Dire state of A&E should be top of the Scottish Election agenda as record numbers experience long waits
As thousands of patients each month in Scotland are forced to wait more than half a day in Emergency Departments (ED) before being discharged, transferred or admitted, whoever forms the next Scottish Government must make this healthcare crisis an emergency. That’s the key message from the Royal College of Emergency Medicine following the publication of new ED performance data from Public Health Scotland.
A total of 7,967 patients, or one in 13, people who attended a major (type 1) ED in Scotland in February waited 12 or more hours before being admitted, discharged or transferred.
That’s an unacceptable proportion – and the worst of any February on record. In February 2025, the figure stood 1,895 lower, which was already dangerously high.
Less than a decade ago, in February 2019, just 344 patients waited that long across the entire month, despite more people attending EDs.
Dr Fiona Hunter, RCEM Vice President for Scotland, said: “Long waits in EDs are dangerous for patients and, for the sickest patients who require admission into a ward, are associated with increased risk of death.
“The state of our departments is utterly dire. This winter has left our members, and the departments they work in, on their knees. We are crying out for help.”
Driving this breakdown in patient flow are inefficiencies and blockages throughout the system. One of the greatest causes is delayed discharges.
PHS’s new data showed that in February, a daily average of 1,984 patients were occupying hospital beds despite being medically fit to leave.
Dr Hunter continued: “If the ‘back door’ blockages in our hospital, causing patients to be stuck in beds they do not need, it would ease pressure across the system – particularly in ED.
“Addressing the elephant in the room, next month’s elections: we call on all political parties to bring patient flow to the top of the agenda.
“We need whoever forms the next Scottish Government to tackle delayed discharge, end ED overcrowding and help us make the abhorrent practice of corridor care a thing of the past.”
Latest figures also showed that, for February 2026:
16,041 (one in six patients) waited eight or more hours to be admitted, discharged or transferred in a major ED
The proportion of patients waiting less than the target of four hours stood at 62.4%, far lower than the 95% system target
105,647 people attended ED, a slight increase compared to last February, but a reduction compared to February 2019, when patient flow was substantially better.
Devolved governments call for more cash for NHS pay
The UK Government has been urged to increase the amount of funding available for NHS pay.
Ahead of the Autumn statement, Scottish Health Secretary Humza Yousaf and Welsh Health Minister Eluned Morgan have written to UK Health Secretary Steve Barclay to ask for additional funding to help avert strike action this winter in the NHS.
The letter reads:
“We wanted to write to you in advance of the Chancellor’s Autumn Statement on 17th November to once again make the case for additional funding for our hardworking NHS staff.
“In recent weeks the Deputy First Minister of Scotland and the Welsh Government Minister for Finance and Local Government have written to His Majesty’s Treasury to make clear the need for additional funding for public services.
“The Royal College of Nursing have announced a sweeping legal mandate for industrial action across the UK. In Scotland, they have joined several other unions representing NHS staff in gaining a legal mandate for industrial action with ballots expected to confirm a mandate in the rest of the UK.
“The risk to the NHS of industrial action this winter is profound, and we all need to do all we can to avert industrial action in any form. The NHS across the UK continues to feel the effects of the pandemic as it recovers and remobilises, and any action is likely to have catastrophic effects in all parts of the UK.
“We are experiencing a cost of living crisis and the anger of NHS staff is entirely understandable. Sky rocketing inflation combined with high interest rates, a direct result of the havoc caused by the UK Government’s mini-budget, means that we are simply unable to come close to matching the expectations of NHS staff across the country. While the support provided by the UK Government on areas such as support for energy bills is welcome, it has not gone nearly far enough.
“Media reports suggest that the Chancellor is considering reimposing austerity on the people of the UK again, for which there is no mandate, through extensive spending cuts. That would be a disaster for our public services, including the NHS, at a time when they need more investment, not less.
“We would therefore implore you to work with us to make the case to the Chancellor in advance of his Autumn Statement for increased funding for the NHS and the devolved governments as a whole, primarily to pay our hard working NHS staff a fair pay rise in the face of the cost of living crisis this winter, and avoid what could be catastrophic industrial action in the NHS.”
Responding to the latest Emergency Department performance figures published by NHS England for October 2022, Dr Adrian Boyle, President of the Royal College of Emergency Medicine, said: “The crisis in Emergency Care is dire. October saw nearly 44,000 patients face a 12-hour DTA wait – we know 12-hour waits measured from decision-to-admit are just the tip of the iceberg and hides the reality.
“We know far more patients wait for 12-hours measured from their time of arrival. NHS England and the Department of Health and Social Care will still not commit to publishing this data, despite it being collected by all Trusts. We believe this is a barrier to tackling the root of the crisis.
“We know excessively long waits and dangerous crowding are associated with patient harm and increased risk of mortality. Scientific studies have shown that there is one death for every 67 patients waiting between eight and 12-hours from their time of arrival in the Emergency Department.
“The ONS continue to report worryingly high excess mortality figures and we believe that dangerous crowding, long delays, and the crisis in urgent and emergency care are contributing to a significant proportion of these excess deaths.
“We are increasingly concerned about the winter and the health system’s ability to cope. We are already at 94.3% bed occupancy for all general and acute beds and each month patients face the longest waits on record. The system is failing in its core function – the quick and effective delivery of emergency care.
“We need meaningful action now – sticking plasters like setting up tents or handover units will do nothing to resolve these long-waits and may actually cause more harm to patients. We know we need to be able to admit patients, we know ambulances need to handover patients quickly, we agree that it is vital that ambulances must return to Urgent and Emergency calls in the community – but to achieve this we must tackle the issue of poor flow in our hospitals.
“Many patients in hospital no longer meet the criteria to reside, they are occupying beds to which we could be admitting patients. Around 13,000 people are in hospital unable to be discharged. We urgently need an effective social care workforce to help with the discharge of these patients, so we can admit patients, receive patient handovers promptly, and get ambulances back out to the community.
“It is crucial that those in power understand that this is not a demand issue, attendances are not causing crowding and long waits. Crowding and long waits are a consequence of the inability to move patients through the hospital, a consequence of patients who are unable to be discharged because of severe cuts to social care.
“If you can’t discharge patients, beds are indefinitely occupied and the whole system is blocked. The government must get a grip of the social care crisis to fix flow.”
Commenting on the news that the RCN have voted in favour of strike action, Dr Adrian Boyle said: “In Emergency Medicine there is a retention crisis, particularly amongst our nursing colleagues.
“Emergency Medicine nurses are a critical part of the workforce – EM is a team sport. We know and understand that many EM staff, including nurses, are burned out, exhausted and overwhelmed.
“They are skilled, competent professionals who deliver excellent care for our patients. It is vital that our nursing colleagues feel valued and appreciated.”
Last month there were 97,350 general and acute beds available, an increase of 0.71% from September. The occupancy rate was 94.3%, 0.7 percentage points higher than September, the highest monthly figure on record
The occupancy rate for adult general and acute beds was 95.6%, also the highest figure on record.
Patients leaving the department before being seen stood at 5.2%. This is a decrease of 0.2 percentage points from August 2022, but a decrease of 0.7 percentage points from September 2021.
Unplanned reattendance rate was 8.5%. This is 0.4 percentage points lower than September 2022, but 0.3 percentage points higher than September 2021.
Median time in department for admitted patients was 404 minutes. This is an increase of 29% compared with September 2021 (314 minutes). For all patients, the median wait was 192 minutes.
