The First East Lothian Geriatric Service at East Fortune Hospital

Dr JS Milne

East Fortune Hospital has had a varied history including being a naval air station in the 1914 war, the departure point of the airship R100 to the USA in 1919, a sanatorium between the wars, an RAF aerodrome in the 1939 war and a sanatorium again after that war. In the 1950s, once tuberculosis was no longer a big problem, the function of the hospital changed and it housed a varied group of patients – surgical convalescents, mentally handicapped patients from Gogarburn, people with respiratory illnesses and older people who were virtually long-stay patients. There was no geriatric service in East Lothian and in 1975 the Lothian Health Board decided to start one, the opening date being 1st January 1976.

At that time, Dr AP Littlewood, who was also a physician at Roodlands Hospital, was in charge of the 120 medical beds. He made available an assessment ward (nine female and nine male beds, with a day room) and a long-stay ward for the start of the geriatric service. As this service expanded, Dr Littlewood gradually withdrew until all the medical beds were part of the geriatric unit. In return, the geriatric unit tried to keep taking patients from Roodlands, especially those (eg with stroke) who would delay further admissions to Roodlands.

The service also had some assessment beds and long-stay beds at Edenhall Hospital, serving Musselburgh and what eventually rose to 48 long-stay beds at Belhaven Hospital in Dunbar.

The medical staff consisted of one consultant, a registrar and 2 senior house officers (SHO). Eventually one SHO was exchanged for a house physician who spent four months at Roodlands, and two months at East Fortune, thus giving newly qualified doctors some experience of geriatric care. There was an SHO at Edenhall and Belhaven was covered by East Fortune. East Fortune had a full complement of nurses, physiotherapists, occupational therapists, a visiting dentist, a visiting audiologist, a speech therapist, a social worker and hairdresser. Simple radiology was available and more complicated x-rays were taken at Roodlands. Laboratory work went to Edinburgh. The buildings were not ideal, having been put up for various service personnel but the excellent service provided by the nurses and other staff more than made up for that.

All patients referred by GPs were first visited at home by me and the next step decided. We had no outpatient department because the ambulance service could not support one. However, one nine-bedded ward was turned into an excellent day hospital with an examination room, seating and dining areas and bathing facilities. After a home visit, patients could be admitted to the assessment ward or attend the day hospital a few times for further investigation. The day hospital offered what the ward offered, without the hotel component. Weekly meetings were held of all of the staff to discuss the progress and the probable future of the patients. Those who could not go home or to a residential home could have a long-stay bed. I had more long-stay beds than average because of the former functions of the hospital and once the service was well established, there was virtually no waiting list. We kept two beds in the winter, and six in the summer used only as respite beds to admit people from the community for two weeks and so to give carers a rest. GPs rang the secretary to book these beds. Some patients spent Monday to Fridays in hospital and went home at weekends.

The long-stay beds used two days a week of consultant time. There were no GP clinical assessments in East Lothian, and long-stay patients need regular visits from a senior doctor. In East Fortune this fell on the consultant.

We had excellent liaison with the Social Work Department. This was because of the helpful attitude of the Director, David Affleck. Between us we pioneered the examination by the geriatrician of applicants for local authority homes, thus avoiding putting people in homes who needed to be in hospital.

The geriatric service as described here has changed considerably in recent years. First many long-stay beds have been lost and many patients who would have lived in hospital now go to nursing homes. Unfortunately the geriatrician is no longer responsible for these patients, which is a pity because sometimes a long-stay patient is found later not to need such care. Secondly, East Fortune has closed and a new very well equipped geriatric unit has been opened in Roodlands for assessment and treatment. This unit includes an attractive long-stay unit.

Nevertheless in its day the geriatric service in East Fortune was effective and a very pleasant place in which to work. I remember admiring the trouble ward sisters took to provide fun in the lives of long-stay patients. Sometimes they used to borrow a bus with a rear-lift from Edinburgh and take their patients shopping in Hadddington in wheelchairs if necessary.