IT has become almost commonplace, year after year, for those on the frontline to warn that the NHS is facing its “worst winter ever”.

Having said that, the annual alarm bell probably fairly reflects a service finding it ever harder to cope.

Consultant vacancy rates have climbed steadily from three per cent in 2012 to 7% now (maybe as much as 15% once you count the un-advertised empty posts).

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In nursing and midwifery the picture is even more stark, with vacancy rates more than doubling from 3.7% in 2016 to 8.6% now.

The average number of staffed hospital beds, meanwhile, has fallen by 700 since 2012, amid a noble ambition to keep people well for longer in the community instead.

Unfortunately, this has not been matched by sufficient investment in social care at a time when the number of over-70s living with multiple long-term conditions has increased by around 50%.

The Herald: Source: Public Health Scotland Source: Public Health Scotland (Image: PA)

The result is that, as of August, 13% of hospital beds –nearly 1,800 per day – were occupied by patients ready for discharge but unable to leave. On average, these patients were taking up a bed, unnecessarily, for three weeks.

Good quality social care has a dual function: it helps to keep frail, elderly or disabled people from deteriorating in the first place and, once in hospital, gets them back out quicker.

Little wonder then, that A&E departments are logjammed.

For nearly 5,000 people to be spending more than 12 hours in A&E departments would have been unheard of a few years ago, even at the height of winter.

For the most part, these are patients stuck on A&E trolleys because there are no hospital beds to move them to.

The Herald: Source: Public Health Scotland Source: Public Health Scotland (Image: PA)

Increased demand isn’t to blame: A&E attendances remain 11% below pre-pandemic levels; the proportion of patients being admitted – 23% – is not unusually high; and the number of patients admitted to hospital for a planned operation in August was still around 4,000 lower than the average pre-Covid.

The fact is, Covid has accelerated, rather than caused, the current NHS crisis. The number of people spending over 12 hours in A&E was already rising fast, from 128 in January 2012 to 1,213 by January 2020.

Fixing it requires the same solutions those on the frontline have been calling for the past 10 years, and longer: adequate staffing, beds, and social care.