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The Fourth Statistical Account of East Lothian

Hospital services

Helen Zealley

See also firsthand accounts by Dr RJ Kellett; Mr G Meikle; Sister MJ McDonald; Professor J Williamson; Dr JS Milne; Dr L Waddell; and Ms L Headland (ELCAP).

Hospital Services

The most significant changes to East Lothian hospitals during the latter half of the twentieth century resulted from the development of new diagnostic and treatment possibilities and the changing patterns of disease. Hospital-based services in East Lothian, 1945-2000, can be divided into the following main components: a) GP hospitals; b) 'Acute' hospitals; c) Maternity and gynaecology; d) Tuberculosis (TB) sanatorium; e) Geriatric Service; f) Mental health service; and g) Mental handicap/Learning disabilities.

GP hospitals

Initially the main providers of hospital care, GPs in East Lothian were unique in Lothian by continuing to provide direct care in the Edington Hospital, North Berwick and Belhaven Hospital, Dunbar as well as through special 'joint' appointments in Roodlands Hospital, Haddington.

'Acute' hospitals

In 1948, two of the old wooden wards at the fever hospital in Haddington were burned down to prevent infection and the hospital was transferred from the Council to the new South East Regional Hospital Board.

It assumed a new existence as a specialist 'acute' hospital renamed 'Roodlands' - a name found on a local map. In 1950, a full-time consultant surgeon joined visiting consultants from Edinburgh. His sole duties were at Roodlands where he was responsible for an emergency and elective general surgical service, including urology, vascular, ENT, casualty and orthopaedics - all of which subsequently became separate specialties. His medical and gynaecological colleagues continued to have responsibilities in East Fortune and Edinburgh respectively. Initially, the small teams of staff in training as surgeons and physicians worked long hours - as did the nursing staff - and provided cross-cover for each other. Gradually the numbers of staff increased in response to the growth of specialisation; the demands on the staff; the development of externally validated training requirements; and the introduction of regulations to limit the working hours of staff.

However, by 1990, after 40 years with local general acute services, much of the medical care required in acute specialties had become so complex that it could only be provided safely in larger hospitals with a wider range of specialists and modern technology than is possible in a small general hospital - even if the travel distance was greater. This applied equally to accidents and to the delivery of babies as it did to specialist surgical and medical practice. It was helped by the introduction of 'para-medic' staff in the ambulance service who could provide 'life-support' during transfer. As a result, the hospitals in East Lothian changed dramatically - often to the distress of the local community who regretted, in particular, the loss of their local maternity and accident and emergency services.

However, by 2000, Roodlands had become a thriving Community Hospital with a pro-active geriatric service and a revised general service involving contributions from visiting Edinburgh consultants for outpatient clinics, day surgery and a local GP supervising the medical ward.

A similar evolution occurred at Edenhall Hospital at Musselburgh although, being closer to Edinburgh, it never had a casualty department and there was less need for the development of a Community Hospital when the time came to transfer the general services to the Eastern General Hospital. By the end of the period, the geriatric unit provided long-term care for the elderly.

Maternity and gynaecology

Until the early 1970s, the Vert Hospital, Haddington provided an important focal point for the maternity service in East Lothian, with GPs and local midwives providing a much valued service. A visiting consultant from Edinburgh provided specialist advice and a gynaecological service at Roodlands. However, by the 1970s, maternity services were becoming more specialised and patients were increasingly being referred to the consultant-led units in Edinburgh. As a result the Vert was closed but two GP delivery beds were established in Roodlands. However, these were never used for deliveries and indeed only a few women chose them for 'lying-in' after delivery in Edinburgh before they too were closed.

Tuberculosis (TB) sanatorium

East Lothian was unusual in having a sanatorium for the treatment of tuberculosis at East Fortune Hospital provided by the Joint Sanatorium Board for the Lothian and Border counties. The hospital (originally built as an airship station) became a sanatorium in 1922 but reverted to military use during World War Two; the TB patients were transferred temporarily to hutted accommodation at Bangour Hospital. After the war, the introduction of streptomycin and, subsequently, other drugs for the treatment of TB radically altered the need for a dedicated sanatorium. Evolution on the site in the 1950s led to the development of wider services for chest diseases and a new geriatric service before both transferred to Roodlands; East Fortune closed in the 1990s.

Another group, which was transferred into the extensive accommodation at East Fortune in the 1970s, was an overflow group of children from Gogarburn. This subsequently led to the introduction of a new service for people with a mental handicap (see below).

Geriatric Service

Once TB was no longer a big problem, the role of East Fortune Hospital changed to accommodate an increasing number of elderly patients in the 'medical' beds. In 1976, Lothian Health Board formally established a geriatric service for East Lothian using 18 assessment beds, a day room and a long-stay ward in the hospital, and appointed a consultant (formerly a GP in East Lothian) and support team. Gradually the service expanded to fill all 100 of the medical beds at East Fortune together with assessment and long-stay beds at Edenhall Hospital in Musselburgh and long-stay beds at Belhaven Hospital in Dunbar.

All patients referred by GPs were first visited at home and the next step decided. There was no outpatient service because the ambulance service could not provide the necessary transport. After the home visit, patients could be admitted to the assessment ward or attend the day-hospital a few times for further investigation.

Weekly meetings were held of all the staff to discuss the progress and probable future of the patients. Those unable to return home or to a residential home could be transferred to a long-stay bed of which there were plenty because of the former function of East Fortune. Once the service was established there was virtually no waiting list and it was able to accept transfer patients, such as those who had had strokes, from Roodlands to leave the acute beds free for new referrals. Two or three beds in winter and six in the summer were kept as respite beds to admit patients from home to allow their carers to have a rest. This was arranged directly by the GPs with the ward. There was excellent liaison with the social work department, including the development of joint assessment to ensure patients were admitted to the most appropriate accommodation whether this was a local authority home or hospital.

During the 1990s the geriatric service lost most of its long-stay beds as a result of government guidance indicating that patients who could be cared for in nursing homes should not be admitted to hospital as long-stay patients. East Fortune Hospital closed in 1997; a new geriatric assessment and treatment unit was established at Roodlands together with a small continuing care unit.

From Nita Fraser, who worked at East Fortune during 1992-1997:

Less well known was the great diversity of roles, interests and talents used by patients, staff and friends of East Fortune that helped to create a community to be proud of. Such was the diversity of this great little community that it was able to have its own magazine; Fortune contributions were encouraged from everyone.

Mental health service

The original East Lothian County Asylum at Herdmanflat transferred, with others, to the NHS in 1948 - initially linked with Rosslynlee Hospital in Midlothian. In 1964 the first whole-time consultant psychiatrist was appointed to Herdmanflat. From then, the medical team increased significantly and the number of inpatients decreased from around 300 (including Edinburgh and West Lothian overflow patients from Bangour Village Hospital) to around 100. These included two wards of psycho-geriatric patients who had originally been accommodated in the Vert Maternity Hospital from 1971 until its final closure in the 1980s. The effectiveness of treatments for depression and psychotic disorders, initially introduced in the 1960s, gradually improved, allowing more and more people with mental health problems to remain in the community.

Geographical and historical factors allowed the early development of 'community' psychiatry in East Lothian, including the transfer of many 'long-stay' patients to small domestic units. This was helped by the Mental Health (Scotland) Act 1960 which encouraged 'informal' treatment status; the establishment of outpatient clinics at Roodlands, Tranent, North Berwick and Port Seton; close personal links between the psychiatrists and GPs; the development, in 1973, of a small but active community psychiatric nursing service and the contribution of multidisciplinary rehabilitation teams; the development of a Day Hospital in 1976 for general mental health patients with a second Day Hospital in the late 1980s for dementia sufferers; and excellent close personal contacts with the Social Work, Housing and Education Departments, as well as with many voluntary organisations.

At the same time the type of patients referred to the service expanded to include more elderly people; those with family and personal problems, adjustment reactions, personality disorders; and those abusing alcohol and drugs.

Mental handicap/Learning disabilities

In the past, mentally handicapped people from East Lothian itself tended to remain at home, often tucked away in a back room and denied access to school or other opportunities to develop their maximum potential. However, the transfer in the early 1970s of a group of 120 young mentally handicapped patients from Gogarburn resulted in the establishment of a forward-looking service in East Lothian. Two part-time consultants were appointed in 1974 with responsibilities split between East Fortune and Gogarburn. They were active promoters of a community care approach to people with mental handicap/learning difficulties and initially arranged, in 1983, for the transfer of the service from the relative isolation of East Fortune to a new 74 bedded Hopetoun Unit in the grounds of Hermanflat - technically in contravention of the Mental Health Act 1913 which precluded the co-location of services for the mentally ill and the mentally handicapped on the same site. By 2000, while this Unit still acted as the focal point for the service to this group of people in East Lothian, all had been discharged to small family units in the community under the supervision of ELCAP, an innovative voluntary organisation.

(See David Affleck Promoting Social Welfare in East Lothian: Learning Disability.

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