“There can be no denying it; the Emergency Care system is failing”

RCEM launches campaign to resuscitate Emergency Care as polling reveals the public’s lack of confidence in UK government’s policies to tackle the crisis

The Royal College of Emergency Medicine has outlined five priorities for UK governments to tackle the crisis in Emergency Care, after polling carried out by Ipsos on behalf of the College found 59% of respondents expressed a lack of confidence that the UK Government have the right policies to tackle long patient waiting times in A&E departments in hospitals.

The campaign launches amid the worst Emergency Care crisis on record, as reflected in A&E performance figures across all four-nations.

Five Priorities for UK Governments to #ResuscitateEmergencyCare lays out what UK governments must focus on to tackle the crisis, improve patient care, retain staff, and prevent harm.

The five priorities are:

  • Eradicate overcrowding and corridor care for patients
  • Provide the UK with the Emergency Medicine workforce it needs to deliver safe care
  • Ensure our NHS can provide equitable care to emergency patients
  • Focus on evidence-based interventions to tackle overcrowding
  • Introduce meaningful and transparent metrics to facilitate performance and better outcomes for patients.

More patients than ever before across the UK are facing long and dangerous waits. It has been widely reported that crowding, corridor care and long waiting times for patients in Emergency Departments are associated with patient harm and patient deaths.

The public are acutely aware of the issues and pressures in A&E departments, with an Ipsos poll, commissioned by the College, showing that:

Nearly half of those polled by Ipsos expressed that they did not feel confident they would be treated in an appropriate area if they personally had a medical emergency in the next week that required them to attend their local A&E.

Meanwhile, two-thirds did not feel confident that a hospital bed would be available if they personally had a medical emergency in the next week and needed to be admitted to hospital.

Dr Adrian Boyle, President of the Royal College of Emergency Medicine, said: “There can be no denying it; the Emergency Care system is failing and not functioning as it should.

“We can argue about numbers and calculations of excess deaths or we can work together and take the urgent and necessary action to prevent any further harm or deaths occurring. Patients and staff are rightly concerned, they deserve to see honesty and meaningful action from our political and health leaders. This is our plan to tackle the crisis.

“The roots of the problem lie in the lack of adequate capacity in hospitals, lack of staff, and lack of social care in the community. Since 2010, more than 29,000 beds have been removed from the system despite the increasing complexity of population healthcare needs.

“While for many years, social care has faced devastating cuts, meaning patients medically ready to leave hospital do not have the support they need to leave – so they reside in hospital for longer than they should preventing others from being admitted.

“The inability to discharge patients and the inability to admit patients is causing severe exit block – our hospitals are completely gridlocked, meaning Emergency Departments are becoming dangerously crowded and patients are facing extremely long waits.

“These delays and crowding impact heavily on the existing workforce, which has been stretched to its limit for too long. There are significant shortfalls of staff in Emergency Medicine; Emergency Departments across the UK are not safely staffed and the public recognise that.”

Polling shows that just 18% of respondents surveyed agreed their local A&E had enough staff to care for them in a timely way while just 23% expressed agreement that their local A&E had enough staff to care for patients in a safe way.

Dr Boyle said: “Clinicians are doing all they can and what they can to bridge the gap between an under-resourced system and the quality of care patients require, but it’s plain as day to anyone that we have too few staff.

“We are in a dire place right now, but it is fixable. We know what needs to be done to tackle the crisis and improve patient care, but this requires sustained and continued cross-party political willingness and investment to engage with the issue and tackle it root and branch.

“Our campaign to resuscitate Emergency Care shows the way forward for governments, with five key priorities to address. The first priority must be on improving flow through our hospitals to end corridor care and overcrowding.

“UK governments must open more staffed beds, where safely possible, and run hospitals at no more than 85% bed occupancy. In tandem with this, UK governments have been right to invest in community and social care but this can no longer be short-term; we need sustained expansion, resource and funding for social care to ensure patients are discharged safely and promptly when their medical care is complete.

“There must also be recognition of the impact of the crisis on the workforce, they do excellent work, but they cannot continue to flirt with burnout or this will lead to burn away. UK governments must urgently work to retain our highly-skilled frontline clinicians – but they must feel supported, listened to and valued.

“Lastly, performance is at an all-time low and metrics are currently documenting a failing service. Together with the expansion of capacity and resourcing of social care, we must see a renewed effort to improve performance and meet the four-hour waiting time target in Emergency Departments.

“We cannot afford to be in a performance vacuum any longer, metrics must have meaning and drive improvement and better patient care. In England, this must start with monthly publication of 12-hour waits from the time a patient arrives – as it is in the rest of the UK – rather than the misleading and dishonest current metric which measures 12-hours from the time a decision to admit a patient is made.”

‘There is more to care than caring’

Scottish Government campaign aims to help fill vacant posts

A marketing campaign to support the recruitment of more adult social care workers has launched To help address the high level of vacancies in the sector.

The campaign – titled ‘there is more to care than caring’ – will raise awareness of the career opportunities available in adult social care and encourage people to apply. Activity includes radio, outdoor and digital advertising, highlighting the important work done by adult social care workers.

It is part of the Scottish Government’s commitment to attract more people to work in adult social care, retain existing staff and raise its status as a profession. This builds on a pay uplift for all adult social care staff which guarantees them a minimum of at least £10.90 an hour from this April.

Social Care Minister Kevin Stewart visited Leuchie House in North Berwick yesterday to see the work it does to support people affected by stroke, multiple sclerosis and neurological conditions.

Mr Stewart said: “Working in adult social care can be challenging but offers the opportunity to have a hugely positive impact on people’s lives on a daily basis.

“We are increasing pay, improving terms and conditions in the sector, and developing clear career pathways for the workforce, ahead of the introduction of the National Care Service. This will lead to more rewarding roles for the existing adult social care workforce, and for new entrants to the profession.

“This campaign highlights that while relevant experience can help, it is core interpersonal skills such as communication, compassion, empathy and respect that are most highly valued. If these are skills you possess then adult social care could be the career for you.”

Nurses: Strikes on hold as new talks to open with Scottish government

Nursing trade union Royal College of Nursing (RCN) Scotland has paused a formal announcement of strike action in response to further talks with the Scottish government. 

The decision follows a meeting with the First Minister and RCN General Secretary and Chief Executive Pat Cullen today and talks this week between Scottish government, the RCN and the other trade unions currently in dispute regarding NHS pay (the GMB and Royal College of Midwives) to consider a roadmap to resolving the dispute. The Scottish government was fully aware that an announcement on RCN strike dates was imminent. 

The overwhelming mandate for strike action from RCN members in Scotland has been instrumental in securing these further negotiations. 

The proposal from Scottish government includes:

  • Negotiations for the 2023/24 NHS Agenda for Change pay offer to commence on an accelerated timetable starting next week with an aim of concluding by the end of February
  • A commitment to an additional payment equivalent to three calendar months value of the difference between the 2022/23 and the agreed 2023/24 pay rates
  • A firm commitment from Scottish government to a full review of the Agenda for Change framework in Scotland to ensure nursing is recognised and rewarded with a clear route for career progression 
  • A commitment to match any NHS pay increase in England for 2023/24 if it is higher than that agreed in Scotland
  • A commitment to invest any additional consequentials for NHS pay in England for 2022/23 in NHS pay in Scotland for 2022/23.

Scottish government would also support NHS employers to agree an extension of the RCN’s ballot mandate for strike action beyond early May if required.

Pat Cullen, RCN General Secretary and Chief Executive said: “The Scottish government has shown a willingness to return to the negotiating table and to act to address the nursing workforce crisis. The pressure from you, our members, has been key to these negotiations moving forward. We need to see this process through in good faith. 
 
“Our members in Scotland are being listened to and the First Minister is in no doubt that we will take strike action if the proposals being outlined do not deliver a significant improvement by the end of February.” 
 
Colin Poolman, RCN Scotland Director told union members: “You have said enough is enough and that was before the current pressures trying to care for patients and keep services running. 
 
“We know it is frustrating that things are not moving more quickly but things are moving. While the Scottish government repeated their assertion that there is no more money for NHS pay in 2022/23, it was my strong mandate from you that led to the positive discussions this week and the commitment to keep negotiating.

“The Scottish government needs to do more and to take this opportunity to do the right thing, for nursing and for patients. These new pay negotiations must acknowledge the safety critical role of nursing.”

Additional Winter support for NHS

Measures to help NHS deal with extreme pressure

Funding of at least £8 million for additional care home beds and efforts to boost NHS 24 capacity are among the measures outlined by Health Secretary Humza Yousaf to help the NHS and social care deal with ongoing extreme winter pressure.

Health and Social Care Partnerships will share £8 million to procure around 300 additional care home beds to help alleviate pressures caused by delayed discharge. The funding will allow boards to pay 25% over and above the National Care Home rate for beds. This is in addition to around 600 interim care beds already in operation across the country.

NHS 24 is taking forward plans to recruit around 200 new starts before the end of March. In the run up to Christmas NHS 24 had already recruited over 40 whole time equivalent call operators, call handlers and clinical supervisors.

Guidance has been issued to all Boards making it clear they can take necessary steps to protect critical and life-saving care.

Mr Yousaf said: “This is the most challenging winter the NHS in Scotland has ever faced and the immediate pressure will continue for the coming weeks. My thanks to all health and social care staff for their incredible efforts during these exceptionally challenging times.

“We are ensuring all possible actions are being taken to support services, and the additional measures I have outlined today will help relieve some of the extreme pressure Health Boards are facing. We know one of the most significant issues our NHS is facing is delayed discharge, that is why I have announced further support to buy additional capacity in the care sector.

“NHS 24 has a vital role in referring people to appropriate urgent care services outside of hospitals and plans to increase staff numbers over the course of winter,  will help the service deal with increases in demand.

“Emergency care will always be there for those who need it, but for many people, the best advice and support might be available on the NHS Inform website or the NHS 24 App, or by calling NHS 24, so I would encourage people to make use of these services as many are already doing.”

Responding to the Scottish Government NHS briefing on Monday, Dr Iain Kennedy, Chair of BMA Scotland said: “”Scotland’s NHS is not just being pushed to the limit, in many places it is well past that.

“Bed occupancy of 95% across our hospitals is just not sustainable in terms of providing the safe and effective care that patients need on a daily basis either in A&E or across all wards. And we know demand is far exceeding capacity at GP surgeries too and has been for some time.

“In that context, the very fact that the First Minister and Health Secretary provided today’s briefing should emphasise the seriousness and urgency of the situation. Our members provided us with first hand testimony from all across the health service just before Christmas, and the picture that painted was really harrowing. Services and staff are on their knees.

“In terms of the short term actions that the Government indicated today, we have long emphasised the need to focus on ensuring people who are able to leave hospital, can do so – freeing up desperately needed capacity and therefore ensuring those who need to can be admitted from A&E more quickly and safely. So the focus on this is welcome, but we will need to see the details and extent of the proposals to make any judgement on the immediate impact it may have. Extra interim care beds – while something which could help as part of the overall plan – will also deliver nothing unless there are people there to staff them, which we know is a huge issue in social care.

“More fundamentally, many doctors remain to be convinced that the Scottish Government’s practical response matches up to the huge scale of the problems the NHS is facing. In particular, staffing shortages will only get worse as more staff burn out and dread going to work, unless there is a more comprehensive and urgent package of investment in staffing to support and retain them in our NHS for good.

“Longer term, these pressures are the culmination of the warnings the BMA and many others have delivered for some time, that Scotland’s NHS isn’t sustainable within the resources – both staffing and financial – we are willing to provide it with.

“We have to get serious about this and have a proper long term discussion about the future of our health service rather than just struggle to survive from crisis to crisis as the NHS and its staff endure the kind of perpetual pressures which in the past were reserved for the worst of winter.

“We absolutely agree with the assessment of the First Minister that there are no easy solutions, so the sooner we truly get to grips with the big picture issues, the sooner we can get away from having to implement short term measures in the desperate hope of bolstering collapsing services and begin actually start talking about an NHS fit for the future. That’s why a national conversation on the NHS in Scotland is required without delay.”

Health and social care crisis: Sturgeon and Sunak host emergency meetings

Clinical leaders, health experts and ministers will convene in Downing Street for an NHS Recovery Forum today. Scotland’s First Minister hosted a meeting of the Scottish Government’s Resilience Committee yesterday to discuss ongoing pressures on Scotand’s struggling health service.

In addition to his regular meetings on the health service, the Prime Minister will host the Forum to bring together experts from across the health and care sector to identify opportunities to go further and faster on improving performance and outcomes.

The Forum will major on four crucial issues: social care and delayed discharge; urgent and emergency care; elective care; and primary care.

Some of the best health and care minds in the country will use the session to share best practice and to understand whether any innovations developed at a local level could be applied to other regional areas or on a national basis.

As the Prime Minister set out in his speech earlier this week, innovation is at the heart of the UK government’s approach and will be a vital aspect of the solution, and so Forum attendees will include representatives from both the public and independent sector to ensure we’re harnessing a wide spread of expertise and talent.

The Forum is the next step in the significant action that the government has taken to improve outcomes and relieve the immediate pressures on the NHS and in social care caused by the pandemic, with further pressures due to the recent rise in covid and flu cases.

On improving capacity in the NHS, the government has provided an extra £500 million to speed up hospital discharge this winter and we’re also increasing bed capacity by the equivalent of 7,000 more beds.

The NHS is rolling out virtual wards across England, with an ambition to establish 40-50 virtual ward beds per 100k population, by December 2023. Virtual wards are where people, for example, who have acute respiratory infections can actually be treated at home with telemedicine or pulse oximeters and there is also a new fall service which can save about 55,000 ambulance call outs a year by treating people with falls at home.

In total, the government will invest up to £14.1 billion additional funding over the next two years to improve urgent and emergency care and tackle the backlog – the highest spend on health and care in any government’s history. £7.5 billion of this support is for adult social care and discharge over the next two years, which will also help deal with immediate pressures. 

91 Community Diagnostic Centres have been opened so far and they have delivered over 2.7 million tests, checks and scans to help diagnose patients earlier.

The government is also continuing to grow the NHS workforce, with around 42,000 more staff than a year ago, including over 10,500 more nurses and almost 4,700 more doctors.

The government is investing at least £1.5 billion to create an extra 50 million general practice appointments by 2024, while the NHS is accelerating the rollout of new state-of-the-art telephone systems to make it easier for patients get through to their GP surgeries.

Earlier this week, the Prime Minister set out one of his key promises that NHS waiting lists will fall and people will get the care they need more quickly. He also pledged to make sure the NHS is built around patients.

The Forum will run for the majority of Saturday and attendees will include chief executives and clinical leaders from NHS organisations, local areas and councils from across the country, clinical experts from Royal Colleges and independent sector organisations working with health and social care services to deliver services for patients. 

The Health and Social Care Secretary, the Chief Secretary to the Treasury, the Chancellor of the Duchy of Lancaster and Chief Executive Officer (CEO) of NHS England will attend the Forum.

A Downing Street Spokesperson said: “As the Prime Minister made clear this week, easing the immediate pressures whilst also focussing on the long-term improvement of the NHS is one of his key promises.

“That’s why we’re bringing together the best minds from the health and care sectors to help share knowledge and practical solutions so that we can tackle the most crucial challenges such as delayed discharge and emergency care.

“We want to correct the unwarranted variation in NHS performance between local areas, because no matter where you live you should be able to access quality healthcare.”

First Minister Nicola Sturgeon has chaired a meeting of the Scottish Government resilience committee (SGoRR) to discuss the response to ongoing winter pressures on the health and social care system.

In addition to the FM, yesterday’s meeting was attended by Deputy First Minister John Swinney, Health Secretary Humza Yousaf, other Cabinet ministers, and key partners from across the system including senior representatives from NHS Boards, COSLA, Integration Joint Boards and the Scottish Ambulance Service.

The latest situation with flu and COVID-19 infections was covered, along with the increased demands on acute sites and social care which have been experienced over the Christmas and New Year period.

A number of measures are being taken to alleviate pressures on the system, improve patient flow and ensure people receive the right care in the right setting. These include the use of Flow Navigation Centres as part of the redesign of urgent care, Hospital at Home and ambulance service staff providing treatment, where appropriate, to help avoid hospital admission.

The Health Secretary will update parliament at the earliest opportunity on ongoing work to support the system, and further resilience meetings will be held to monitor the situation in the coming days and weeks as required.

The First Minister said: “It is clear that health and social care is currently experiencing a period of intense and indeed unprecedented pressure. Staff are working exceptionally hard and have been doing so throughout the Christmas and New Year period.

“This comes after nearly three years of pandemic-related demands on the system, and we are all incredibly grateful to them for their efforts.

“I am clear that the Scottish Government must and will do everything it can to support our health and care service throughout the next few weeks. We remain in daily contact with Health Boards and there is already a huge amount of work being done, but we will leave no stone unturned to explore and implement any additional measures that could be taken to help alleviate pressures.

“With that in mind we will continue to work with all partners to implement actions that can help ensure the workforce is supported to deliver the high standards of care that we want everyone to receive.

“This will include actions to reduce unnecessary attendances at A&E – ensuring people get care in more appropriate settings, and those who need hospital care get it quickly, and also on effective discharge arrangements to reduce pressure on hospital occupancy. My thanks go to all those working incredibly hard across the whole health and care system during this period of exceptional pressure.”

Choice in care for older people is all very well, but they must be made aware of the options available to them

For people who find themselves in need of care in the twilight of their lives, and for families who want to support them in their care journey, embarking on a particular course of action may be the most important decision they ever make (writes MIKE COLLIER).

However, though it is crucial at this stressful time to make informed choices, many people do not fully understand which elements of care are which, or where to go and who to speak to in order to get the best impartial advice.

It is more than eight years now since Scotland made a first attempt to put the voice of the supported person at the heart of care processes with the passing of the Social Care (Self-directed Support) (Scotland) Act 2013 (SDS).

It was intended to deliver choice and control when accepting support, with agreement about individual outcomes and a range of options to achieve these outcomes if people were assessed as having identified needs and requiring a budget.

The Act imposed a duty on local authorities to take reasonable steps to facilitate a supported person’s dignity and involvement with the community and to explain the nature and effect of the four options available to them, which are:

  • A direct payment to individuals to allow them to manage their own budget and procure their own care provider.
  • The supported person chooses their own provider, but opts for a third party such as a local authority to manage their budget.
  • The local authority or someone on their framework manages both the budget and the support provision, which was essentially the status quo ante.
  • Lastly, a mix of all these.

Well-intentioned as these provisions may be, increasingly across the country social workers who are in place to advise clients are not even mentioning these options when they go to do assessments and, as a consequence, people remain in ignorance.

There has been intensive scrutiny by a number of agencies of SDS since it was implemented, mostly concluding that it had not yet been fully implemented and that its potential was not being realised.

Inconsistent knowledge across the workforce has been highlighted, which may explain the silence of social workers about the system, and it has been suggested that traditional care culture has been difficult to shift.

Certainly, option three – that is, direct delivery of services by the council, which prevailed before the Act – remains the dominant kind of provision and research shows that failure by social work staff to discuss the options is a common issue.

Most people would not of their own volition choose to go into live-in care and more needs to be done within the limitations of SDS to highlight alternatives such as domiciliary care, which enables older people to maintain a level of independence while staying in their own home.

In this milieu, professional carers can assist with meals, cleaning, shopping – and simple companionship – at a time and duration of the client’s choosing. It provides a sense of stability and normality which can be beyond value.

This is sometimes known as an hours service, since clients can choose the time carers are with them, in contrast to unpredictable, rushed and short home visits offered by councils which are under significant financial and resource constraints.

The main thing is for people to have a choice, and to be aware of the choices available to them. Speaking to a practicing care professional is often the best first step towards the right decision.

Mike Collier is Managing Director of Plus Homecare Ltd

Carers Trust Scotland research reveals family carers experiencing unprecedented financial hardship

“All general bills are a worry. It’s crushing to not even be able to afford the most basics in life due to being an unpaid carer.” (unpaid carer responding to the Carers Trust survey)

  • Almost three quarters (74%) of unpaid carers in Scotland are worried about being able to afford energy bills.
  • Almost two thirds (58%) of unpaid carers in Scotland have either had to give up work altogether or reduce their paid hours because of their caring role.
  • One in eight (12%) unpaid carers in Scotland have had to use a food bank.
  • Carers Trust is urging the Scottish Government and the UK Government to provide additional cost-of-living support to unpaid carers now and to develop long-term solution for funding of social care.

A new survey of unpaid carers in Scotland provides a stark assessment of how many of Scotland’s 800,000 unpaid family carers have been plunged even further into financial misery by the cost-of-living crisis. 

The research, undertaken by Carers Trust, the UK infrastructure charity for local carer organisations, revealed that 38% of all unpaid carers have had to give up paid work altogether to provide the dedicated care at home that a sick or disabled relative needs. A further 20% of respondents reported having reduced the number of paid hours they work because of their caring role.

The research, which was responded to by 531 family carers, uncovered the shocking fact that one in eight (12%) unpaid family carers are now using food banks as a result of soaring living costs. In addition:

  • 28% have had to cut back on food
  • 7% have either sold their home or released home equity to pay for essential items
  • 17% have not been able to pay household bills on time
  • 38% have had to cut back on other household items
  • 27% have had to use a credit card to pay for essential household items.
  • 25% have had to borrow money from a friend or a relative
  • 17% have had to take out a loan

One survey respondent said“I am terrified that I won’t be able to pay the bills this winter”.

Responding to a survey question about what essential costs they would no longer be able to afford, almost half (48%) said transport, almost three quarters (74%) said energy bills and over one third (34%) said rent or mortgage costs.

Carer’s Allowance failing to prevent poverty among unpaid carers

The survey also starkly highlighted the inadequacy of Carer’s Allowance, the principal state benefit for unpaid carers.

Currently set at £69.70 per week, providing this is the lowest level benefit of its kind, despite more than one third (34%) of unpaid carers spending 50 hours or more a week caring for a sick or disabled relative.

The Scottish Government does provide a Carer’s Allowance Supplement of £245.70 twice per year to provide additional support to unpaid carers in Scotland.

However, eligibility criteria for Carer’s Allowance benefit are strict: claimants must earn £132 a week or less after tax and must be spending a minimum of 35 hours a week caring for someone.

Over half of all survey respondents said that they do not receive the allowance and, of those who did, 56% of respondents in Scotland said it was not enough to meet their needs as an unpaid carer.

The survey also found that, instead of preventing poverty among recipients, Carer’s Allowance recipients were more likely to be experiencing financial hardship.

  • 58% of respondents receiving Carer’s Allowance said they were struggling to make ends meet, compared to 38% of respondents who don’t receive Carer’s Allowance.

More support needed for local carer organisations supporting unpaid carers

A parallel survey of Carer’s Trust’s UK network of over 120 local carer organisations, who provide services to unpaid carers, has also highlighted the impact of recruitment challenges and funding shortages on their ability to support unpaid family carers. 

48% of services cited fundraising and sustainability as the principal challenge to work supporting unpaid carers, whilst 40% of respondents cited staff recruitment and retention as a challenge – almost twice the level (23%) reported the year before.     

Carers Trust Scotland’s Director Louise Morgan said: “Scotland’s health and social care system relies on the hard work of millions of unpaid family carers. However, the double whammy of lack of financial support and struggling local services means that thousands of unpaid family carers are being pushed into dire poverty. 

‘With little ability to work, unpaid carers simply cannot boost their earnings to meet the cost-of-living crisis. Yet they need to keep the heating on and equipment running to keep their sick and disabled relatives warm and safe.

“The recent Autumn Statement simply did not recognise the extra cost of being an unpaid carer. We therefore need to raise Carer’s Allowance urgently, provide and to add it to the list of benefits qualifying for the additional £900 cost-of-living support payment and provide double payments of Carer’s Allowance Supplement payments to help unpaid carers to pay their rising bills during the cost-of-living crisis.

As a country we’re relying on unpaid carers to keep the health and care system afloat. The least we can do in return is ensure they get a fair deal in return”.

Find out about how your Giving Tuesday donations can help support #UnpaidCarers👉https://bit.ly/3zEj3aE

RCEM: Emergency care ‘in dire crisis’

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.”

The latest Emergency Department performance figures published by NHS England for October 2022 for show:

  • There were 1,399,916 attendances at major Emergency Departments
    • This represents a 7.5% increase compared with September 2022, and a 1.7% increase compared with pre-pandemic levels (October 2019)
    • There were 2,000,493 attendances at all Emergency Care facilities
  • 43,792 patients were delayed for 12-hours or more from decision to admit to admission
    • This is the highest number of 12-hour waits on record
    • It is 520% higher than the same month last year, October 2021, and it is 5932% higher than October 2019
    • There have now been 255,334 12-hour DTA stays recorded so far in 2022 – three times as many as were recorded in the 137 months prior to 2022
  • Four-hour performance at major Emergency Departments was 54.8%, this is the worst four-hour performance on record
    • This is a 7.1 percentage point decrease from October 2021, and a 19.7 percentage point decrease compared with October 2019
  • Type 1 admissions stood at 366,964 (a daily average of 11,838)
  • 26.2% of type 1 attendances were admitted, this is a one percentage point decrease from September 2022
  • 150,922patients spent more than four hours in an Emergency Department from decision to admit to admission (also referred to as ‘trolley waits’)
    • This is the highest figure on record and is a 14.5% increase from September 2022
  • Delays to admission stood at 29.8%, this is the highest on record and a 2.8 percentage point decrease from September 2022

The latest beds data for October 2022 show:

  • 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.

The latest Hospital Episodic Statistics published by NHS Digital for September 2022 show:

  • 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. 

Invitation to help shape the new National Care Service

Adults with first-hand experience of social care services in Scotland are being invited to help design the new National Care Service (NCS).

Applications are now open for both the Lived Experience Experts Panel (LEEP) and Stakeholder Register, which will bring together people from across the country to help develop a care system that puts people first, in one of the biggest co-design exercises the Scottish Government has ever undertaken.

The new National Care Service will provide the national oversight and guidance that ensures community healthcare and social work services can be delivered locally in a way which best meets the needs of those who use them.

The panels launched today will allow people with direct experience of community health and social care the opportunity to help design these future services.

Anyone over the age of 18 living in Scotland who has views on how the future NCS should look can apply to take part in the Lived Experience Experts Panel.

Over the next few years the design work will consider a number of themes, the first of which are:

  • Information sharing to improve health and social care support
  • Realising rights and recognising responsibilities
  • Keeping health and social care support local
  • Making sure my voice is heard
  • Valuing the workforce

Organisations in Scotland with an interest in health and social care can note their interest in specific themes by joining the Stakeholder Register.

In the future, there will be additional targeted ways for people get involved – for example children and young people under 18, care experienced people, and young carers.

Minister for Social Care Kevin Stewart said: “As we build a National Care Service that best fits the needs of everyone in Scotland, we need to hear from people directly.

“The new National Care Service will set the standards and guidance to support the design and delivery of community healthcare and social work services locally.

“The complexities of getting this right should not be underestimated. People with experience of the current system, whether in receipt of health and care support or delivering it, are the experts. We particularly need to hear those voices.

“These reforms are the biggest since the creation of the National Health Service almost 75 years ago and these Lived Experience Experts and Stakeholder Panels will make sure we deliver a service that puts people at its very heart. I encourage anyone with direct experience of social care to take part.”

How to join the Lived Experience Expert Panel or the Stakeholder Register

The first NCS Forum on 3 October in Perth will be another opportunity for individuals to engage and shape the NCS co-design process. Register to join the event online

This is not the only opportunity to get involved in co-design work. In the future, there will be additional ways for specific groups to get involved – for example children, young people and families, care experienced people, and young carers.

For this reason, we’re not asking children (under the age of 18) to join the Lived Experience Experts Panel right now. Instead, we will work with organisations that represent different groups of young people to make sure we reach as many different groups as we can and undertake research work in a way that best suits their needs.