There was a total of 562,062 instances of staff absences
249,173 instances of staff absences were covid related, an increase of 41% on the previous week
Nearly half of instances of staff absences were covid related
Since the start of December there has been an increase of 198% in covid-related instances of absence
On average 16,906 patients resided in hospital who no longer fit the criteria and were ready to be discharged, of these, on average, 9,858 remained in hospital
This is equal to almost six in 10 patients who were ready to be discharged remaining in hospital
Nearly one quarter of ambulance arrivals were delayed by 30 minutes or more
Almost one in 10 ambulance arrivals were delayed by at least an hour
Dr Katherine Henderson, President of the Royal College of Emergency Medicine, said:“The scale of the pressures facing the health service is highlighted in these figures. Instances of covid-related absence have tripled since the beginning of December. Now the army has been deployed to assist the health service in London.
“Ambulances continue to be delayed in handing over patients on arrival putting patient safety at risk, while high numbers of patients ready to be discharged remain in hospital due to the ongoing social care crisis.
“Promoting flow through the hospital is vital but rests upon timely discharge of patients back home once their treatment is complete. To ensure this social care must be resourced and supported, this will help reduce admissions and free up beds in hospital.
“It is a perilous situation, and an enormous strain is put upon staff working in hospitals, who continue, as ever, to go above and beyond to ensure care continues to be delivered and patients are kept safe.”
73.8% of attendances were seen and resulted in subsequent admission, transfer or discharge within four hours – an increase of 3 percentage points compared to the previous month, October 201
There were 103,726 attendances, a 4% decrease when compared to the previous month, October 2021
More than one in four patients were delayed by four hours or more
5,697 patients were delayed by eight hours or more, equal to 5.5% of all attendances
1,729 patients were delayed by 12 hours or more
Responding to these figures, Dr John Thomson, Vice President of the Royal College of Emergency Medicine Scotland, said:“The reality on the ground is that many Boards are under enormous strain, as there has been a significant increase in staff absences due to the surge in covid. Staff are isolating with a positive test or due to a contact with someone with a positive test.
“Emergency Departments were overstretched prior to the new variant. But current winter pressures met with widespread staff absences mean staff are put under more and more strain on each shift which affects the quality of care provided and both the patient and staff experience alike.
“For many staff, there hasn’t been a Festive break, and they have had no rest or respite but continue to work tirelessly in Emergency Departments.
“The pressures are mounting on the health service once again. It is imperative that we are able to continue delivering vital care to patients.
“But the surge of covid across Scotland is affecting all parts of the system, not just Emergency Care.
“It is a deeply concerning situation to be in, and what concerns us most is the functionality of the health system and our ability to continue delivering urgent and emergency care to those who need it.”
NHSGGC issues urgent public A&E appeal as staff struggle to cope with demand
Amidst unprecedented and unsustainable demand on emergency services, NHS Greater Glasgow and Clyde is urging the public not to attend A&E without a very urgent or life-threatening condition and to use more appropriate services instead.
A&Es across the health board remain extremely busy, with all operating well over normal capacity which is having a huge impact on service provision.
Unless very urgent or life-threatening, patients should not attend A&E without first calling NHS24 on 111. This will ensure they are directed to the most appropriate urgent service for their needs and A&Es are safeguarded those who need them.
Commenting Dr Scott Davidson, Deputy Medical Director for Acute Services for NHSGGC, said: “Our A&Es remain open and continue to assess, treat and admit emergency patients, however they are extremely busy and staff are facing huge challenges to ensure we’re able to treat patients safely and as quickly as possible.
“We continue to see large numbers of people attending with symptoms that could be managed by speaking to a GP, local pharmacy, or, by calling NHS24 on 111 before attending A&E.
“As a result of current demand at A&E, people are facing long wait times and our staff are under severe pressure.
“There are other services geared up and ready to see and treat you. If you’ve had a slip, trip or fall, we have numerous Minor Injuries Units (MIUs) across NHSGGC which can look after you, including if you’ve broken a limb.
“GP practices across Greater Glasgow and Clyde are operating normal hours, and community pharmacies are also open to help you get the treatment you need.
“Unless very urgent or life-threatening, please do not attend our A&Es unless you are referred.”
Across NHS Greater Glasgow and Clyde there are three standalone Minor Injuries Units (MIUs) – at the Vale of Leven Hospital, Stobhill Hospital and the New Victoria ACH.
MIUs operate in a similar manner to A&Es and can take care of a vast range of injuries.
Patients who attend MIUs following a call to NHS24 are far more likely to be seen, treated and discharged quicker than if they present to an A&E. They will also be helping to protect vital frontline A&E services for those people whose lives are at risk.
Four-hour performance was second lowest on record at 69.7%
There were 24,009 attendances
7,285 patients were delayed by four hours or more, equal to one-third of patients
1,803 patients were delayed by eight hours or more
598 patients were delayed by 12 hours or more
Responding to these figures, Dr John Thomson, Vice President of the Royal College of Emergency Medicine Scotland, said:“The latest data is shocking, as performance sinks to record lows once again. Staff are working tirelessly in Emergency Departments, and we anticipate pressures to mount further as covid surges across Scotland, and with this performance to drop even more.
“We are deeply concerned. Our fear is that staff absences due to covid may prevent the health service from delivering effective care. The current pressures are already leading to long waits for patients, ambulance handover delays, dangerous crowding and corridor care. If we lose staff to covid, these consequences will be further exacerbated. We know that long waits in Emergency Departments threaten patient safety and can lead to avoidable harm or death.
“The crisis is extremely worrying. The coming weeks will be a significant challenge, morale is already plummeting as concern for whether the health service in Scotland will be able to cope is escalating.
“We hope the public understand the unprecedented pressures facing the health service and the crisis that is deepening each week. Staff are doing all they can to deliver effective care and to keep patients safe.
“We urge the public to be cautious in the coming weeks, to use face masks, avoid crowded places, get tested and isolate when they have symptoms, and crucially, to get vaccinated or boosted – these steps go a small way to alleviating pressures on Emergency Departments and the wider health service.”
In October 2021 there were 108,279 attendances to major Emergency Departments across Scotland, the number of attendances dropped by 5,719 patients (5%) compared to the previous month, September 2021.
Despite this, data show that four-hour performance in major departments has once again reached a new record low, with 70.9% of patients being seen, transferred or discharged within four-hours – 2.5 percentage points lower than the previous month, September 2021.
In October 2021 2,533 patients spent 12-hours or more in a major Emergency Department, this is an increase of 30% compared to the previous month, September 2021, and the highest number on record.
Data also show that 8,181 patients spent eight hours or more in a major Emergency Department. This is an increase of 21% compared to the previous month, September 2021 and is also the highest number on record.
Dr John Thomson, Vice President of the Royal College of Emergency Medicine Scotland, said: “Yet again we are reporting on the worst performance figures on record. 1 in 13 patients are now delayed by eight hours are more.
“This trend is extremely worrying and, most of all, dangerous for patients. Each month, the number of patients that have come to avoidable harm grows. So far in 2021, 387 excess deaths have occurred as a direct result of crowding.
“This number will continue to increase unless patient flow is prioritised this winter; this means freeing up beds where possible by ensuring that patients have timely access to social care, utilising the Discharge to Assess model, and avoiding admission when appropriate by maximising the use of Same Day Emergency Care.
“Every winter we know that the increase in demand for unscheduled care, and therefore beds, disrupts elective surgery – this is not a new phenomenon by any means.
“However, with a record number of patients awaiting surgery, ensuring that unscheduled care does not derail progress on the backlog is more crucial than ever. This requires a whole system approach and cannot be tackled in isolation. If poor patient flow in emergency departments is addressed successfully, this will go some way in mitigating the risk of further disrupting elective care.
“We are very keen to work with the Scottish government on what can be done in the short term to alleviate the immense pressures EDs are currently facing.
“Accompanying this, we continue to call on the Scottish government to set out a long-term workforce plan. The required expansion in capacity cannot be safely achieved without both recruiting new and retaining existing staff.
“At present we need an additional 130 EM consultants along with sufficient numbers of both junior and supporting staff and nurses.”
Data from The Royal College of Emergency Medicine’s Winter Flow Project 2021/22 reveals that in November 2021 6,726 elective care operations were cancelled and in October 2021 6,335 elective care operations were cancelled.
Dr Adrian Boyle, Vice-President of the Royal College of Emergency Medicine, said:“In its first week of reporting, the Royal College’s Winter Flow project 2021/22 has a stark warning for the months ahead.
“Nearly 7,000 elective care operations were cancelled at reporting sites in November alone. This data comes as the National Audit Office, in their latest report, predict that the elective care waiting list could reach 12 million by March 2025.
“Data show 12-hour stays are twice as high as the same time last year; four-hour performance remains incredibly low averaging at 62% in November; long hospital stays have increased 13% since the beginning of October. Urgent and Emergency Care is verging on crisis and it is impacting and derailing elective care, meaning surgery for patients with serious conditions is delayed.
“The situation is unsustainable; we must see a willingness to address these crises and tackle the problems. The core of the issue is poor patient flow throughout the hospital and exit block caused by difficulties in discharging patients. These blockages cause ambulance handover delays, crowding and corridor care.
“Capacity must be expanded to avoid a hard-hitting impact on elective care. While it is crucial that social care is resourced to enable a timely and supported discharge of patients.
“In the long-term, restoring bed capacity to pre-pandemic levels and publishing a long-term workforce plan are vital to ensuring no parts of the system are compromised or derailed; to promoting good flow throughout the system; and keeping patients safe.”
This reveals for the first time the extent of potential harm that is being caused to patients when they must wait in the back of ambulances or in corridors before they are accepted into the care of their local hospital.
The review found that the proportion of patients who could be experiencing unacceptable levels of preventable harm is significant. Over eight in ten of those whose ‘handover’ (from ambulance clinician to hospital clinician) was delayed beyond 60 minutes were assessed as having potentially experienced some level of harm; 53% low harm, 23% moderate harm and 9% (one patient in ten) could have been said to have experienced severe harm.
The impact assessment was coordinated by AACE and was undertaken in all ten English NHS ambulance services who reviewed a sample of cases from one single day in January 2021, where handovers exceeded one hour.
Experienced clinicians assessed the range and severity of potential harm experienced by those patients who were already seriously ill, frail or elderly and who waited for sixty minutes or more before being accepted into the care of the hospital from the ambulance crews in attendance.
The nationally defined target for hospitals included in the NHS Standard Contract states that all handovers between ambulance and A&E must take place within 15 minutes, with none waiting more than 30 minutes.
Since April 2018, an average of 190,000 handovers have missed this target every month (accounting for around half of all handovers) while in September 2021 over 208,000 exceeded the 15-minute target.
Responding to the latest report ‘Delayed hospital handovers: Impact assessment of patient harm’ published yesterday by the Association of Ambulance Chief Executives, Dr Katherine Henderson, President of the Royal College of Emergency Medicine, said:“This report makes for stark reading but will come as no surprise to Emergency Department staff.
“Patients should never be delayed in the backs of ambulances. Patient safety is being compromised. When there is simultaneously no space in the Emergency Department and ambulances queuing outside the Emergency Department, we are no longer delivering effective urgent and emergency care to the community.
“We support our paramedic colleagues and will continue to work with them to tackle these handover delays and keep patients safe. But these pressures must not be addressed in isolation. The answer does not lie with the ambulance services nor in the Emergency Department. This is a system-wide problem that requires system-wide action and solutions. In particular, the answer is not just to increase physical space in the Emergency department with no additional staff.
“Trusts and Boards must focus on increasing flow throughout the hospital to reduce exit block and ensure patients are moved through the system. In the immediate term, Trusts and Boards must safely expand capacity throughout the hospital where possible to stop patients being delayed in ambulances. Social care must be resourced to ensure patients can be discharged when they have completed their treatment to prevent long hospital stays.
“We entered the pandemic with too few beds in the system and have continually struggled to manage with reduced capacity, now this is unsustainable. It is vital that the government restore bed capacity to pre-pandemic levels to achieve a desirable ratio of emergency admissions to beds. Currently 7,170 beds are required across UK Trusts and Boards.
“Patient safety is at risk and without urgent action avoidable harm will continue to fall upon patients while urgent and emergency care will fall deeper into crisis.”
Lothian MSP Foysol Choudhury has warned that NHS Lothian is in crisis as another week of dismal A&E figures has been recorded.
Statistics published yesterday show that only 64.8 per cent of attendances in NHS Lothian at A&E in the week ending 31st October were seen within four hours.
363 patients spent over eight hours in A&E, with 132 waiting over 12 hours.
1,504 patients waited over 4 hours.
These are among the worst weekly A&E times on record for NHS Lothian.
Scottish Labour MSP Foysol Choudhury said:“Yet another week of shocking statistics showing the reality of SNP mismanagement of our NHS.
“Lothian patients are in dire need of medical help and they are not receiving the swift attention they deserve. These are truly shocking figures that show once again just how out of depth the SNP Health Secretary Humza Yousef is.
“The SNP has left NHS doctors and nurses over-worked, under-staffed and under-resourced – and it is patients who are paying the price.’’
The latest Emergency Department performance figures for Scotland published by the Scottish Government yesterday for September 2021 show a deterioration in performance for the fifth consecutive month. The data show the worst four-hour performance on record and both the highest number of 12-hour and eight-hour stays since records began.
In September 2021 there were 113,998 attendances to major Emergency Departments across Scotland, the number of attendances dropped by 3,500 patients (3%) compared to the previous month, August 2021.
Despite the slight decrease in attendances data show that four-hour performance reached a new record low, with 73.8% of patients being seen within four-hours, this is 1.5 percentage points lower than the previous month, August 2021. It is the second time in 2021 that performance has fallen below 75%.
In September 2021 1,840 patients spent 12-hours or more in a major Emergency Department, this is an increase of 31.5% compared to the previous month, August 2021. This number increased for the fifth consecutive month and is once again the highest number of 12-hour stays since records began.
Data also show that 6,413 patients spent eight hours or more in a major Emergency Department. This is an increase of 20%, equal to over 1,000 patients. The number of patients delayed by eight-hours or more increased for the fifth consecutive month and once again this is the highest number of eight-hour stays since records began.
Dr John Thomson, Vice President of the Royal College of Emergency Medicine Scotland, said: “The consistent fall in performance is seriously worrying. What we are seeing: ambulance handover delays; dangerous crowding; long stays; put patient safety at risk and can lead to harm or avoidable deaths.
“The problem is poor flow throughout the hospital and exit block, this will not be resolved in the Emergency Department, it is a system-wide problem and requires system-wide solutions and collaboration.
“Boards must safely expand capacity where possible, provided doctors and nurses and other healthcare workers are available to staff the beds. Same-day emergency care can help to reduce unplanned hospital admissions, maximising the delivery of this service may alleviate some pressures.
“Discharge to assess, ensuring that patients can be discharged in a safe and timely way where they have the support they need to recover in the community, can help free up beds to increase flow throughout the hospital.
“Lastly, it is vital that adequate support and resources are given to social and community care so vulnerable patients do not face successive trips to the Emergency Department or hospital.
“Clear communication between Clinical Leads and senior Board management about the reality of ambulance handover delays; dangerous crowding; and long stays is also vital. Stating the threat these practices pose to patient safety and both reporting and escalating incidents as they occur should guide leadership to take swift action.
“It is a very difficult time, and we are preparing for a gruelling winter. The past five months of performance figures suggest that more deterioration is set to come. In Emergency Medicine we must continue to work towards collaborative solutions and work with other departments, specialties, and management.
“But we continue to call on the Scottish government to set out a long-term workforce plan. In Emergency Medicine (EM) in Scotland there is a vital need to both recruit new and retain existing staff, we need at least 113 EM consultants along with sufficient numbers of both junior and supporting staff and nurses.”
Today’s statistics revealed the worst weekly and monthly A&E statistics since records began.
The statistics show that only 65.6% of attendances at A&E services in NHS Lothian were seen and resulted in a subsequent admission, transfer or discharge within 4 hours for the week ending on the 24th of October.
This is lower than the previous record low of 66.3% recorded in week ending 12th September. Furthermore, 508 patients in NHS Lothian waited more than 8 hours, with 240 not being seen for 12 hours.
Scottish Labour MSP Foysol Choudhury said: “A&E services in the Lothians are in crisis, with the situation rapidly deteriorating with every passing week.’’
“Hard-pressed frontline staff have been sounding the alarm for months, but the Health Secretary has spectacularly failed to take action. Patients in the Lothians are being put in danger thanks to the SNP’s catastrophic failure to support A&E services.
‘’The Health Secretary is without a workable plan, so we have a health service in freefall. Action must be taken now. Our NHS deserves better’’
NHS Lothian has warned patients not to attend A&E unless their condition was life-threatening.
It comes after statistics published this week have revealed the worst weekly A&E statistics on record.
Chief executive of NHS Lothian, Calum Campbell, said a request has been submitted for mutual aid from other health boards after services became caught in the grip of a “perfect storm” caused by staffing and bed pressures, combined with high volumes of patients presenting with complex and serious cases.
Lothian list Labour MSP Foysol Choudhury said: “Patients in the Lothians are being put in danger due to the SNP’s catastrophic failure to support A&E services.’’
‘’Lives are on the line and the Health Secretary’s current strategy is clearly not dealing whatsoever with this crisis.’’
‘’ The NHS is under-resourced, under-staffed and under pressure, and the Scottish Government must fund the NHS properly so that people can access care and treatment at A&E when they need it.’’
“If action is not taken now, we risk a winter of chaos in A&E departments across the Lothians.
Responding to the latest urgent and emergency care survey published this week by the Care Quality Commission (CQC), Dr Katherine Henderson, President of the Royal College of Emergency Medicine, said:“The survey is welcome as it provides an invaluable insight into the patient experience and confirms that Emergency Departments are doing an incredible job in difficult circumstances.
“We are appreciative of patients engaging and providing this feedback in the middle of the pandemic in September 2020. Managing to continue these core assurance processes is a challenge but continues to be very important.
“It is encouraging to see improvements in many areas compared to previous years. It is particularly pleasing to see one-third of patients using type 1 services rate their experiences 10 out of 10, and also that 94% of patients had confidence and trust in the doctors and nurses examining and treating them. This is a testament to the dedication, commitment, expertise, and compassion of Emergency Medicine staff.
“While there are many positives to highlight in this report, understandably there are some areas for improvement. Many of the areas that are a source of frustration for patients are largely a result of staff shortages and the existing workforce’s ability to dedicate ample time to each patient.
“It is important that patients have the opportunity to talk through their treatment or condition, that all patients receive the help they need when they need it whether before, after or during their care, and that their pain or condition is managed throughout their time in A&E.
“The current challenges facing the health service are no doubt affecting clinicians’ ability to deliver the highest quality of care that they strive to provide. Current workforce numbers do not match current demand, and workforce shortages crossed with increases in demand mean existing staff are stretched thinly.
“To meet current demand the workforce needs 2,500 more consultants in England along with sufficient numbers of nurses, trainees, allied health professionals and SAS doctors.”
Dr Katherine Henderson continued:“It is interesting to see that 41% of patients contacted NHS 111 before going to A&E and 32% contacted their GP before going to A&E.
“This highlights the importance of NHS 111 as a resource for patients. It is absolutely essential that the efficacy of NHS 111 is properly evaluated so we can learn how best to resource it and wider services. Call handlers must have the tools they need to provide sound guidance to patients, and they must have an adequate range of services and pathways to which they can direct patients.
“It is also significant that 32% of patients also contact their GP before going to A&E. This highlights the crucial link between primary and urgent and emergency care and makes clear that both are under-resourced. Plans to tackle the challenges facing urgent and emergency care must include a joined-up approach that include ways of supporting and resourcing primary care.”
