NHS Lothian HBCCC review

NHS Lothian hospital-based complex clinical care review

Between November 2015 and May 2016, Healthcare Improvement Scotland carried out a review of hospital-based complex clinical care (HBCCC) services in Edinburgh after wider analysis of issues initially raised following a complaint in a hospital facility in NHS Lothian. 


The review was carried out by a multidisciplinary team of individuals working across health and social care in Scotland and supported by staff in Healthcare Improvement Scotland (terms of reference below). The methodology for the review included analysis of documents and reports, a one day visit to four facilities across Edinburgh in February 2016, were we interviewed senior management, the senior clinical team, clinical and non-clinical staff involved in the care of complex frail older people and the psychiatry of old age. We also held drop-in sessions for staff from the HBCCC service and set up a confidential email address available for staff and patients to share their experiences. We also carried out unannounced inspections, across 4 days in February 2016, to the frail elderly wards in each of the four facilities, using Healthcare Improvement Scotland methodology for the inspections of care for older people in acute hospitals.

Our findings

The report below details the findings and recommendations of this review. Key findings include:

  • The NHS across Scotland is facing a number of challenges, due to an ageing population, particularly in areas providing care to patients with complex care needs. These pressures are evident in hospital-based complex clinical care (HBCCC) services in NHS Lothian.
  • Within the services we visited, we saw evidence of good relationships between staff and a positive culture of openness and willingness to learn from mistakes.
  • Since February 2015, NHS Lothian has invested over £1.13 million in nursing staffing, but the use of temporary staff, levels of sickness absence and difficulties in recruiting show pressures on the system. A number of initiatives have been recently introduced to help address these pressures.
  • Importantly, there are a number of weaknesses in relation to record keeping, particularly for assessment and care planning. Good record keeping is an important aspect of providing high quality care and the issues we highlight in this report need to be fully addressed.
  • Patients and families provided positive feedback but identified some areas for improvement. Many of their comments reflect challenges due to staffing pressures.
  • NHS Lothian is putting in place the building blocks to allow its strategic vision for the HBCCC service to be implemented and is working with partners to develop a comprehensive operational plan.
    NHS Lothian will develop an improvement action plan to implement the recommendations set out in this report. Healthcare Improvement Scotland will monitor the progress against this action plan.

More information

Published Date: 31 May 2016