Scottish Conservative and Unionist MSP for Lothian Miles Briggshas accused the SNP of presiding over “horrifying” A&E waiting times in Lothian.
Mr. Briggs’ remarks come after monthly A&E waiting times for November showed that only 58.5% of patients across Lothian were seen within the SNP’s four-hour target waiting time.
In the Royal Infirmary of Edinburgh, the figure is at a shockingly low 44.1%.
This was below the average for Scotland which sits at 65.8%.
The SNP’s own target is for 95% of patients to be seen within that time after arriving at A&E.
Lothian MSP Miles Briggs says these waits are “unacceptable” and “undoubtedly put lives at risk” and insists that the SNP have failed to give dedicated staff the resources they need to see patients quickly enough.
Mr. Briggs says that the SNP’s failures mean A&E services in Lothian are in “permanent crisis” mode and that this could “spiral out of control” over winter.
Mr. Briggs has urged SNP health secretary Neil Gray to come up with a proper plan for the health service, which ensures money gets to the frontline, rather than being wasted on pointless bureaucracy.
Scottish Conservative and Unionist MSP Miles Briggs said:“A&E waiting times in Lothian are absolutely horrifying, and this is mirrored across Scotland.
“Far too many patients are waiting too long to be seen in Lothian and that undoubtedly puts lives at risk.
“These waits are unacceptable and successive SNP health secretaries have left Lothian and the rest of Scotland without the resources to meet the demands of patients turning up in A&E.
“My constituents in Lothian are at even greater risk than other Scots – and the buck stops with the SNP government.
“A&E departments are in permanent crisis mode and as winter continues there is a real danger the waits will spiral out of control.
“These waiting times must finally be the wake-up call for Neil Gray to deliver a proper plan to support Scotland’s NHS.
“This must prioritise getting money to the frontline in Lothian and across Scotland rather than being wasted on pointless bureaucracy.”
Emergency Departments in Scotland are struggling against the combined pressures of extreme weather and a rise in hospital admissions from flu.
The Royal College of Emergency Medicine (RCEM) has described the country’s health service as being “in the depth of a winter crisis” as Scotland braces itself against snow and ice.
Yesterday, after coming under increasing pressure regarding the condition of Emergency Care in Scotland, Health Secretary Neil Gray said A&E demands had been “exacerbated by higher than normal levels of influenza infection in the community”. Data released last week showed hospital admissions caused by flu increased by 12% in a week.
The Health Secretary’s comments come as data released yesterday by Public Health Scotland revealed last November 6,429 patients waited 12 hours or more in Emergency Departments – the highest proportion of 12 hour waits for any November since records began in 2011.
Dr Fiona Hunter, Vice Chair of RCEM Scotland said: “Today’s data, and every previous month’s data, shows just how much pressure Scottish EDs were under coming into this winter.
“The system was already under extreme pressure, and this huge flu surge and cold spell are likely to be the straw that breaks the camel’s back.
“But it cannot – and must not – be blamed as the sole cause of the crisis we are currently experiencing.
“My colleagues are working flat out in very difficult conditions with some departments nearing 400% capacity- four times as many patients as there are cubicle spaces for. We are running on hard work and goodwill, and our patients are receiving unacceptable, undignified and unsafe care in corridors and in the back of ambulances.
“The main issue is that we can’t move our patients who desperately need admission to a hospital bed in to wards or high dependency units. These wards have the highest level ever known of patients who are ready to be discharged but have no available social support to allow them to do so.
“We are predictably gridlocked, in the depth of a winter crisis, and our patients and staff are the ones suffering.”
Curbing sky rocketing A&E waiting times must be the number one priority for the Scottish government with winter just around the corner.
That is the call from The Royal College of Emergency Medicine (RCEM) Scotland as A&E performance data for July represented the worst July since records began in 2011 for extended wait times in Emergency Departments.
This is double the number of people who waited this long in July last year.
The data also shows long waits have increased significantly since the 2010s.
Since July 2017, for example, the numbers of people waiting four hours or more has increased by nearly seven times (5553 to 38,379), eight hours or more by 53 times (248 to 13,146), and 12 hours or more by 279 times (20 to 5,593). This was despite attendances only increasing by 0.9% in the same period.
Delays in discharging patients is a key reason that doctors cannot admit patients into hospitals from their Emergency Departments, therefore causing long waits. In July, there were 61,165 days spent in hospital by people who were well enough to be discharged but unable to be due to a lack of social care provisions. This is equivalent to 167 years.
Dr John-Paul Loughrey, RCEM Vice President for Scotland said: “The Scottish government must take heed and put measures in place to end long wait times in our Emergency Departments.
“These staggering statistics are deeply worrying for the people of Scotland who are facing incredibly long and tiring waits despite it being summer. We have been dealing with ‘winter levels’ of pressure, which does not bode well as we start to head into the colder months. The first day of winter is just three months away, which will inevitably heap pressure on the health care system.
“Continuing to focus on diverting patients away from A&E rather than addressing the capacity problems will not avert the coming crisis. These statistics aren’t just numbers. They are people who have come to our Emergency Departments needing emergency care. They deserve better. Our health care colleagues deserve better.”
A graphical representation of the data can be found here.
This is the response from The Royal College of Emergency Medicine (RCEM) Scotland as the latest Emergency Department performance data reveals that one in every nine people waited eight hours or more to be seen in A&E last month.
The data also shows long waits have increased significantly since the 2010s.
Since May 2017, for example, the numbers waiting four hours or more has increased by nearly five times, eight hours or more by 21 times, and 12 hours or more by 89 times. Despite attendance only increasing by 0.5% in the same period.
Dr John-Paul Loughrey, RCEM Vice President for Scotland said: “It is right that the First Minister has apologised to people who have been forced to withstand treatment in corridors.
“It is unbearable for the people experiencing this loss of dignity at an already difficult time, and for the medical practitioners caring for them in impossible conditions.
“The data clearly shows that extended A&E waiting times due to overcrowding is not a new issue. It is sadly what A&E staff have come to expect.
“We once again call on the Scottish Government to take action to prevent overcrowding in Emergency Departments and the subsequent need to treat people in corridors by increasing the number of hospital beds and improving social care options so people can leave hospital when they are ready.
“I, personally, am growing weary of the inaction to rectify these longstanding issues and the resulting harms.”
“The government is duty-bound to provide the people of Scotland with safe and dignified emergency care, and now is the time to do so.”
“These figures, and our own research, clearly evidence the shameful and shocking reality of poorly patients who need to be cared for on hospital wards having to wait many hour hours, ever days, often on trolleys in corridors because there is not enough capacity in the system.
“There simply are not enough beds to admit people to, often because the people in those beds are medically well enough to go home but can’t because of inadequate or delayed social care support.
“It is not just a matter of inconvenience or lack of dignity – which is bad enough. The longer people’s in-patient admission is delayed, the greater the risk the risk to their life.
“There is no one quick fix, but the problems are fixable. RCEM is ready to work with whoever forms the next Government to begin the process of resuscitating our health system and ending these unacceptable and dangerous long waits.”
New data released yesterday (5 March 2024) for Scotland reveals January was the worst month on record for people waiting to be seen in A&E.
The figures published by Public Health Scotland show that, in January 2024:
41,161 (38%) patients waited over four hours in major Emergency Departments, a 21% increase compared to last January (33,962)
17,077 (16%) of patients waited eight hours or more in Emergency Departments, almost 13 times higher than in January 2016 (1,338)
8,402 (8%) of patients waited twelve hours or more in Emergency Departments, the largest amount for any January since records began and 36 times higher than in January 2016 (232).
There were 1,866 beds occupied due to delayed discharges, an increase of 53 compared to December 2023.
Dr JP Loughrey, Royal College of Emergency Medicine Vice President for Scotland said: “This is beyond exasperating. Most people attend A&E in desperate need – to be seen by a medical professional quickly and with dignity.
“Already struggling, patients are having to endure overcrowded waiting rooms and corridors – for hours. If admission is required, they must wait for a bed – for hours.
“This latest data makes for grim reading, and it is incredibly demoralising for my colleagues to be working under such strenuous circumstances.
“They are working all out to put patients first whilst also having to carry the burden of working in an underfunded, overcrowded, and at times unsafe emergency care system. We need intervention from the Government and policy makers to ensure we never reach this nadir again.”
The data also reports:
In January 2024, there were 108,427 attendances at major Emergency Departments in Scotland. This is marginal decrease of 0.25% compared to the previous month.
62% of patients were seen within four hours at major (Type 1) Emergency Departments. This is the worst four-hour performance for any January since records began.
This is a decrease of 0.5 percentage points compared to December last year and a decrease of 3.2 percentage points compared to January 2023.
41,161 (38%) patients waited over four hours in major Emergency Departments. This is a 1% increase compared to December last year (40,763) and a 21% increase compared to January 2023 (33,962).
The number of patients waiting more than four hours has increased by more than three times compared to January 2016 (9,808).
17,077 (16%) patients waited eight hours or more in Emergency Departments.
The proportion waiting this long has increased by 2% compared to the previous month, December 2023 and has increased by 2.3% compared to the previous year, January 2023.
The numbers waiting more than eight hours is almost 13 times those in January 2016 (1,338).
8,402 (8%) of patients waited twelve hours or more in Emergency Departments
This is the largest amount for any January since records began.
The proportion waiting this long has increased by almost 1% compared to December last year and has increased by more than 1% compared to January 2023.
The numbers waiting more than 12 hours is 36 times those in January 2016 (232).
There were 1,866 beds occupied due to delayed discharges, an increase of 53 compared to December 2023.
‘We must not normalise crisis or celebrate small improvements – our patients and our members deserve more.’That is the response of the Royal College of Emergency Medicine to the latest A&E performance data.
Yesterday (14 December 2023) two sets of data published by NHS England, have been released: the latest Urgent and Emergency Care (UEC) Daily Situation Reports 2023-24 (also known as Winter Sitrep); and monthly A&E performance figures for November 2023.
While there have been some small signs of improvement in certain areas the overall situation remails extremely challenging with A&E departments declaring critical incidents this week, clinicians describing things as the worst they have experienced and ambulance chiefs expressing serious concerns about the pressure their service is under.
The most recent Winter UEC Sitrep data which covers the period 4-10 December 2023 paints a worrying picture with bed occupancy running dangerously high at almost 95% (the level considered ‘safe‘ is 85%) and two-thirds of ambulances not meeting the 15-minute target to hand over patients.
There was a small uplift in the number of beds available within hospitals, but these do not appear to have helped to ease pressure elsewhere in the system, and there remain thousands of patients, who are well enough to go home, but have not been discharged – occupying beds which are needed for other people.
The November performance data reveals that last month more than 144,000 people who visited an A&E within the month were there for more than 12 hours – the target is four hours.
Reacting to these figures, Dr Adrian Boyle, President of the Royal College of Emergency Medicine, said: “While the data suggest a marginal improvement compared to last year, it’s just deja-vu and we must not allow this permacrisis to become accepted as ‘normal’.
“Ambulances are queueing outside A&Es, Trusts are declaring critical incidents, patients are facing dangerously long waits in overcrowded and uncomfortable A&Es. Conditions are intense and difficult for staff, and the experience of patients is distressing and undignified.
“Clinicians are doing their very best, despite the circumstances, to deliver optimal and compassionate care, and mitigate any potential risks to patients but it is taking its toll on them too.
“It is welcome to see small increases in bed numbers, but it is not enough and patients continue to endure long waits.
“Significant and urgent action is required now to address these issues – this is what our members and their patients need and deserve.”
Data in detail:
The latest Urgent and Emergency Care Winter sitrep data for week ending 10 December (week 4 of publication for 2023/24) published today by NHS England show:
Bed occupancy levels at Trusts with a major A&E (Type 1 acute Trust) was 94.9%.
There were 99,497 beds open at Trusts with a major A&E, 1,521 more than the same week last year.
The Government promised that by winter 2023/24 there would be 5,000 more beds open when compared to October 2022 (97,287). For this week, there was an increase of 2,210 Type 1 beds compared with October 2022.
On average, one third of ambulance handovers involved a delay of over 30 minutes, while only one third of patients arriving at A&E were handed over within 15 minutes as per national guidance.
On average, 46,929 patients occupied a bed for more than seven days at a Trust with a major A&E.
On average, 384 beds were general and acute beds were occupied by patients with flu.
On average, 12,927 patients remained in hospital while no longer who were ready to be discharged.
There was an average of 49,020 daily staff absences at Trusts with a major A&E.
This is 7,547 fewer than the same week last year.
Published today (14 December 2023) by NHS England, the latest A&E performance figures for November 2023 show:
There were 1,385,701 attendances to major A&Es (Type 1 EDs) in November 2023. This is a 1.97% decrease compared with the previous month.
In November 2023, 144,085 patients waited 12-hours or more from their time of arrival. This accounts for 10.9% of all major A&E attendances in November. This means that more than one in 10 patients waited 12-hours or more.
The four-hour target at major A&Es stood at 55.4%, this is the fourth worst four-hour performance on record and the lowest so far in 2023.The aggregate four-hour target stood at 69.7%, the lowest so far in 2023. This is 6.3 percentage points lower than the Government’s intermediary threshold target of 76% to be hit by March 2024.
42,854 patients waited 12 hours or more from decision to admit (DTA) to admission. This is a 4% decrease when compared to the previous month. It is a 13.2% increase when compared with November 2022.
Beds data for October 2023 show bed occupancy stood at 94.8%.
Data show there were 98,844 Type 1 General & Acute beds available. This is an increase of 1,473 beds from October 2023 (97,371). And an increase of 1,636 beds from November 2022 (97,208).
Since it was announced in January 2023 that 5,000 new beds would be made available by winter 2023/24 compared with October 2022 (when there was 97,287 beds available), there has been an increase of 1,557 beds.
There were 396,755 emergency admissions at major A&Es. This is a 1.19% decrease since the previous month (401,523). This is the second highest number of admissions so far in 2023.
Latest data show that more than 4,000 patients faced 12-hour delays in Scottish A&Es as RCEM calls on the Scottish government to increase bed numbers and avoid ‘devastating winter’.
In September 2023, there were 113,864 attendances at major A&Es in Scotland.
66.50 % of patients were seen within four-hours at major A&Es (Type 1 EDs)
38,114 (33.5%) patients waited over four-hours in major Emergency Departments, this is a 1.7% increase from the previous month and a 2.3% decrease from September 2022.
This is a decrease of 1.4 percentage points from the previous month.
The number waiting more than four-hours has increased by 145.5% compared with September 2019 (15,526).
11,788 (10.4%) patients waited eight-hours or more in an Emergency Department
This is an increase of 1.1 percentage points from the previous month, and a 1.5 percentage point decrease compared with September 2022.
The number waiting more than eight-hours has increased by more than eight times (701%) compared with September 2019 (1471).
4263 (3.7%) patients waited more than 12-hours before being seen, admitted, discharged, or transferred.
This figure has increased by 0.4 percentage points from the previous month. And has decreased by 1 percentage point compared with September 2022.
The number waiting more than 12-hours has increased by 14 times (1307%) compared with 2019 (303).
There were 1,811 beds occupied due to delayed discharges, the second most for any September on record.
Commenting on these data, RCEM Scotland Vice President, Dr John-Paul Loughrey said:“As we head into winter, we expect many people to attend A&Es with a multitude of conditions and illnesses, and many of them will require admission to hospital for further care.
“It is vital that with this clear expectation comes the necessary winter planning to resource A&Es, and support both clinicians and their patients through the colder months.
“We are concerned that the Scottish government’s winter plan fell short of delivering what is needed ahead of what will likely be a difficult period for emergency care.
“We desperately need to see an increase in bed numbers. This will help to reduce the dangerously high levels of bed occupancy, reduce long and dangerous delays in A&Es, and help to ensure patients are admitted to a bed more promptly.
“We continue to engage with the Cabinet Secretary and his team in good faith and raise the concerns of our members.
“To avoid what could be a devastating winter, we again urge the Scottish government to heed our calls to adopt our priorities to #ResuscitateEmergencyCare.”
The data come as figures obtained through Freedom of Information requests revealed that nearly 4,000 people faced 24 hour waits in Scotland A&Es in the six months up to June this year.
As Dr Loughrey said: “24 hours in A&E belongs on TV, not in daily reality for patients and staff”.
More than TEN TIMES as many people waited over 12 hours in Scottish A&Es in August 2023 than in August 2019 – an increase branded ‘dangerous and shameful’ by the Royal College of Emergency Medicine.
The figure has been calculated using data published yesterday (3 October 2023) by Public Health Scotland and reveals how many people visited a major Emergency Department in Scotland in August 2023.
116,673 people visited a major Emergency Department in Scotland – almost 6,000 more than the previous month (110,854).
67.90% of patients were seen within four-hours at major Emergency Departments.
This is a decrease of 1.7% from the previous month.
37,415 patients waited more than four-hours in major Emergency Departments, which is a 9.8% increase from the previous month and an 5.3% decrease from August 2022.
10,793 (9%) patients waited eight-hours or more in an Emergency Department
This is an increase of 2% from the previous month. But a 1.9% decrease compared with August 2022.
3,847 (3%) patients waited more than 12-hours before being seen, admitted, discharged, or transferred
This figure has increased 0.9% from the previous month, but decreased by 1% compared with August 2022.
There were 1,797 beds occupied due to delayed discharges, the most for any August on record.
Responding to the figures, Dr John-Paul Loughrey, RCEM Vice President for Scotland, said: “When you compare figures month-on-month you only get a snapshot of what is happening, but when you take a longer view it reveals the bigger, much more concerning picture.
“To think that in just three years we have seen the percentage of people experiencing extreme waits increasing so significantly is shocking.
“But worse than that it is shameful, and it is dangerous. We know long waits increase the risk of people dying.
“The system is stretched to beyond capacity. Nobody wants to be in this situation – not patients and certainly not clinicians. And this should not be blamed on the pandemic – it is symptomatic of a much wider issue.
“In the short term, we need decisive and urgent action from the Scottish Government to avert what is looking like an inevitable winter A&E crisis, but we also need and effective long-term strategy to reverse this unacceptable situation.”
LOTHIAN MSPs have spoken out following a critical report on safety issues at the Royal Infirmary of Edinburgh at Little France. Inspectors reported safety concerns following visits to the hospital’s A & E Department in February and subsequent follow-ups.
Conservative Lothian list MSP Miles Briggs said: “These are very serious concerns in regards to overcrowding at Royal Infirmary of Edinburgh and the fire safety risk it creates.
“The A&E department at the hospital has been running over capacity for a number of years now, with SNP Ministers showing an ability to make any progress.
“Patient and staff safety must be the number one priority at the RIE and urgent improvements must be made.
“I have written to NHS Lothian to ask for further details and a timetable for when these improvements are being made .”
Labour list MSP Foysol Choudhury added: “It is incredibly disappointing and worrying that inspectors raised numerous serious concerns about safety in the A&E department at Royal Infirmary Edinburgh (RIE).
“Constituents in Edinburgh need to be sure that they can safely attend hospital for care and treatment. Instead, patient safety, care and dignity were called into question.
“This is terrifying for those patients in the region who need to be able to rely on and trust the A&E department should they ever need it.
“I’m very concerned that our hardworking NHS staff may also be put in danger by this crisis in the NHS, with concerns raised over staff wellbeing at RIE. Our hospital staff work incredibly hard to provide the best service possible.
“Patients at RIE and their relatives spoke highly of the compassionate care they received from staff. “This makes it all the more disappointing that staff and patients alike are being affected by 16 years of SNP incompetence.
“Staff and patients are crying out for help. Will the new Health Secretary answer their call and reverse years of damage done by Humza Yousaf when he held the post?”
NHS Lothian says the concerns expressed in the report are already being addressed. Alison Macdonald, nurse director at NHS Lothian, told the BBC the HIS visit came at a time of “unprecedented pressure” on the hospital.
She said: “We accept and acknowledge the findings of the HIS report and we sincerely apologise to patients for longer than usual waiting times in the emergency department and a poorer experience of care.
“We had already begun our own improvement work when the inspectors carried out their first visit.
“When they returned for their follow-up, it was clear to see that improvements had already been made, but more was required. We are now focused on our improvement and safety action plans.”
HEALTHCARE IMPROVEMENT SCOTLAND’S REPORT
HEALTH watchdog Healthcare Improvement Scotland carried out an unannounced inspection to the Royal Infirmary of Edinburgh, NHS Lothian on Monday 20 to Wednesday 22 February 2023 using our safe delivery of care inspection methodology.
During our inspection, we:
inspected the ward and hospital environment
observed staff practice and interactions with patients, such as during patient mealtimes
spoke with patients, visitors and ward staff (where appropriate), and
accessed patients’ health records, monitoring reports, policies and procedures.
As part of our inspection, we also asked NHS Lothian to provide evidence of its policies and procedures relevant to this inspection. The purpose of this is to limit the time the inspection team is onsite, reduce the burden on ward staff and to inform the virtual discussion session.
On Tuesday 14 March 2023, we carried out an unannounced follow-up visit to the Royal Infirmary of Edinburgh to establish if concerns we raised during our initial visit had been addressed.
On Thursday 16 March 2023, we held a virtual discussion session with key members of NHS Lothian staff to discuss the evidence provided and the findings of the inspection.
As a result of serious concerns about patient safety within the emergency department identified during this inspection we wrote to NHS Lothian to formal escalate our concerns in accordance with level 1 of our escalation process in the Healthcare Improvement Scotland and Scottish Government: operating framework.
A copy of the letter has been published with this report.
Summary of our findings
At the time of inspection, the Royal Infirmary of Edinburgh, like much of NHS Scotland, was experiencing a significant range of pressures including increased hospital admissions, increased pressures in the emergency department and admission units and reduced staff availability. During our onsite inspections the hospital was operating at over 100% capacity.
In ward areas, senior managers were visible, wards were generally calm and well organised and we observed good leadership and care being delivered. Patients and relatives spoken with described a good experience of care and helpful staff.
During the safety huddles we attended, we observed a strong focus on patient care needs across the hospital. However, serious patient safety concerns within the emergency department were identified during this inspection.
Inspectors raised a number of serious patient safety concerns regarding the emergency department during both our onsite inspection and return visit regarding the delivery of fundamental care for patients, patient safety, care and dignity, the current operating environment, leadership and coordination of care in the emergency department, as well as concerns about staff wellbeing.
Other areas for improvement identified during the inspection include the management of intravenous fluids, medicine administration processes, locked doors policies and procedures, and feedback to staff following incident reporting.
NHS Lothian senior managers responded quickly to concerns raised during the initial inspection. However, during our return visit on 14 March 2023, we remained concerned that the immediate actions put in place by NHS Lothian did not lead to significant improvements in the delivery of safe and effective care within the emergency department.
This resulted in us writing a formal letter of non-compliance to NHS Lothian in accordance with level 1 of our escalation process, setting out the serious patient safety concerns that required immediate action.
NHS Lothian promptly responded to this escalation, providing a detailed plan of improvement action to address each of the concerns. We will seek assurance on progress with planned improvement actions in accordance with our published inspection methodology.
This inspection resulted in five areas of good practice, three recommendations and 13 requirements.
