Ambulance crisis: Taxis set to transport some non-emergency patients

They will be paired with a clinical professional and are "expected to be on task for a couple of months". 

The MoD also confirmed that an additional 111 service personnel will help to set up and run mobile Covid testing units "primarily around Glasgow and Edinburgh", starting from September 29.

It came as Health Secretary Humza Yousaf confirmed that some firefighters will also be redeployed to help drive ambulances, with taxis used in some cases to convey non-seriously ill patients who do not require emergency transport.

Mr Yousaf said current pressures on the NHS required "decisive and unconventional action to save lives".

He stressed that taxis would only be used in the case of "low acuity" individuals, and that "if you are in critical or life-threatening need you will be taken to hospital by ambulance". 

He added that calls to increase bed capacity by creating 'pop-up' field hospital sites would be kept "under review", but was not being pursued currently due to safety concerns.

However, he said the Scottish Government would be "repurposing some hospital space to maximise capacity".

Mr Yousaf also announced that 100 second-year paramedic students are being drafted into ambulance control centres over winter to help with call handling and dispatch. 

Speaking in the Scottish Parliament, the Health Secretary said that the Scottish Ambulance Service had responded to 10,733 "immediately life-threatening incidents" in August this year, compared to 5,788 in August 2018.

He said: "It clearly shows a significant increase in acuity in presentation to the service.

"It also means that the vast majority of these patients require to go to hospital and with acute occupancy for most boards already between 87% and 96% and most mainland boards at excess of 100% for ICU [intensive care] occupancy, we can clearly see the pressure our services are under."

It comes days after the Herald revealed the case of 65-year-old Glasgow man, Gerard Brown, who died at home amid a 40-hour wait for an ambulance, and coincides with figures showing that a record number of people spent more than 12 hours in A&E departments as waiting times performance plunged to a record low.

Compliance with the four-hour A&E waiting times target is at an all-time low

Dr John Thomson, vice president in Scotland for the Royal College of Emergency Medicine (RCEM) warned that an extra 1000 acute hospital beds are needed to relieve pressure on emergency departments which are struggling with "exit block" - the inability move patients quickly out of A&E and into hospital because wards are full.

This had resulted in at least one A&E patient recently spending nearly 48 hours in an emergency department, said Dr Thomson.

And according to Public Health Scotland, 551 people spent 12 hours or longer in emergency departments in the week ending September 12.

The previous record was 463 in the first week of January 2018 while, in an average September pre-pandemic, just 30 patients a week would have waited 12 hours or more in A&E.

Dr Thomson, an emergency medicine consultant in Aberdeen, described the figures as "worrying".

He said: "That signifies just how long patients are waiting in emergency departments for an available bed. Those patients that are waiting that length of time are not patients who we see and discharge.

"Those are patients who require to be admitted to hospital to receive ongoing specialist care and the length of time that they are spending in emergency departments equates to a very poor patient experience. It's completely demoralising for staff.

"I'm not going to name the board, but we had one board in Scotland in recent times where the patient was almost at 48 hours waiting for a bed.

"That's utterly unacceptable. It's undignified. It's poor, poor patient care."

Dr John Thomson (inset), VP in Scotland for the Royal College of Emergency Medicine

According to PHS, the worst of the bottlenecks were reported by Borders General hospital where 67 patients out of a total A&E attendance of 606 (11%) spent over 12 hours waiting for a bed.

At Crosshouse hospital in Ayrshire, it was 6% with 4.6% of the 1,677 people presenting at Queen Elizabeth University Hospital in Glasgow waiting 12-plus hours.

The highest overall attendance in the week ending September 12 - at 2,509 patients - occurred at the Royal Infirmary of Edinburgh, where 5.6% of people went on to spend 12 or more hours waiting to be admitted onto a ward.

Performance against the Scottish Government's four-hour target - which stipulates that at least 95% of A&E patients should be seen and subsequently admitted, discharged or transferred within four hours - also fell to an an all-time low of 71.5%.

The slowdown in A&E turnaround times comes despite overall attendance - at 27,354 - remaining in line with the pre-pandemic average for the same week between 2016 and 2019.

However, the picture is complicated because a much higher proportion of people than normal are presenting at A&E with complex and chronic conditions which require urgent treatment and admission to hospital, as opposed to being treated within and discharged from the emergency department.

At the same time, the flow of patients out of A&E is stalled by a lack of available beds in hospital due to factors such as physical distancing, which has reduced total capacity, and a rise in Covid patients occupying beds.

Hospital admissions for Covid, 7-day average (Public Health Scotland)

In the week to September 12, an average of 151.4 Covid patients per day were being admitted to hospital in Scotland - the highest level of Covid admissions since January.

Dr Thomson said "many if not all hospitals are at or near 100% capacity", and called for an increase in beds.

He said: "One of the main things that we think needs to happen is there needs to be an increase in the number of acute beds that are available.

"The College estimates that we're approximately 1000 acute beds short nationally and that would certainly help alleviate some of the issues related to what we call exit block - which are patients waiting to move from the emergency department when they no longer require care within the emergency department."

However, Dr Thomson said staff shortages would make setting up external field hospitals unviable. 

"Yes that would create capacity, but there are no staff to staff something like that," he said.

He added that having the Army drive ambulances “might help delays in the emergency response time, but it won’t have any impact on ambulances stacking outside the emergency department.”

He said: “The sole reason that ambulances stack and are unable offload their patients is because there is no capacity in the emergency department; if we had capacity, no ambulances would stack.

"What [acute hospital] beds give us is the capacity to allow emergency departments to function as they should.

"The problem is that with the problems elsewhere in the system - with delayed discharge, with longer lengths of stay in hospital because [patients have] more complex problems – then that all funnels back to patients spending much longer in emergency departments, making emergency departments unsafe, causing ambulances to stack.

"And that doesn’t just affect the patient who can’t get into the emergency department – that ambulance is then not available to attend other patients in the community.”

Delayed discharges - where a patient is well enough to leave hospital but has nowhere to go, for example because they are awaiting a care home place - have risen 50% since May (Graph, from Scottish Government, shows trend since March 2020)

Earlier Unite convener Jamie McNamee, who represents paramedics, questioned the value of army personnel driving vehicles "without the ability to emergency respond" or having the necessary clinical skills.

Asked how much help they would be, he told BBC Radio's Good Morning Scotland programme: "Whilst we welcome them on board they will be little or no help to the Scottish Ambulance Service in their emergency care provision."

Scottish Labour's health spokeswoman Jackie Baillie said the A&E figures showed Scotland's NHS "is spiralling further and further out of control", adding: "Lives are being jeopardised."

“If it would help for the Army to set up field hospitals then that must be considered immediately," added Ms Baillie.

Scottish Conservative Shadow Public Health Minister Sue Webber described the A&E figures as "shocking and reprehensible", while Scottish Liberal Democrat leader Alex Cole-Hamilton said they were "horrific".

"Behind each and every one is a person in pain, and a team of staff struggling to help them," he added.