Record A&E waits 'deadly portent for winter'

The latest figures on A&E performance shows that a record 3,553 people spent over eight hours waiting to be seen, treated and subsequently admitted, transferred or discharged in the week ending October 9.

This was equivalent to nearly 14 per cent of people who attended A&E departments that week.

The figure includes 1,506 people waiting over 12 hours, virtually unchanged from a record 1,510 the previous week.

Overall attendances remain below pre-pandemic levels and the percentage of patients requiring admission to hospital after presenting at A&E – at around one in five – is not unusual.

The main cause of A&E logjams are a lack of available beds in hospital, due to factors such as delayed discharge and staff shortages.

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

Performance varies widely across Scotland, however, with smaller island A&E departments regularly dealing with more than 90% of patients within four hours and NHS Tayside hitting the four-hour target in 90.4% of cases in the week ending October 9.

However, this fell to just 39.7% in NHS Forth Valley and 54.3% in NHS Lanarkshire.

The target stipulates that 95% of people attending A&E should have been seen and moved out of A&E within four hours, either as a result of being admitted to a hospital bed, being treated and discharged, or transferred somewhere else.

Since summer 2021, performance against the four-hour target has remained consistently below 80% and was just 64.2% in the most recent week.

Scottish Labour health spokeswoman Jackie Baillie said: “Week after week, we are presented with a humanitarian crisis in our A&E departments. That we are now seeing more people waiting over eight hours for treatment than ever before is a deadly portent of the coming winter.”

Research has shown that patients who spend more than five hours in A&E prior to admission are more likely to die in the subsequent 30 days, with the current bottlenecks believed to be contributing to hundreds of excess deaths every month.

Dr John-Paul Loughrey, a Glasgow-based emergency medicine doctor and vice-chair for the Royal College of Emergency Medicine (RCEM) Scotland, stressed that diverting “low acuity” patients from A&E departments to other services, such as pharmacies, “does nothing for those waiting for beds”.

He added: “John Thomson [chair of Scottish board RCEM], Adrian Boyle [RCEM president] and myself, along with many more, have been warning of this for months and months.

“I’m sorry to keep repeating the message but it’s of huge importance; the harm to our patients and staff is very real. Staffing (retention) and more acute beds needed."

Scottish Conservative Shadow Minister for Public Health, Tess White, said latest figures are “nothing short of a scandal”, adding: “Humza Yousaf’s wafer-thin winter plan has failed to make any sort of dent in the mounting pressures our hospitals are facing.

“Hardworking NHS staff are being pushed beyond their limits and patients are suffering needlessly as a result of SNP inaction.”

READ MORE: 'It's not unusual for patients to wait days for a bed' 

Scottish Lib Dem leader and health spokesman Alex Cole-Hamilton called on the Health Secretary to agree to an urgent inquiry into avoidable deaths linked to the crisis in emergency care, including cases where patients have reportedly suffered fatal heart attacks while waiting in ambulances outside A&E.

He added: “Patients and staff cannot carry on like this.”

It comes as data obtained by the party under freedom of information found that almost 170,000 staff hours were lost to mental health absences among emergency service workers between July 2021 and June 2022.

That is up from around 101,000 hours in the previous year.

An employee is included in the Scottish Ambulance Service data if they have an absence due to anxiety, stress, depression or other psychiatric illness.

Figures can include paramedics, technicians, care assistants and accident and emergency team leaders.

In its FOI response, the Scottish Ambulance Service said the mental wellbeing of staff was taken “very seriously”, with robust strategies in place to support those who need it.

Mr Cole-Hamilton said: “The figures that I am unveiling today show that in many cases they have sacrificed their own health to keep others safe.

“Medics and call handlers know that they do a high-pressure job but that doesn’t mean the Government should expect them to constantly go faster and faster. That’s a recipe for a breakdown.

“Soaring staff absences show the heavy toll that this sort of work can take, but the Government isn’t doing enough to ease the pressures.”

A Scottish Ambulance Service spokesman said: “We understand the pressures they face, and during the pandemic, we’ve increased the range of wellbeing support available to our staff, are providing vital additional support to them and have launched a new wellbeing strategy.

“In addition, we are continuing to recruit, train and develop new ambulance staff to provide additional capacity, which includes recruiting an additional 540 frontline staff over the last financial year.”

READ MORE: How will Covid affect the NHS this winter? 

Responding to the A&E figures, Mr Yousaf said the pressures were “driven by delays in discharge elsewhere in our hospitals”, with the Scottish Government’s winter plan focused “on social care and actions to encourage integration authorities to help alleviate these delays”.

The Health Secretary added that the pandemic “continues to impact performance”.

He said: “Recovery from Covid will not happen overnight, which is why we are continuing to work with boards on a number of measures to reduce pressure this winter.

“We are recruiting 1000 new NHS staff, including 750 frontline nurses from overseas. Our £50 million urgent and unscheduled care collaborative looks to help improve A&E performance by offering alternative routes to care.

“This includes our out-patient antimicrobial therapy service, which allows patients to be treated at home or in the community and has already saved 45,000 bed days.”