East Lothian, leading to fewer people needing access to the Edinburgh emergency department. She said: “People do access the care here and we have a relatively low number of people who come from East Lothian who could have gone elsewhere.”

However, Alison Macdonald, East Lothian Health and Social Care Partnership’s director, said: “As our population is increasing then the percentage of people going to the emergency department will increase.”

A Scottish Government spokesperson said: “It is for health boards to determine how best to allocate resources and deliver services to patients.

“We recognise the pressures A&E departments can face and are working closely with boards, including NHS Lothian, to support improvements.

“We are also supporting health boards and integrated joint boards to ensure quality of care, patient safety and access to services are maintained over the winter, and are providing additional funding for this purpose.”

Jan Wilson, chairwoman of Haddington’s community council, described the lack of an A&E department and minor injuries unit in the town as “a missed opportunity”.

She said: “It is all just cutbacks. Money is tight but I think there still should have been an A&E department, you could have had it deal with the whole of East Lothian.

“Haddington being a central point, the furthest to travel would be from Dunbar. If you lived on the outskirts of East Lothian you would still be a lot closer to Haddington than having to go from the outskirts of East Lothian to any of the big hospitals in Edinburgh.”

Mrs Wilson highlighted the continued growth of East Lothian, adding: “As years go on, there are going to be more and more cars on the road.

“They should be trying to cut down traffic going into Edinburgh. I think it is a missed opportunity.”

Dr Tracey Gillies, medical director, NHS Lothian, said: “NHS Lothian, in common with all health boards in Scotland – especially those in the Central Belt, is experiencing rapid and rising levels of demand in ED departments.

“A significant amount of work is under way across the country to understand the complex problem and the contributing factors to provide solutions.

“Health boards are working with health and social care partnerships to shift the balance of care from hospital to community care to provide necessary services closer to home.

“This has already given rise to pioneering initiatives, such as Hospital at Home in East Lothian and our Discharge to Assess teams.

“Out-of-hours services and GP surgeries are also changing the ways they work by changing the ways patients can access care and advice, increasing availability of appointments and in some cases offering minor injury services to help prevent admissions to hospital and attendance at the ED.

“Creating an emergency department is complex and apart from the building space requires a full complement of clinical, medical and nursing staff as well as specialist support services including diagnostics, laboratories and theatre provision.”