Covid Scotland: Patient numbers soar amid 'out of control' A&E crisis

The number of Covid patients in hospital still remains well below the first and second wave peaks, but there is less capacity available as the NHS is also trying to remobilise non-Covid care

Case numbers also show little sign of slowing, with a further 6,029 new infections detected in the past 24 hours - the third highest daily count on record.

In the past week, nearly half (47 per cent) of Covid cases were identified among under-25s - the age group with the lowest vaccination uptake, but who are also least likely to become seriously ill.

However, it comes amid warnings that the NHS is “stretched” by an influx of non-Covid illness, with the latest figures from Scotland’s emergency departments showing the worst performance against the four-hour waiting times target to date - the third week in a row that it has fallen to a record low.

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Just three quarters (75.1%) of patients attending A&E in the week ending August 22 were seen and subsequently admitted, discharged or transferred within four hours, compared to the 95% target set by the Scottish Government.

At the Royal Infirmary of Edinburgh, this fell 57.5%, and to 67.8% at the Queen Elizabeth University Hospital in Glasgow, where the health board urged the public on Monday not to go unless their situation was “life-threatening”.

Compliance with the four-hour waiting time has been deteriorating as A&E departments deal with a rise in attendances including unusual numbers of very sick patients requiring admission at a time when hospital bed numbers are limited by physical distancing, Covid patients, and an elective care backlog

Annie Wells, Scottish Conservative health spokeswoman, said the NHS was at “breaking point” with people “struggling to access care”, while Scottish Labour’s health spokeswoman Jackie Baillie said the A&E crisis was “continuing to spiral out of control”.

Meanwhile, a series of bulletins from Public Health Scotland (PHS) revealed that a record 400,000 people were waiting to see a specialist at the end of June for an outpatient appointment, with a further 96,500 on waiting lists for day case and inpatient procedures - of whom nearly one in four had already been waiting at least a year.

Source: Public Health Scotland

The figures predate the scaling back of operations by a string of health boards at various points during July and August, with NHS Lanarkshire, Lothian, Ayrshire and Arran, Highland, and Borders among those to temporarily pause non-urgent elective surgeries amid an influx of non-Covid urgent admissions, a spike in Covid patients in late July, and staff shortages due to self-isolation, annual leave or sickness absence.

READ MORE: NHS recovery? Burned out staff and retirement exodus make even a return to pre-pandemic normality look challenging

The latest rise in infections is expected to exacerbate delays for patients awaiting elective surgery, with the PHS report noting that there will also be an impact from outpatient consultations.

It states: "As the number of new outpatient referrals continues to rise and activity gradually increases, it is likely that the number of patients referred for inpatient or day case treatment will rise, which may lead to a further increase in overall list size if not accompanied by an equal rise in removals [as patients undergo treatment]."

The longest waiting times are currently in Ear, Nose and Throat (ENT) , where 40% of patients referred are waiting at least a year for treatment.

In neurosurgery and orthopaedics, a quarter of patients are waiting a year or more - while one in three children (35%) due to undergo paediatric surgery had been waiting at least 52 weeks.

The proportion of patients waiting at least a year for treatment is highest in ENT and paediatric surgery (Source: Public Health Scotland)

A separate report highlighted pressures on diagnostics, with more than 115,000 patients waiting for tests such as CT scans, colonoscopies and non-obstetric ultrasounds by the end of June this year - up by around a third compared to pre-pandemic waiting lists.

One in ten patients had been waiting over a year for an endoscopy procedure, but in NHS Ayrshire and Arran this rose to nearly one in three (29.9 per cent) patients.

PHS noted that "the lull in referrals during the height of the first Covid-19 wave", when all but the most urgent or emergency scans and tests were paused, "is a contributing factor to the current volume of waits over 52 weeks".

In radiology, waiting times were most acute for non-obstetric ultrasound, where one in three patients are now waiting longer than six weeks, compared to one in 10 pre-Covid.

READ MORE: Covid hospital patient numbers at highest level since March 

The Scottish Government stipulates that no one should wait longer than six weeks for any of its eight key diagnostic tests, but the target has not been met since June 2010.

David Ferguson, public affairs manager for Cancer Research UK in Scotland, said this was "unacceptable", adding: "It’s clear action is long overdue.

"Last week’s news that there’s to be new investment in diagnostic services is welcome.

"A commitment to creating new radiographer training places will, in time, also be helpful. But this is little comfort to patients who are on the waiting list now."

More than 60% of patients are waiting more than six weeks for endoscopy (Source: Public Health Scotland)

The Scottish Government's NHS Recovery Plan, unveiled last Wednesday, outlined a £1 billion investment to re-mobilise the health service over five years.

This included delivering an additional 40,000 elective procedures a year, compared to pre-pandemic levels, through a network of National Treatment Centres and £29m for diagnostics, including extra CT and MRI scanners.

First Minister Nicola Sturgeon said tackling the backlog "will be a priority".

Health Secretary Huma Yousaf said the situation in A&E is being closely monitored.

He added:"Hospitals are reporting increased levels of people attending A&E who are much sicker and require higher levels of care.

"Weekly performance is impacted due to a range of challenges including high attendances, staffing pressures due to isolation and annual leave and the continued requirement for infection control precautions that is affecting the time people need to spend in A&E."