‘The Emergency Care system is not functioning as it should’, RCEM says as Emergency Department performance drops
Responding to the latest Emergency Department performance figures for Scotland for March 2023 Dr John-Paul Loughrey, Vice President of the Royal College of Emergency Medicine Scotland, said: “The data show another drop in performance. This means more patients facing longer waits, more delays to care and more harm.
“We cannot continue to see this occur, we need to be seeing improvements in performance and a reduction in delays to care. This is a signal that the current interventions and actions are not having the time critical impact that we need to be seeing.
“The Scottish Government needs to understand that hesitancy to take the necessary actions will impact on the safety of patients and their care. Emergency care is not functioning as it should, no patient should face a 12-hour wait in an Emergency Department.
“We know what needs to be done: ensuring social care is responsive and able to support the timely discharge of patients; expanding acute bed capacity across Scotland; retaining existing staff while recruiting more staff into Emergency Medicine. These are the solutions laid out in our campaign Five Priorities for UK Governments for #ResuscitatingEmergencyCare.
“We would welcome an opportunity to meet the new Cabinet Secretary for Health and Social Care, Michael Matheson MSP, to put forward these solutions and the means to tackle the crisis in Emergency Care. We cannot consider this to be winter pressure anymore; this is year-round, and it continues to cause harm. We must do better for patients and staff, there is no time to delay.”
“While it is true that the data for January 2023 show improvements when compared with December 2022, December was the worst month on record. We are relieved that we have mitigated against a repetition of December, but we remain extremely concerned about our patients and their safety, and for the welfare of staff who are struggling.
“January saw continued high numbers of extremely long waits; the third highest number of 12-hour waits on record. While the weekly data from February also show that we cannot let up in our requirement for substantial improvement.
“As the Scottish leadership election begins, tackling the crisis in Emergency Care as well as the crisis in the wider health and social care system must be a priority for the next First Minister. In 2022, a total of 55,095 patients waited 12-hours or more in an Emergency Department in Scotland.
“Analysis by the College shows that consequently, in 2022, there were an estimated 765 patient deaths associated with these dangerously long waiting times – equal to an estimated average of 64 each month. This is entirely unacceptable and a marker of a system that is not functioning as it should.
“To tackle this, in Scotland we urgently need a restoration of the acute bed base, that means opening an additional 1,000 staffed acute beds where safely possible.
“There are also significant shortfalls of staff in Scotland. The Emergency Medicine workforce needs at least 100 more consultants, as well as senior decision makers, ACPs/ANPs/Physician Associates, junior doctors, and vital nurses.
“We welcomed the expansion of Emergency Medicine medical training places in Scotland by 10, but this expansion is considerably short of what is required and there has yet to be any commitment to maintain this each year.
“This winter continues to be the most challenging yet for the NHS in Scotland. A failure for meaningful action now will prolong the risk to patient safety and maintain these dangerously long waiting times at the detriment to staff who are already burned out and exhausted. 2023 must be the year that we see political will translated into action that improves patient care and conditions for staff.”
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.”
Investment to create 152 extra doctor training places
The biggest ever expansion of medical training posts will see 152 additional places created for trainee doctors in 2023.
The Scottish Government will provide £37 million over the next four years to help meet the challenges facing Scotland’s NHS and future-proof it against rising demand.
This exceeds last year’s record increase of 139 places, and equates to a 2.5% increase in the current Whole Time Equivalent (WTE) workforce of 6100 trainees – making it the most significant increase in medical training places to date.
NHS Education for Scotland (NES) recommended the Scottish Government fund the creation of additional training places in a number of key specialties including General Practice, Core Psychiatry, Oncology, Emergency Medicine, Intensive Care Medicine, Anaesthetics and Paediatrics.
The majority of successful applicants will take up posts in August 2023, however the Scottish Government is also funding additional Core Psychiatry training places which will have an earlier start date of February 2023. Further Core Psychiatry training places will also be made available for the August 2023 start date.
Health Secretary Humza Yousaf said: “These additional training places highlight the Scottish Government’s continued commitment to ensure our health service is resilient and can continue delivering high quality care to those who need it.
“This record expansion will support a wide range of medical specialties, many of which are under increased pressure as a result of growing demand.
“We will continue to monitor the number of available training places in collaboration with NHS Education for Scotland to help make sure the NHS is equipped to meet the country’s current and future needs.”
NHS Education for Scotland Medical Director, Dr Emma Watson said: “We welcome this announcement of additional posts across a wide range of specialties.
“We believe Scotland offers the highest quality medical education. Our trainees are the NHS workforce of the future – enabling us to offer better quality care and outcomes for every citizen in Scotland.”
The biggest ever expansion of medical training posts will see 152 additional places created for trainee doctors in 2023.
The Scottish Government will provide £37 million over the next four years to help meet the challenges facing Scotland’s NHS and future-proof it against rising demand.
This exceeds last year’s record increase of 139 places, and equates to a 2.5% increase in the current Whole Time Equivalent (WTE) workforce of 6100 trainees – making it the most significant increase in medical training places to date.
NHS Education for Scotland (NES) recommended the Scottish Government fund the creation of additional training places in a number of key specialties including General Practice, Core Psychiatry, Oncology, Emergency Medicine, Intensive Care Medicine, Anaesthetics and Paediatrics.
The majority of successful applicants will take up posts in August 2023, however the Scottish Government is also funding additional Core Psychiatry training places which will have an earlier start date of February 2023. Further Core Psychiatry training places will also be made available for the August 2023 start date.
Health Secretary Humza Yousaf said: “These additional training places highlight the Scottish Government’s continued commitment to ensure our health service is resilient and can continue delivering high quality care to those who need it.
“This record expansion will support a wide range of medical specialties, many of which are under increased pressure as a result of growing demand.
“We will continue to monitor the number of available training places in collaboration with NHS Education for Scotland to help make sure the NHS is equipped to meet the country’s current and future needs.”
NHS Education for Scotland Medical Director, Dr Emma Watson said: “We welcome this announcement of additional posts across a wide range of specialties.
“We believe Scotland offers the highest quality medical education. Our trainees are the NHS workforce of the future – enabling us to offer better quality care and outcomes for every citizen in Scotland.”
Commenting on the Scottish Government’s expansion of the Emergency Medicine workforce by opening 10 additional training places in 2023, Dr John-Paul Loughrey, Vice President of the Royal College of Emergency Medicine Scotland, said:“We welcome the Scottish Government’s commitment to expand the medical workforce in Scotland and open 152 additional training places for doctors in 2023 – 10 of which have been allocated to Emergency Medicine.
“RCEM has been campaigning to safely staff emergency departments in Scotland for some time. Our Scotland Census, published in 2021, illustrated the significant shortfall in staff of all disciplines. In particular, the shortage of senior decision-making doctors in Scotland including consultants.
“We have also consistently called for a long-term fully funded NHS workforce plan in Scotland, so we are pleased to see the Scottish government heed our calls and take action. We particularly commend the move to exceed last year’s record increase and fund Emergency Medicine as a key specialty.
“Given the time taken to train senior specialists in Emergency Medicine, the benefit of this increase will take time to be seen. While it will take several years to train these future doctors, staff will be relieved to know that there is the will to acknowledge our staffing gaps and respond appropriately.
“However, it is critical that this commitment to bolster the workforce does not ignore the fact that existing staff are overstretched, burnt out and exhausted. We ask the Scottish Government to take the next step and ensure that we retain existing staff who, given the incredibly challenging conditions, may be considering their careers.”
Four-hour performance was 71.7%, 1.9% lower than the previous month, January 2022, and the second lowest on record
27,087 patients were delayed by four hours or more, this is means more than one in four patients were delayed by four hours or more
6,248 patients were delayed by eight hours or more
2,230 patients were delayed by 12 hours or more, this represents the highest proportion of attendances experiencing 12 hour waits since records began
Dr John Thomson, Vice President of the Royal College of Emergency Medicine Scotland, said:“The crisis in Urgent and Emergency Care is dire. The health system in Scotland is ceasing to function as it should. Patients are at risk of severe harm and staff are facing stress, distress, burnout and moral injury on a daily basis.
“This is unsustainable and dangerous. The first step to tackling this crisis is opening 1,000 beds that are desperately needed across the system and recruiting senior decision makers in Emergency Medicine. In addition, the crisis in social care, which is resulting in the most vulnerable patients residing in hospital for extremely long periods of time before being discharged means that the system is unable to cope.
“This patient safety crisis must be a priority for the Scottish Government, and they must take meaningful action now before more patients come to severe harm.”
