The Royal College of Emergency Medicine has joined calls for the Scottish government to address ‘delayed hospital discharges’ in the upcoming budget announcement.
Delayed discharges are when people are considered medically fit enough to leave hospital but are unable to, often because the required social care support is not available.
This issue means that the whole system for admitting people grinds to a halt and people can end up stranded in A&Es often waiting hours and even days for a ward bed to become available.
The latest data release comes as the Auditor General of Scotland published a damning report into the state of the Scottish health system which concluded that the Scottish Government has no clear plan to reform the country’s NHS, or to address pressures on the service.
Auditors found:
commitments to reducing waiting lists and times have not been met
the number of people remaining in hospital because their discharge has been delayed is the highest on record
and NHS initiatives to improve productivity and patient outcomes have yet to have an impact and lack clear progress reporting.
The issue of delayed discharges has also been highlighted by the Royal College of Physicians Edinburgh (RCPE) which has written an open letter to the First Minister calling on him to address this ‘urgent issue’ in his Government’s budget which will be unveiled tomorrow (4 December 2024).
Dr Fiona Hunter, The Royal College of Emergency Medicine’s Vice Chair for Scotland said yesterday: “Delayed discharges are a key reason that patients get stuck in Emergency Departments, often on trolleys in corridors – often experiencing extreme waits which are dangerous.
“So we join, and fully support, the calls from RCPE, and the Auditor General to address this issue. It must be prioritised as a matter of urgency.
“Today’s data is another timely reminder of scale of the issue. Just think about what it shows. More than 2,000 people every single day stranded in in hospital when they are well enough to go home.
“People – through no fault of their own, lying in beds which could be used for other patients who need to be admitted – who themselves are probably on a trolley in the Emergency Department, waiting for that bed to become available.
“We have to be able to move patients through our hospitals and out again when they are well enough. To do that takes a functioning and resourced social care system working alongside a functioning and resourced health system. They are inextricable.
Dr. Hunter concluded:“Tomorrow’s budget is an opportunity for the Government to #ResuscitateEmergencyCare, ahead of the depths of winter which is shaping up to be a gruelling several months ahead, for both patients and staff alike. They must take it.”
The Scottish Government needs a delivery plan that clearly explains to the public how it will reform the NHS and address the pressures on services.
Despite increasing funding and staffing, the NHS in Scotland is still seeing fewer patients than before the Covid-19 pandemic.
Auditors found that:
commitments to reducing waiting lists and times have not been met
the number of people remaining in hospital because their discharge has been delayed is the highest on record
and NHS initiatives to improve productivity and patient outcomes have yet to have an impact and lack clear progress reporting.
Health accounts for about 40 per cent of the Scottish budget. Funding grew again in 2023/24 but has mostly been used to cover pay commitments and inflation. Costs are forecast to continue rising and making savings remains challenging. Work to build new healthcare facilities also remains paused.
The Scottish Government’s restated vision for health and social care is not clear on how these operational pressures on the NHS will be addressed or how reform will be prioritised. It needs to work with NHS staff, partners and the public to set out a clear delivery plan and make tough decisions about how it may change or potentially even stop some services.
Stephen Boyle, Auditor General for Scotland, said: “To safeguard the NHS, a fundamental change in how services are provided remains urgent. The Scottish Government needs to set out clearly to the public and the health service how it will deliver reform, including how progress will be measured and monitored.
“Difficult decisions are needed about making services more efficient or, potentially, withdrawing those services with more limited clinical value to allow funding to be re-directed. Taking those steps will require greater leadership from Scottish Government and NHS leaders than we’ve seen to date.”
Funding to help practices retain and recruit key staff
An additional £13.6 million will be invested in General Practice this financial year to support GPs to retain and recruit key staff, Health Secretary Neil Gray has announced.
Speaking at the annual conference of BMA Scotland’s Local Medical Committees, Mr Gray confirmed the immediate funding for 2024-25 will address known financial pressures, support staff costs and enable GPs to take on partners and salaried GP staff.
Mr Gray said: “I recognise the significant financial and workload challenges facing both the NHS as a whole and General Practice, especially during this period of high demand, and understand the significant strain this places on GPs.
“My focus remains firmly on finding ways to recruit more GPs, even within the constraints of the current financial climate, and that is why I am allocating an additional £13.6 million for General Practice this financial year to support staff costs. This additional funding will help GPs to underpin business decisions and provide high-quality patient care.
“Sustainable reform of the NHS means we must look to shift more care to primary and community care with a relentless focus on better outcomes for people.
The Scottish Government reform programme will develop the means to credibly restore, and further increase GP and wider primary care spend, within the overall health budget.
“This will be a long-term endeavour but this strategic shift is crucial. Our reform plans over the next period will look to explore this in partnership with key stakeholders including the GP profession.”
Addressing the separate issue of next year’s UK National Insurance contribution increases, Mr Gray added: “The UK Government’s decision to increase national insurance contributions will have a major financial impact on GPs.
“I have been very clear that this is completely unacceptable and the UK Government must fully cover the costs. Scotland’s GPs should not be paying the price for UK Government decisions.”
The Scottish Budget for 2025-26 will be published on 4 December.
An awareness campaign is underway to ensure people know the best place to access healthcare this winter.
Right Care Right Place helps the public decide the most appropriate service for their healthcare needs – whether they should contact their GP or pharmacy, call NHS 24 on 111 or use self-help guides on the NHS Inform website. Hospital emergency departments should only be visited for critical emergencies.
The campaign features targeted advertising on television, radio and online and aims to help alleviate pressures on the NHS and social care ahead of an expected seasonal increase in demand.
Health Secretary Neil Gray visited East Lothian Community Hospital to hear about work being undertaken to address delayed discharges. The hospital supports patients leaving acute hospitals who require intermediate care before returning home.
Mr Gray said: “We have been working closely with colleagues across the NHS and social care to make sure we are as prepared as possible ahead of winter.
“Public information and awareness of the treatment options and how to access them when needed is key to ensuring services are directed where they are most needed.
“This will help everyone to get the right care, in the right place as quickly as possible while helping alleviate pressures on the rest of the NHS. People can also help by making sure they receive their Respiratory Syncytial Virus (RSV), Covid-19 and flu vaccinations if eligible.”
Self-help guides can be found on NHS inform and include advice on the most common winter illnesses.
Medical equipment and supplies will be sent from Scotland to Ukraine.
The shipment of over 500 items includes oxygen concentrators, electric height-adjustable beds with replacement batteries and mattresses, and ICU ventilators identified by NHS Scotland as surplus to operational requirements
The donation will not impact on services to patients using the healthcare services in Scotland.
It brings the total value of medical supplies donated from Scotland to Ukraine to £3.8 million.
First Minister John Swinney confirmed the latest donation during a meeting with the Ukrainian Ambassador to the UK General Valerii Zaluzhnyi in London. It follows a request from the Ukrainian Consulate in Edinburgh in May 2024 to contribute medical equipment on a humanitarian basis.
The First Minister said: “The people of Ukraine are suffering as a consequence of the illegal invasion of their country, and it is vital we do all we can to support them.
“These supplies, identified by NHS Scotland as being surplus to requirements, will provide direct humanitarian support to Ukraine at a critical time.
“Scotland stands in solidarity with Ukraine and offers unqualified support for its independence, sovereignty and territorial integrity.”
Ambassador of Ukraine to the United Kingdom General Valerii Zaluzhnyi said: “The act of generosity and solidarity demonstrated by NHS Scotland in extending a helping hand to Ukraine in its time of need exemplifies the true spirit of humanity and compassion.
“It serves as a powerful reminder that, in the face of adversity, solidarity and cooperation can transcend borders and make a meaningful impact on the lives of those in war. The Ukrainian people are deeply grateful for the support and assistance provided by NHS Scotland, knowing that these supplies will make a difference between life and death for many.
“The bonds of friendship and solidarity forged through this act of kindness will not be forgotten and will serve as a beacon of hope for a brighter future beyond the shadows of Russia’s war against Ukraine.”
Agenda for Change pay offer accepted by trade unions
Almost 170,000 nurses and healthcare workers in Scotland will receive a 5.5% salary increase this year, ensuring they have the best reward package in the UK.
Unions representing NHS Agenda for Change staff – which includes nurses, midwives, paramedics, allied health professionals, porters and others – unanimously agreed to an investment of more than £448 million for improved pay conditions.
The pay rise, backdated to 1 April 2024, will come into effect from next month.
Health Secretary Neil Gray said: “I am pleased that trade unions have unanimously agreed to accept this pay offer, which ensures that nurses and healthcare staff in Scotland, who are part of Agenda for Change, will have the best reward package in the UK.
“I want to express my thanks again to Scotland’s hardworking healthcare staff for the care they provide to patients, day in, day out. They are the very backbone of the NHS and we are committed to ensuring they feel supported and valued.”
Children in Scotland diagnosed with a brain tumour that has a specific genetic mutation can now be treated on the NHS with a kinder, more effective targeted therapy.
It’s used in combination with another medicine, trametinib, and both can be administered at home as they are taken orally. This means fewer hospital visits.
The news follows the approval given in April this year by the National Institute for Health and Care Excellence (NICE).
Current standard treatment for the condition typically involves surgery – where that’s possible – chemotherapy and/or radiotherapy. But less than 30% of children diagnosed with high-grade gliomas survive for five years or more and the treatment often has brutal side effects.
Outcomes for low grade gliomas – the most common childhood brain tumour – are better at a 90% survival rate following surgery. But chemotherapy may also be prescribed whereas this treatment means improved quality of life for patients as clinical trials showed its side effects were rare.
The combination medication is the first targeted treatment to be made available on the NHS for paediatric gliomas. It is already licensed for use in the USA, and for use in the UK in adults with the BRAF mutation who have some types of lung and skin cancers.
The two drugs work together to block the growth signal coming from the mutant BRAF protein, slowing or even stopping the tumour from growing.
Brain tumours affect around 500 children a year in the UK, of whom between 150 to 175 may have a glioma and fewer still will have the BRAF mutation. But despite the small numbers involved, this is the first progress made in treating the disease in years.
In 2008, research carried out by Dr David Jones which was funded by The Brain Tumour Charity (then known as the Samantha Dickson Brain Tumour Trust), identified a BRAF mutation that was common in pilocytic astrocytoma brain tumours.
This was the first time that a specific genetic change had been detected in these tumour types and it paved the way for drug development as it could then become a target for diagnostic tests, changing the research landscape for low grade brain tumours in children.
Dr Jones now leads the EVEREST Centre in Germany, which carries out research into paediatric low grade brain tumours.
Dr Michele Afif, Chief Executive at The Brain Tumour Charity, said: “We are delighted that the Scottish Medicines Consortium has joined NICE in approving the first new treatment for paediatric brain tumours in decades.
“We hope that this will be the first of many new treatments that will ensure our community can live longer and better lives.”
To find out more about The Brain Tumour Charity, visit:
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.
In a ground-breaking first for Scotland, laboratory specimens have been flown from one NHS board to another – by drone.
This step forward by the Project CAELUS initiative, led by AGS Airports in partnership with NHS Scotland, took place during a three-week flight trial between NHS Lothian and NHS Borders.
Live flying took place between the Edinburgh BioQuarter next to the Royal Infirmary of Edinburgh and Borders General Hospital in Melrose.
Invited guests were involved in a special event on Wednesday (21st August) showcasing the live flight trial with presentations around the work conducted by Project CAELUS.
Currently, laboratory samples which inform urgent clinical decision-making are transported by road and can take up to five hours between NHS Borders and NHS Lothian due to due to needing to make multiple pick-ups.
Innovation activity being conducted by Project CAELUS could see this delivery take 35 minutes, enhancing the transport provision, particularly for rural areas.
Project CALEUS is working with 16 consortium partners to deliver what will be the first national drone network that can transport essential medicines, bloods and other medical supplies throughout Scotland including to remote communities.
Fiona Smith, Project Director for Project CAELUS said: “Our consortium has been working extremely hard to get to this stage and we are delighted we have been able to test this important use case for the NHS.
“Transporting laboratory specimens by drone could speed up the clinical decision making allowing for same day diagnosis and treatment.
“It is also one of the first times in the UK that there has been a demonstration of beyond the visual line of sight medical drone operations transiting between controlled and uncontrolled airspace.
“This is an important milestone for our project and we now look forward to testing more potential use cases by drone across Scotland in the coming months.”
Hazel Dempsey is the CAELUS NHS Scotland programme lead: “Our aim, from an NHS perspective, is to explore opportunities where drone technology could benefit patients and NHS services in urban, remote, rural and island landscapes.
“The NHS is reliant on van logistics that have provided valuable service for decades, however these can take time, travelling hundreds of road miles each day. In some parts of Scotland, patients who live in remote and rural locations are dependent on ferry or airline availability.
“This project will enable the NHS to consider if drone technology is viable and able to contribute to improving the health and wellbeing of our population. This project will position the United Kingdom and NHS Scotland as a leader in healthcare and aviation industries.”
CAELUS (Care & Equity – Healthcare Logistics UAS Scotland), is part funded by the UK Research and Innovation (UKRI) Future Flight Challenge.
It brings together 16 partners including the University of Strathclyde, Skyports Drone Services, NATS and NHS Scotland.
In the latest live flight trials, tests were also carried out on how NHS staff in future would engage with the drone both physically and digitally.
Dr Tracey Gillies, Medical Director and Executive Lead for Innovation, NHS Lothian said, “Across NHS Lothian, we are continually exploring ways to innovate and enhance our patient experience.
“Lothian and the surrounding areas are very diverse, from city to country and coastal living. Drones could play an important role in helping to transport samples for testing or speed up the delivery of critical medical supplies.
“These exciting trial flights have been a collaborative effort between our clinical leads, South East Innovation Hub and partner organisations and I look forward to seeing further developments with this project.”
Laura Jones, Director of Quality & Improvement at NHS Borders said: “We are proud to be involved in Project Caelus, exploring how drone technology could provide an additional logistics service to enhance access to essential medical supplies particularly in rural parts of Scotland like the Scottish Borders.
“Our involvement in this project is part of our commitment to providing high quality person-centred care by modernising services so that they are fit for the future using the technologies that are available to us going forward.”
Since January 2020, the CAELUS consortium has designed drone landing stations for NHS sites across Scotland and developed a virtual model (digital twin) of the proposed delivery network which connects hospitals, pathology laboratories, distribution centres and GP surgeries across Scotland.
In October 2023, in a hugely successful trial, flying took place between Glasgow Airport and NHS Golden Jubilee in Clydebank. This initiative was showcasing the integration of drones with modern airspace.
Live flight trials were operated by CAELUS consortium member Skyports Drone Services. The UK-based operator is an experienced provider of drone delivery, survey and monitoring services. The company has a long history of operating medical drone deliveries, including the first drone deliveries with the NHS.
The Scottish Ambulance Service also carried out a simulation study in August to better understand the feasibility of delivering an Automated External Defibrillators (AEDs) via drone technology.
Paul Gowens, Associate Director, Research and Innovation with the Scottish Ambulance Service, said: “We are delighted to be a key partner in Project CAELUS.
“Our recent study carried out in Edinburgh was a great success as we learned more about the feasibility of delivering an Automated External Defibrillators (AEDs) via drone technology. We look forward to working alongside AGS and our partners on Project CAELUS on future milestones.”
Richard Ellis, NATS New Airspace Users Director, said: “This is a major step forward for the project and its fantastic to see many of the operational concepts we’ve helped developed be put into use.
“We are now a step closer to realising a truly integrated airspace where drones fly safely and seamlessly alongside conventional aircraft.”
The University of Strathclyde’s principal investigator for the project, Dr Marco Fossati, said: “The latest live flight trials mark an important milestone in the journey to developing a national medical transport drone network.”
Mike McNicholas, managing director for Infrastructure at AtkinsRéalis said: “It is a fantastic step forward for the project to make its first drone delivery and to see the ground infrastructure in use as part of the test flight.
AtkinsRéalis has been working closely with the AGS Airports-led consortium on the development of large, portable landing pads that can be folded up and stored when not in use, or moved to another location to receive another drone landing.
“Using a combination of digital twin technology and live test flights, Project CAELUS is able to trial various prototypes, taking learnings from each iteration to hone designs and land on something that can demonstrate the viability, scalability and efficiency of a drone network for medical deliveries across Scotland.”
Anne-Lisa Scaillierez, partner at The Drone Office: “Public feedback from our engagement activities has shown overwhelming support for using drones in medical logistics across Scotland.
“We’re thrilled by the significant progress achieved as part of Project CAELUS.”
David Hiller, Associate Director of Arup, said: “Arup has been enormously privileged to contribute to such a pivotal study, helping to better understand the human impacts of noise in relation to health and wellbeing.
“The study facilitated by CAELUS is one of the first of its kind and will support broader innovation globally. Cross-sector collaboration is both exciting and crucial as the capabilities of advanced air mobility technology evolve.”
Connected Places Catapult’s Ecosystem Director for Air Mobility & Airports, Andrew Chadwick said: “It is tremendous to see drones being used as part of Project CAELUS to transport essential medical supplies from one site to another, particularly as this is the first time a drone flight has operated in Scotland between two different NHS health boards.
“Connected Places Catapult has been working with NHS Scotland to develop the business and economic cases for these types of services alongside consortium members, and we look forward to exploring future opportunities for drone operations.”
