More than half of excess deaths due to non-Covid illnesses

This contrasts sharply with the pattern seen in 2021, when 81% of excess deaths were directly caused by Covid, and 90% since the beginning of 2020.

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Commenting on the shift in mortality, Professor Linda Bauld, a Scottish Government advisor and chair of public health at Edinburgh University, said: “I suspect it is a ‘hangover’ from people not being treated and health problems that built up during the pandemic - late diagnosis, no diagnosis, and ongoing problems accessing care.”

Links have also been drawn with growing A&E waits.

The number of patients waiting over four, eight and 12 hours in A&E has been climbing steadily, particularly since summer 2021 (Image: aa)

The most recent monthly statistics show that a record 4,483 people spent more than 12 hours in A&E during July - a key signal of the extreme bed shortages facing the NHS.

Research estimates that one extra death occurs for every 82 patients who wait more than six to eight hours in emergency departments before admitted into a hospital bed, due to factors such as delays in receiving pain relief, antibiotics and other vital treatment, as well as increased risk of acquiring hospital infections.

The longer the wait, the higher the risk.

Chart showing 30-day standardised mortality ratio plotted against duration in emergency department from time of arrival up to 12 hours (Source: Emergency Medicine Journal, January 2022) (Image: BMJ)

Long stays in A&E are also known to trigger delirium in elderly patients, while staff working in overcrowded A&E departments are less able to monitor patients for signs of deterioration.

Bed shortages also mean patients are more likely to be transferred at night, when wards are quieter but staffing levels lowest.

Figures covering the six months to August 28 show that nearly 63,000 patients spent more than eight hours in A&E, suggesting that at least 800 excess deaths could be traced back to hospital logjams.

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Dr John-Paul Loughrey, vice chair of the Royal College of Emergency Medicine, said Scotland is facing a shortfall of around 1000 beds and at least 100 consultants, with expanded workforce and bed capacity required “urgently”.

He added: “Long waits in crowded emergency departments can lead to diluted quality of care, and a lack of monitoring and assistance.

"This potential for harm transfers to those patients waiting in the backs of ambulances outside emergency departments, which in turn transfers to patients in the community waiting for ambulances facing delayed handovers - this only happens because emergency departments are dangerously overcrowded and cannot move patients on into the hospital in a timely manner

“We know the sickest and most vulnerable patients tend to experience the longest waits.

"If you’re a patient with a serious condition, it is likely to be at best severely uncomfortable and at worst seriously damaging if your treatment is delayed.”

Dr Loughrey added that while delays of six to eight hours are known to cause harm, there is currently “little research into the harm and additional mortality for those patients spending more than 12 hours, or even days, on a trolley” - a situation that has becoming increasingly common in the NHS over the past year in both Scotland and the rest of the UK.

Excess deaths are counted by the National Records of Scotland by comparing mortality against a five-year average to identify abnormal spikes.

For the past six months, and during 2021 as a whole, the total number of deaths from all causes has been running at 10% above expected levels.

The figures for 2022 are compared against 2016-19 plus 2021, while 2021 was compared against 2015-19.

The shift towards a majority of these excess deaths being due to causes other than Covid may also reflect the protective effect of multiple vaccinations, antivirals, and drug treatments, all of which have helped to reduce mortality from the disease.

Statistically, it is now no more lethal than flu, even for the elderly.

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However, very high virus rates compared to earlier in the pandemic mean that it has still been responsible for nearly 1,300 deaths in Scotland since the end of February.

Of the non-Covid excess deaths over that period, around one in three - 458 - are due to “circulatory” causes, such as heart attacks or strokes.

Allan Cowie, interim chief executive at Chest Heart & Stroke Scotland, said the NHS is being “forced to operate in crisis mode” as a result of the impact of the pandemic on health.

He added: “We’re already seeing a dramatic increase in deaths from stroke and heart disease; nearly 500 more people died of ischaemic heart disease in 2021 compared to 2019 and stroke deaths were higher in 2021 than they were before the pandemic.

“If we don’t see urgent action the NHS will be in a permanent state of crisis management which will affect hard-working NHS staff and the care we receive."

Dr John Montgomery (Image: jj)

Dr John Montgomery, a Deep End GP whose practice is based is one of the most deprived areas of Glasgow, said his patients had been disproportionately harmed by Covid and were now more likely to be in deteriorating health.

He said: “We’ve got a higher incidence of cancer and our patients tend to present later, with the worst outcomes, so you’re certainly seeing that.

"Then of course that’s compounded by the delays in getting investigations and referrals, so you’ve got that triple whammy of more cancer to manage, presenting late, and then delays in investigations and onward referrals.

“Then you’ve got ongoing issues with substance and alcohol misuse, and again late presentations seeking assistance and then delays getting them into the system to get help.

“We’ve got 50% above average COPD patients in our practice, and more type 2 diabetes - again tending to present later and with complications.

“So you’ve got a patient population with multiple problems presenting later, more severely affected, and with poorer outcomes, and then there’s the whole demand issue.

"Our consultation rate is still running at 1,860 per month, up from 1,100 before the pandemic, but you’re having to trying to sift out the most important ones to prioritise for face-to-face.”

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The Scottish Government said the 80% of excess deaths over the past six months listed Covid as either an underlying or “contributory” cause.

Death certificates can include only one underlying illness as the main cause of death, but mention multiple other factors as contributors.

A spokesman said it is “not possible” to determine from NRS statistics “whether deaths are linked to waits for treatment”, adding: “We recognise the impact of long waits, which have grown as a result of Covid-19, on people’s physical and mental health. That is why we have introduced ambitious targets for NHS Scotland to tackle the backlog of planned care.

“We are working hard with health hoards to remobilise the NHS in the safest possible way, while also supporting boards to prioritise elective activity based on clinical urgency and long waits.”