Head of casualty unit quits in protest

ONE OF Britain's most respected hospital doctors has resigned as the head of Scotland's busiest accident and emergency department because the shortage of beds has made his job impossible.

The resignation of Keith Little, a blunt Yorkshireman, as clinical director of the unit at Edinburgh Royal Infirmary has shaken the complacency in Scotland that although NHS hospitals are under pressure, the problems are not nearly as bad as in England.

Demands for a further resignation - that of health minister Sam Galbraith - were made by health service workers at the Edinburgh hospital and by the Scottish National Party. Earlier this week Mr Galbraith, a former neurosurgeon, committed the cardinal ministerial error of saying there was "no crisis".

Dr Little said he accepted there was no "bottomless pit" of money available but maintained that the needs of patients were not being met by resources. He cited examples of patients waiting on trolleys for up to 10 hours. "It is no use struggling to find a bed two hours after a patient arrives. Empty beds must be available when they are needed," he said yesterday.

Dr Little tendered his resignation early in December before the winter crisis. He will continue to work as a consultant in the hospital's A&E department.

A past president of the British Association for Accident and Emergency Medicine, he pioneered fast-response teams to treat disaster and crash victims on the spot.

Dr Little has been forthright in warning Tory and Labour ministers about mounting pressure on health services in Scotland. "Staff [at the ERI] are working extremely hard, but they have to have their problems recognised and not denied by anyone," he said in a rebuke to Mr Galbraith.

"The people in power have to recognise there is a problem, a difficulty, which is not an exaggeration or make-believe, otherwise staff will become worn down and disillusioned."

He spoke of the "frustration" of having patients waiting on trolleys for "four, six or eight hours" or even "in extreme cases" up to 10 hours, before being found a bed. Tracing the problems back to May last year, he said the underlying cause was a more elderly population combined with bed closures.

"Somehow those in charge have to identify a structure and a strategy which enable acute hospitals like this to have empty beds available to deal with emergency patients on a daily basis."

Mr Galbraith's trenchant denial of any crisis followed a claim by Dr Brian Potter, Scottish secretary of the British Medical Association, that the NHS was in "an unbelievably awful state". Admissions at the ERI's accident and emergency department surged on Monday, with staff struggling to cope with 188 patients in 10 hours. At the time, Mr Galbraith responded: "The NHS is not in crisis. The message is, we are very busy, but we are coping."

Mr Galbraith remained insistent yesterday that there was "no crisis" and said that no one in the NHS had been gagged. Admitting that Dr Little's resignation was "not helpful", the minister said: "I am sorry that Keith has given up his managerial post... We are not too far apart." A long-term solution was in place with extra money, but it was "frustrating" waiting for it to take effect.

Dr Little said he was not aware that the position was as serious elsewhere in Scotland. "Certainly my colleagues down south, at a meeting I was at in London [on Thursday]... everyone has major difficulties in processing patients through the emergency services."

Dr Potter said he was not surprised by Dr Little's reasons for resigning. "It is a natural consequence if you keep putting people in a position where they have to cope with intolerable odds." He blamed the private finance initiative, adopted by Labour from Conservatives, for "ripping the heart out of the NHS".

Joe Owens, chief executive of the hospital, claimed measures had been put in place to tackle acute bed availability but these would "take time".

Tom Waterson, Unison representative at the hospital, said Mr Galbraith should change his policies or go. "There is massive pressure and massive frustration because there is just too much work and not enough staff - we are lurching from crisis to crisis." Alex Salmond, leader of the SNP, said the minister's position was untenable.