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.”
‘We have detected a single confirmed human case of Clade Ib mpox. This is the first detection of this Clade of mpox in the UK, the wider risk to the UK population remains low’.
The UK Health Security Agency (UKHSA) has detected a single confirmed human case of Clade Ib mpox. The risk to the UK population remains low.
This is the first detection of this Clade of mpox in the UK. It is different from mpox Clade II that has been circulating at low levels in the UK since 2022, primarily among gay, bisexual and other men-who-have-sex-with-men (GBMSM).
UKHSA, the NHS and partner organisations have well tested capabilities to detect, contain and treat novel infectious diseases, and while this is the first confirmed case of mpox Clade Ib in the UK, there has been extensive planning underway to ensure healthcare professionals are equipped and prepared to respond to any confirmed cases.
The case was detected in London and the individual has been transferred to the Royal Free Hospital High Consequence Infectious Diseases unit. They had recently travelled to countries in Africa that are seeing community cases of Clade Ib mpox. The UKHSA and NHS will not be disclosing any further details about the individual.
Close contacts of the case are being followed up by UKHSA and partner organisations. Any contacts will be offered testing and vaccination as needed and advised on any necessary further care if they have symptoms or test positive.
UKHSA is working closely with the NHS and academic partners to determine the characteristics of the pathogen and further assess the risk to human health.
While the existing evidence suggests mpox Clade Ib causes more severe disease than Clade II, we will continue to monitor and learn more about the severity, transmission and control measures. We will initially manage Clade Ib as a high consequence infectious disease (HCID) whilst we are learning more about the virus.
Professor Susan Hopkins, Chief Medical Adviser at UKHSA, said: “It is thanks to our surveillance that we have been able to detect this virus. This is the first time we have detected this Clade of mpox in the UK, though other cases have been confirmed abroad.
“The risk to the UK population remains low, and we are working rapidly to trace close contacts and reduce the risk of any potential spread. In accordance with established protocols, investigations are underway to learn how the individual acquired the infection and to assess whether there are any further associated cases.”
Health and Social Care Secretary Wes Streeting, said: “I am extremely grateful to the healthcare professionals who are carrying out incredible work to support and care for the patient affected.
“The overall risk to the UK population currently remains low and the government is working alongside UKHSA and the NHS to protect the public and prevent transmission.
“This includes securing vaccines and equipping healthcare professionals with the guidance and tools they need to respond to cases safely.
“We are also working with our international partners to support affected countries to prevent further outbreaks.”
Steve Russell, NHS national director for vaccination and screening, said: “The NHS is fully prepared to respond to the first confirmed case of this clade of mpox.
“Since mpox first became present in England, local services have pulled out all the stops to vaccinate those eligible, with tens of thousands in priority groups having already come forward to get protected, and while the risk of catching mpox in the UK remains low, if required the NHS has plans in place to expand the roll out of vaccines quickly in line with supply.”
Clade Ib mpox has been widely circulating in the Democratic Republic of Congo (DRC) in recent months and there have been cases reported in Burundi, Rwanda, Uganda, Kenya, Sweden, India and Germany.
Clade Ib mpox was detected by UKHSA using polymerase chain reaction (PCR) testing.
Common symptoms of mpox include a skin rash or pus-filled lesions which can last 2 to 4 weeks. It can also cause fever, headaches, muscle aches, back pain, low energy and swollen lymph nodes.
The infection can be passed on through close person-to-person contact with someone who has the infection or with infected animals and through contact with contaminated materials. Anyone with symptoms should continue to avoid contact with other people while symptoms persist.
The UK has an existing stock of mpox vaccines and last month announced further vaccines are being procured to support a routine immunisation programme to provide additional resilience in the UK. This is in line with more recent independent JCVI advice.
Working alongside international partners, UKHSA has been monitoring Clade Ib mpox closely since the outbreak in DRC first emerged, publishing regular risk assessment updates.
The wider risk to the UK population remains low.
UKHSA has published its first technical briefing on clade I mpox which provides further information on the current situation and UK preparedness and response.
Ensuring Scotland is prepared as mpox cases increase in Central and Eastern Africa
With the World Health Organization declaring a recent rise in mpox cases in Central and Eastern Africa a Public Health Emergency of International Concern, Dr Kirsty Roy and Dr Kate Smith, Consultants in Public Health at PHS, explain more about the current international situation and what is being done to prepare for any cases seen in Scotland:
The recent rise of mpox cases in Central and Eastern Africa is of global concern due to the potential for the virus to spread beyond the affected countries. It’s therefore important that we’re prepared in the event a case is identified in Scotland.
Mpox is an uncommon viral infection compared to viruses like influenza or COVID-19.
It typically causes a blistering rash which can last 2 to 4 weeks and can be accompanied by fever, headaches, muscle and back aches, tiredness and swollen lymph nodes.
There are two main types of mpox – clade 1 and clade 2 that are then further divided into clade 1a, clade 1b and clade 2b. Each type can differ in who they affect, how they spread, and the severity of the outcomes.
Clade 1 mpox is more serious than clade 2, as it can be passed on more easily, can make people more severely ill, and has a higher fatality rate. This is why clade 1 is classified as a high consequence infectious disease (HCID). HCIDs are rare in the UK, and established protocols and guidance are in place to manage these.
What’s the current global situation?
Historically, clade 1 mpox has been associated with Central Africa and linked with more severe disease and higher death rates. Recently, a new type (clade 1b) has emerged and is circulating, particularly in sexual networks in the Democratic Republic of Congo (DRC) and neighboring countries.
It was the emergence and rapid spread of clade 1b that prompted the World Health Organization to declare the outbreak as a Public Health Emergency of International Concern (PHEIC) in August 2024.
Although most cases are currently confined to Central and Eastern Africa, there is the potential for the virus to spread out with the continent to other countries, as we saw with the global outbreak of mpox clade 2 in 2022.
It’s therefore important to be aware of the above symptoms. Anyone with these should stay at home, avoid close contact with others and get medical help by phone. More information can be found on NHS inform.
How is mpox passed on?
Mpox is not passed on very easily between people. However, you can get it from close contact with an infected person, including during sex or by contact with contaminated materials (for example bedding or towels).
It’s possible that mpox may also be passed on through close and prolonged contact that can include talking, breathing, coughing or sneezing. There is currently limited evidence around this, and information will be updated when new evidence becomes available.
What’s the current situation in Scotland?
Currently, no cases of clade 1 mpox have been confirmed in Scotland. The UK Health Security Agency (UKHSA) confirmed it had detected the first case of mpox clade 1b in England on 30 October, however, the risk to the UK population is still considered low.
PHS is working closely with public health partners across the UK, as well as NHS boards, to monitor the situation and prepare for any cases of clade 1 mpox in Scotland.
As part of this, we have rapidly put testing in place to ensure suspected cases can be quickly tested in Scotland at the Edinburgh Specialist Virology Centre (SVC) and the West of Scotland Specialist Virology Centre (WoSSVC) Glasgow.
What’s the travel advice?
Currently the risk to most travellers is small. A list of countries where cases of Clade 1 mpox have been identified can be found on the UK Government website
Anyone travelling to an affected country is encouraged to take precautions, such as minimising physical or sexual contact – especially with individuals showing signs of a rash – to reduce the risk of infection.
Working in partnership with Scottish airports, we have ensured that information about the clade 1b international situation is visible to travellers in Scottish Airports. These signpost to key information on affected countries and how to access healthcare services in Scotland if an individual develops mpox symptoms.
Is there a vaccine to protect against mpox?
Mpox belongs to a family of viruses that includes smallpox and a vaccine that was developed to protect against smallpox is also considered effective against mpox.
This vaccine was used as part of the response to the 2022 outbreak of clade 2 mpox, which mainly affected gay, bisexual or other men who have sex with men (GBMSM), and Scotland continues to offer mpox vaccination to those at greatest risk.
On behalf of Scotland, and other devolved nations, the UK Government has procured more mpox vaccine doses to strengthen the UK preparedness against clade 1 mpox. More information about vaccine eligibility can be found on NHS inform.
Scotland has a robust public health intelligence system, is now able to rapidly identify and test potential cases and has a supply of effective vaccines. There is also public health information available to ensure people are prepared if they are visiting an area of higher risk. These should all ensure Scotland is prepared should cases emerge within the country.
This Challenge Poverty Week, Public Health Scotland’s CEO, Paul Johnston explains how PHS are advocating for a Scotland where everyone has access to an adequate income to enable a healthy standard of living:
Living in poverty is detrimental to health and one of the main causes of poor health and health inequalities, with negative consequences for children and adults. Policy changes which impact on the drivers of poverty (income from employment, income from social security and the cost of living) have the potential to impact on population health and health inequalities.
Since 2010 a series of changes have been implemented to the UK (reserved) social security system. An intention of The Welfare Reform Act 2012 which triggered these changes was to help people into work and reduce poverty for adults and children, which in turn would lead to improvements in health.
Policies included reduced financial support to low-income families with three or more children and increased conditionality for lone parents. These are families who already have an increased risk of living in poverty.
Since 2013, Public Health in Scotland (PHS) has been monitoring the economic and health trends associated with Welfare Reform. Our latest report Improving Lives? highlights that the anticipated improvements to income and health from Welfare Reform have not been realised for people in Scotland.
Aspects of health have worsened or remained unchanged since 2010 and importantly, many of these trends pre-date the COVID-19 pandemic. These trends were also observed for the rest of the UK. A forthcoming PHS systematic review found that for people exposed to the changes, UK Welfare Reform made mental health worse, and had no positive effect on physical health.
This is concerning, especially as our report shows that population groups most likely to be affected by these changes are the groups who are already more likely to be at risk of or experiencing poverty. We know from 2013 that the relative child poverty rates in Scotland increased after a period of decline.
Evidence also tells us that mental health problems became more prevalent, especially after 2015, while health inequalities have risen. The period also saw stalled improvement or worsening trends in financial insecurity and long-term sickness.
This Challenge Poverty Week, we are advocating for a Scotland where everyone has access to an adequate income to enable a healthy standard of living. This will help to create a Scotland where everybody thrives.
A number of changes are needed to make this happen. These include promoting quality employment which supports good health. Almost 19% of employees in Scotland aged 18-55 are in poor quality work, and most working-age adults and children in poverty live in a household where someone works.
We also need to ensure our social security system protects people’s mental health and wellbeing. This could include an Essentials Guarantee to protect people from hardship, supported by 72% of the population.
During 1997–2010 policy choices by the UK government directed financial support at children and pensioners and as a result poverty fell for both of these groups. This period also saw increased employment rates translate into improved mental health for lone parents. This proves that we can make a difference to people’s lives through social security and employment policies.
In Scotland, child poverty rates are lower than many other UK nations. In Scotland, we are doing things differently to tackle child poverty.
Scotland is delivering a strengthened employment offer to parents, to provide holistic support and address specific barriers to enable more parents to gain and progress in work. This along with focussed action to create a Fair Work Nation, which includes supporting more employers to pay the living wage, provides a platform to build on, to support more parents to escape poverty.
Learning and evidence from past UK policy approaches and Scotland’s actions to tackle child poverty should be used to inform further policy changes to address poverty and improve health.
It is imperative that providing an effective social security safety net for when families need it and creating high quality, flexible employment opportunities for parents, will be central to the UK’s child poverty strategy going forward.
The Scottish government must heed the ‘alarms bells’ as new A&E data suggests another very challenging winter ahead.
That’s the call from The Royal College of Emergency Medicine (RCEM) Scotland as new data for Emergency Department performance in August reveals it was the worst August since records began in 2011, for patients experiencing extremely long waits.
The figures released yesterday (Tuesday 1 October) by Public Health Scotland, show that the number of patients waiting 12 hours or more in August was higher than in any January or February from 2012 to 2022, despite it being a month in summer when Emergency Department performance tends to improve.
More than a third of people (34.2%) waited over four hours, more than one in 10 (11.3%) waited eight hours or longer, while 4.65% of patients waited over 12 hours in a Scottish ED.
The data shows long waits have increased significantly since the 2010’s.
Since August 2017, for example, the numbers waiting four hours or more has increased by six times (6,743 to 39,096), eight hours or more by 37 times (347 to 12,954), and 12 hours or more by 127 times (42 to 5,312). This is despite attendance only decreasing by 0.7% in the same period.
Dr John-Paul Loughrey, RCEM Vice President for Scotland said: “It once was that the summer months provided some respite from the stresses experienced in Emergency Departments, but those days are long gone.
“Yet again the figures show the reality of the pressure we have been dealing with this summer, which is on a level with what we would have experienced during the busiest winter months just a few years ago. Overcrowding in our A&Es is now at winter crisis levels all year round.
“The alarm bells are sounding loudly as winter approaches, and the government must respond.
“Last week’s Winter Preparedness plan however gives me little hope that they will respond in the ways we have recommended. It lacks any specific measures to address the inevitable spikes in demand for Emergency Care which comes during the colder months, or the lack of capacity in the acute care system as a whole.
“Once again Scottish people seeking emergency care this winter are facing extreme waits and, for many, the indignity of so called ‘corridor care’. These are not just inconvenient, they are dangerous and potentially life threatening.
“The Scottish government must bolster its winter planning to ensure that people who need to be admitted to hospital from A&Es can be, without excessive waits, and that when they are well enough to leave there is the necessary social care in place for them to do so.
“Failure to do so puts us on course for a harmful and incredibly difficult winter which is not what we or our patients want or deserve.”
A graphical representation of the data can be found here.
The full data set can be found on the RCEM website.
With Scotland’s new Respiratory Syncytial Virus (RSV) vaccine programme having begun, Public Health Scotland (PHS) is encouraging those eligible to get vaccinated.
PHS’s Head of Immunisation and Vaccination, Dr Sam Ghebrehewet, joined the First Minister, John Swinney, in a visit to the vaccination clinic in the Hub Community Centre in Clydebank today.
During the visit to the clinic in NHS Greater Glasgow and Clyde, Dr Ghebrehewet and the First Minister were delighted to meet with pregnant women and older adults who are among the first to have come forward for their RSV vaccine.
RSV is a common and highly infectious respiratory virus that affects the breathing system. It is the leading cause of emergency respiratory admissions to hospital in Scotland in infants, with 1,516 children aged under one hospitalised with the virus last year.
To help protect newborns and infants, pregnant women are being offered the vaccine during antenatal appointments with their midwife from 28 weeks into their pregnancy.
There were also over 1,000 cases of RSV recorded in adults aged 75 and over in Scotland between October 2022 and September 2023, with more than half (535) having to spend time in hospital as a result.
Local health boards in Scotland have been inviting all those currently eligible by letter to come forward for their free RSV vaccine including:
Those turning 75 years old on and between 1 August 2024 and 31 July 2025.
Anyone who is aged 75 to 79 years old on 1 August 2024.
Highlighting the importance of pregnant women and older adults coming forward for the RSV vaccine, Dr Sam Ghebrehewet, Head of Immunisation and Vaccination at PHS, said: “I’m pleased to join the First Minister and NHS Greater Glasgow and Clyde’s vaccination team at Clydebank Community Centre today and see people coming forward for the RSV vaccine.
“Vaccinations have played a major role in protecting the health of people across the globe over the last 50 years. Today’s launch of the new RSV vaccination programme marks another significant step in protecting the population of Scotland against preventable diseases.
“RSV can be very serious for those who are more vulnerable, such as newborns, infants and older adults. If you’re eligible, getting vaccinated is the best and simplest thing you can do to protect yourself or your newborn baby from RSV.
“Public Health Scotland continues to work closely with all health boards to ensure as many people as possible receive their vaccine and protect themselves against the more serious complications of an RSV infection.”
Sara, a pregnant woman who received her vaccine at the clinic today, said: “I’d heard of RSV before and how serious it can be for babies.
“After I saw there was going to be a vaccine, I read up about it and decided it was the obvious thing to do to protect my baby when they are born.”
The First Minister said: “I encourage pregnant women to take up their vaccination appointments to protect their babies against the leading cause of hospitalisation in infants during the first weeks and months of life.
“Ensuring a healthy childhood is every parent’s first priority, however, it is equally important that those aged 75-79 take up their offer of this vaccine.
“We have acted quickly with partners to introduce this vaccine in time to maximise the benefit to the more vulnerable ahead of winter. This programme will reduce the numbers seriously ill or hospitalised, helping to manage the significant winter pressures on our NHS.”
Following last year’s advice from the Joint Committee on Vaccination and Immunisation (JCVI), Public Health Scotland has been working with the Scottish Government and NHS boards to develop plans for the roll out of Scotland’s Respiratory Syncytial Virus (RSV) vaccination programme to protect newborns, infants and older adults.
RSV is a common respiratory virus that generally causes mild illness with cold-like symptoms. Most cases recover after 2-3 weeks of illness, but RSV can cause severe illness in some people, including newborns, infants and older adults, leading to complications and hospitalisation.
With the new programme set to commence later in the summer, some information is now available on NHS inform and more detail will follow soon.
A total of 938 residential rehabilitation placements were approved between 1 April 2023 and 31 March 2024 to support people to attain an alcohol or drug-free lifestyle.
The Scottish Government is making £100 million available over this parliamentary term to increase access to residential rehabilitation for problematic drug or alcohol use. Latest statistics from Public Health Scotland (PHS) show the number of placements given the go ahead for public funding last year was up 126 on the previous year. The first three months of 2024 represented the highest number of quarterly approved placements since records began.
Drugs and Alcohol Policy Minister Christina McKelvie said: “These Public Health Scotland statistics indicate welcome progress – we are firmly on track to meet our commitment to giving 1,000 people access to public funding for residential rehabilitation each year by 2026.
“We do, however, recognise the scale of the challenge we continue to face and are determined to do more by expanding on good practice and addressing gaps in pathways in collaboration with Healthcare Improvement Scotland.
“My focus is on taking action to save and improve lives now as part of our £250 million National Mission. We’ve already reinforced our human rights-based approach where problematic drug use is treated as a health, not a criminal matter. We are prioritising getting people into the treatment and recovery that is right for them, at the right place at the right time.
“We are determined that every penny of the £100m we are investing to expand residential rehabilitation will make a difference to those who are suited to this form of treatment.”
