Patron of the Royal College of Emergency Medicine (RCEM), Her Royal Highness The Princess Royal addressed more than 300 delegates at RCEM’s Annual Scientific Conference in Gateshead last week (10 October 2024).
Her Royal Highness praised the dedication of Emergency Medicine professionals and highlighted the work of the NHS workforce, in particular Emergency Departments, with the Covid outbreak and high workloads.
The Princess Royal was greeted at the conference venue by Dr Adrian Boyle, President of the Royal College of Emergency Medicine and Catherine Feast, RCEM’s Director of Engagement and External Affairs.
Her Royal Highness viewed the winning submissions from the poster competition and met the designers, and then went on to meet the abstract authors, discussing their studies which focused on key issues facing Emergency Medicine.
The Princess Royal further engaged with speakers and delegates before listening to Professor Richard Body from the University of Manchester and Manchester University NHS Foundation Trust, who delivered his presentation on how to optimise shared decision making for patients with chest pain.
Dr Adrian Boyle, President of the Royal College of Emergency Medicine said: “It was a great honour to welcome Her Royal Highness to our conference.
“Once again, she showed her understanding of the specialty, her interest in the people who work in it, and her awareness of the challenges it faces.
“We are so lucky to have such an engaged and passionate patron, and I know it means so much for those members who were able to meet and chat with her about their work.”
Catherine Feast, Director of Engagement and External Affairs at the Royal College of Emergency Medicine said: “Her Royal Highness’s presence at our Annual Scientific Conference marks the second event The Princess Royal has attended this year and we are so grateful she gives us so much of her time.
“As ever, our delegates were delighted to have her here and to hear her support for the specialty.
“She is a fabulous royal patron, and we are honoured to have had her visit us last week.”
The Princess, who has been royal patron of the Royal College of Emergency Medicine since 2008, previously attended RCEM’s trainee conference, which was also held in Gateshead in February 2024.
This is the response from The Royal College of Emergency Medicine (RCEM) Scotland as the latest Emergency Department performance data reveals that one in every nine people waited eight hours or more to be seen in A&E last month.
The data also shows long waits have increased significantly since the 2010s.
Since May 2017, for example, the numbers waiting four hours or more has increased by nearly five times, eight hours or more by 21 times, and 12 hours or more by 89 times. Despite attendance only increasing by 0.5% in the same period.
Dr John-Paul Loughrey, RCEM Vice President for Scotland said: “It is right that the First Minister has apologised to people who have been forced to withstand treatment in corridors.
“It is unbearable for the people experiencing this loss of dignity at an already difficult time, and for the medical practitioners caring for them in impossible conditions.
“The data clearly shows that extended A&E waiting times due to overcrowding is not a new issue. It is sadly what A&E staff have come to expect.
“We once again call on the Scottish Government to take action to prevent overcrowding in Emergency Departments and the subsequent need to treat people in corridors by increasing the number of hospital beds and improving social care options so people can leave hospital when they are ready.
“I, personally, am growing weary of the inaction to rectify these longstanding issues and the resulting harms.”
“The government is duty-bound to provide the people of Scotland with safe and dignified emergency care, and now is the time to do so.”
“These figures, and our own research, clearly evidence the shameful and shocking reality of poorly patients who need to be cared for on hospital wards having to wait many hour hours, ever days, often on trolleys in corridors because there is not enough capacity in the system.
“There simply are not enough beds to admit people to, often because the people in those beds are medically well enough to go home but can’t because of inadequate or delayed social care support.
“It is not just a matter of inconvenience or lack of dignity – which is bad enough. The longer people’s in-patient admission is delayed, the greater the risk the risk to their life.
“There is no one quick fix, but the problems are fixable. RCEM is ready to work with whoever forms the next Government to begin the process of resuscitating our health system and ending these unacceptable and dangerous long waits.”
The Royal College of Emergency Medicine is urging whoever forms the next Westminster Government to ensure the Scottish executive has sufficient funding for Emergency Medicine as the country’s A&E crisis continues.
The call comes after the latest Emergency Department (ED) performance data for Scotland was released today (4 June 2024).
Published by Public Health Scotland, the data shows that in April:
112,005 people visited a major Scottish ED (down 4.6% on March 2024)
64% of those people were treated, discharged or admitted within the target time of four hours
14,237 people waited more than eight hours (12.7%) and 6,412 (5.7%) patients had to endure waits of more than 12 hours
This represents the worst four-hour, eight-hour and 12-hour performance for any April since records began in 2011.
The number of patients who were unable to leave hospital despite being well enough to do so – which is a key contributor to overcrowding in Emergency Departments – was up 12% on the same month the previous year.
Dr John-Paul Loughrey, Royal College of Emergency Medicine Vice President for Scotland, said: “Extreme waits in A&Es are degrading and dehumanising and critically they are dangerous.
“We must not allow this vitally important message to be drowned out by the posturing and political coverage which naturally comes ahead of an election.
“The crisis in our departments continues and whoever forms the next Westminster Government must be pragmatic, proactive and provide adequate resources so the devolved governments including here in Scotland can really address this issue.
“It is nothing less than our members and their patients deserve.”
A graphic illustration of the data can be found here. The full data can be found here.
A&Es in Scotland are under “constant strain” amid extended wait times and delays to patient discharge.
This is the response from The Royal College of Emergency Medicine (RCEM) as new Scottish National Party leader John Swinney lists the NHS as being among his “focus” points in power.
RCEM has called for the incoming First Minister, which is expected to be Mr Swinney as the only candidate, to address hospital discharge delays and extended A&E wait times.
The data, which covers March, shows slight improvement since February. However, it was the worst March since records began in 2011 for patients being seen within four hours of arriving at A&E.
In March, one in three people attending Scottish Emergency Departments waited four hours or more to be seen, one in eight waited eight hours or more, and one in 20 waited 12 hours or more.
There was a total of 58,646 days spent in hospital by people who were well enough to be discharged, but unable to leave due to inadequate social care.
Dr JP Loughrey, The Royal College of Emergency Medicine’s Vice President for Scotland said: “The constant strain on staff and patients is causing an immense amount of damage. They are stuck in the danger zone of a long-wait pressure gauge without enough support to relieve this alarming situation.
“Any modest improvements on February’s figures are not enough. Scotland’s new First Minister must commit to bringing about positive change by putting the nation’s healthcare at the top of their priorities.
“Delays to patients discharge from hospital is one key area to improve upon as this blocker mean Emergency Department doctors cannot admit patients, causing unacceptably long waits that are continually getting worse.
“Delays in ambulance handovers, hospital discharges and a lack of social care provisions continue to take a toll on hardworking staff who are at their limit.
Dr Loughrey added: “The College would like to congratulate John Swinney on his appointment as SNP leader. We look forward to working together to improve Emergency Care in Scotland.”
A graphic illustration of the data can be found here. The full data set can be found here.
It is difficult to celebrate slight improvements as patients and staff bear the brunt of long waits. This is the response from The Royal College of Emergency Medicine (RCEM) as the latest performance data from Public Health Scotland shows one in eight people attending A&Es in Scotland in February waited eight hours or longer to be seen.
There has been a small improvement since January – the worst month on record for A&E waiting times. However, last month was the worst February on record for four-, eight-, and twelve-hour performance in Scotland.
The data also shows: One in three patients waited four hours or more in Emergency Departments, one in eight waited eight hours or more, and one in 18 waited 12 hours or more.
Since February 2017, the numbers waiting four hours or more has increased by more five times (370%), the numbers waiting more than eight hours by 15 times (1446%), and the numbers waiting more than twelve hours by seven times (571%). This is despite attendance only increasing by 8% from February 2017.
There were 1,874 beds occupied due to delayed discharges, an increase of 8 from the previous month and the highest February on record. There was a total of 54,355 days spent in hospital by people whose discharge was delayed.
Dr Jason Long, Vice President of RCEM, said: “Any slight improvement from January is welcome, however it is difficult to celebrate when patients and staff continue to bear the brunt of long waits.
“Problems exist throughout the entire system, from ambulance pick up, to delayed discharge and a lack of social care provisions. This, of course, takes a toll on hardworking staff pushing themselves to their limits and the people facing these extended waits.
“Now is the time for change. We encourage the Scottish government to adopt our Manifesto points to #ResuscitateEmergencyCare.”
New data released yesterday (5 March 2024) for Scotland reveals January was the worst month on record for people waiting to be seen in A&E.
The figures published by Public Health Scotland show that, in January 2024:
41,161 (38%) patients waited over four hours in major Emergency Departments, a 21% increase compared to last January (33,962)
17,077 (16%) of patients waited eight hours or more in Emergency Departments, almost 13 times higher than in January 2016 (1,338)
8,402 (8%) of patients waited twelve hours or more in Emergency Departments, the largest amount for any January since records began and 36 times higher than in January 2016 (232).
There were 1,866 beds occupied due to delayed discharges, an increase of 53 compared to December 2023.
Dr JP Loughrey, Royal College of Emergency Medicine Vice President for Scotland said: “This is beyond exasperating. Most people attend A&E in desperate need – to be seen by a medical professional quickly and with dignity.
“Already struggling, patients are having to endure overcrowded waiting rooms and corridors – for hours. If admission is required, they must wait for a bed – for hours.
“This latest data makes for grim reading, and it is incredibly demoralising for my colleagues to be working under such strenuous circumstances.
“They are working all out to put patients first whilst also having to carry the burden of working in an underfunded, overcrowded, and at times unsafe emergency care system. We need intervention from the Government and policy makers to ensure we never reach this nadir again.”
The data also reports:
In January 2024, there were 108,427 attendances at major Emergency Departments in Scotland. This is marginal decrease of 0.25% compared to the previous month.
62% of patients were seen within four hours at major (Type 1) Emergency Departments. This is the worst four-hour performance for any January since records began.
This is a decrease of 0.5 percentage points compared to December last year and a decrease of 3.2 percentage points compared to January 2023.
41,161 (38%) patients waited over four hours in major Emergency Departments. This is a 1% increase compared to December last year (40,763) and a 21% increase compared to January 2023 (33,962).
The number of patients waiting more than four hours has increased by more than three times compared to January 2016 (9,808).
17,077 (16%) patients waited eight hours or more in Emergency Departments.
The proportion waiting this long has increased by 2% compared to the previous month, December 2023 and has increased by 2.3% compared to the previous year, January 2023.
The numbers waiting more than eight hours is almost 13 times those in January 2016 (1,338).
8,402 (8%) of patients waited twelve hours or more in Emergency Departments
This is the largest amount for any January since records began.
The proportion waiting this long has increased by almost 1% compared to December last year and has increased by more than 1% compared to January 2023.
The numbers waiting more than 12 hours is 36 times those in January 2016 (232).
There were 1,866 beds occupied due to delayed discharges, an increase of 53 compared to December 2023.
The Scottish Government needs to develop a clear national strategy for health and social care to address the pressures on services.
Significant changes are needed to ensure the financial sustainability of Scotland’s health service. Growing demand, operational challenges and increasing costs have added to the financial pressures the NHS was already facing. Its longer-term affordability is at risk without reform.
Activity in hospitals and other secondary care settings has increased in the last year, but it remains below pre-pandemic levels and is being outpaced by demand. This pressure is creating operational challenges throughout the whole system and impacting staff, patient experience and patient safety.
There are a range of strategies, plans and policies in place for the future delivery of healthcare, but no overall vision. The absence of a shared national vision, and a clear strategy to deliver it, makes it more difficult for NHS boards to plan for change.
Stephen Boyle, Auditor General for Scotland, said: “Without change, there is a risk Scotland’s NHS will take up an ever-growing chunk of the Scottish budget. And that means less money for other vital public services.
“To deliver effective reform the Scottish Government needs to lead on the development of a clear national strategy for health and social care.
“It should include investment in measures that address the causes of ill-health, reducing long-term demand on the NHS. And it should put patients at the centre of future services.”
Responding to the Auditor General’s report on the state of Health and Social Care in Scotland Dr JP Loughrey, Royal College of Emergency Medicine Vice President for Scotland, said: “We welcome this report which addresses many of our recent and ongoing concerns – particularly around a lack of long-term planning and poor Emergency Department performance.
“The Scottish government must do more to address capacity and demand pressures. Hospitals are dangerously overcrowded and do not have the space, staff, or resources to provide safe and timely care for the number of patients who need it.
“There needs to be long term strategies to maintain an adequate baseline in capacity and staffing, and deal with predictable surges in pressure.
“As we have seen time and time again across Scotland, there are simply not enough beds to meet demand and our hospitals are routinely almost fit to burst, with patients enduring long, undignified waits and demoralised staff forced to deliver treatment in inappropriate areas, such as corridors and car parks.
“We urge the government to move away from short-term firefighting towards long term fundamental change to #ResuscitateEmergencyCare in Scotland.”
‘We must not normalise crisis or celebrate small improvements – our patients and our members deserve more.’That is the response of the Royal College of Emergency Medicine to the latest A&E performance data.
Yesterday (14 December 2023) two sets of data published by NHS England, have been released: the latest Urgent and Emergency Care (UEC) Daily Situation Reports 2023-24 (also known as Winter Sitrep); and monthly A&E performance figures for November 2023.
While there have been some small signs of improvement in certain areas the overall situation remails extremely challenging with A&E departments declaring critical incidents this week, clinicians describing things as the worst they have experienced and ambulance chiefs expressing serious concerns about the pressure their service is under.
The most recent Winter UEC Sitrep data which covers the period 4-10 December 2023 paints a worrying picture with bed occupancy running dangerously high at almost 95% (the level considered ‘safe‘ is 85%) and two-thirds of ambulances not meeting the 15-minute target to hand over patients.
There was a small uplift in the number of beds available within hospitals, but these do not appear to have helped to ease pressure elsewhere in the system, and there remain thousands of patients, who are well enough to go home, but have not been discharged – occupying beds which are needed for other people.
The November performance data reveals that last month more than 144,000 people who visited an A&E within the month were there for more than 12 hours – the target is four hours.
Reacting to these figures, Dr Adrian Boyle, President of the Royal College of Emergency Medicine, said: “While the data suggest a marginal improvement compared to last year, it’s just deja-vu and we must not allow this permacrisis to become accepted as ‘normal’.
“Ambulances are queueing outside A&Es, Trusts are declaring critical incidents, patients are facing dangerously long waits in overcrowded and uncomfortable A&Es. Conditions are intense and difficult for staff, and the experience of patients is distressing and undignified.
“Clinicians are doing their very best, despite the circumstances, to deliver optimal and compassionate care, and mitigate any potential risks to patients but it is taking its toll on them too.
“It is welcome to see small increases in bed numbers, but it is not enough and patients continue to endure long waits.
“Significant and urgent action is required now to address these issues – this is what our members and their patients need and deserve.”
Data in detail:
The latest Urgent and Emergency Care Winter sitrep data for week ending 10 December (week 4 of publication for 2023/24) published today by NHS England show:
Bed occupancy levels at Trusts with a major A&E (Type 1 acute Trust) was 94.9%.
There were 99,497 beds open at Trusts with a major A&E, 1,521 more than the same week last year.
The Government promised that by winter 2023/24 there would be 5,000 more beds open when compared to October 2022 (97,287). For this week, there was an increase of 2,210 Type 1 beds compared with October 2022.
On average, one third of ambulance handovers involved a delay of over 30 minutes, while only one third of patients arriving at A&E were handed over within 15 minutes as per national guidance.
On average, 46,929 patients occupied a bed for more than seven days at a Trust with a major A&E.
On average, 384 beds were general and acute beds were occupied by patients with flu.
On average, 12,927 patients remained in hospital while no longer who were ready to be discharged.
There was an average of 49,020 daily staff absences at Trusts with a major A&E.
This is 7,547 fewer than the same week last year.
Published today (14 December 2023) by NHS England, the latest A&E performance figures for November 2023 show:
There were 1,385,701 attendances to major A&Es (Type 1 EDs) in November 2023. This is a 1.97% decrease compared with the previous month.
In November 2023, 144,085 patients waited 12-hours or more from their time of arrival. This accounts for 10.9% of all major A&E attendances in November. This means that more than one in 10 patients waited 12-hours or more.
The four-hour target at major A&Es stood at 55.4%, this is the fourth worst four-hour performance on record and the lowest so far in 2023.The aggregate four-hour target stood at 69.7%, the lowest so far in 2023. This is 6.3 percentage points lower than the Government’s intermediary threshold target of 76% to be hit by March 2024.
42,854 patients waited 12 hours or more from decision to admit (DTA) to admission. This is a 4% decrease when compared to the previous month. It is a 13.2% increase when compared with November 2022.
Beds data for October 2023 show bed occupancy stood at 94.8%.
Data show there were 98,844 Type 1 General & Acute beds available. This is an increase of 1,473 beds from October 2023 (97,371). And an increase of 1,636 beds from November 2022 (97,208).
Since it was announced in January 2023 that 5,000 new beds would be made available by winter 2023/24 compared with October 2022 (when there was 97,287 beds available), there has been an increase of 1,557 beds.
There were 396,755 emergency admissions at major A&Es. This is a 1.19% decrease since the previous month (401,523). This is the second highest number of admissions so far in 2023.
Latest data show more than one in 20 patients attending A&Es in Scotland faced a 12-hour wait in October, as RCEM Scotland describes the data as “deeply concerning”
In October 2023, there were 111,179 attendances at major A&Es in Scotland.
This is a decrease of 2.4% from the previous month.
64.8% of patients were seen within four-hours at major A&Es (Type 1 EDs)
39,157 (35.2%) patients waited over four-hours in major Emergency Departments, this is a 2.7% increase from the previous month and a 3% decrease from October 2022.
The number waiting more than four-hours has increased more than five times since October 2016 (7,793).
13,800 (12.4%) patients waited eight-hours or more in an Emergency Department.
This is the highest number of patients waiting eight-hours recorded this year.
The proportion of patients waiting eight hours has increased by 2 percentage points from the previous month and has decreased by 1.4 percentage points compared with October 2022.
The number waiting more than eight hours is more than 21 times the number waiting in October 2016 (654).
5,927 (5.3%) patients waited more than 12-hours before being seen, admitted, discharged, or transferred.
This is equal to more than one in 20 patients waiting 12-hours or more in major A&Es in Scotland.
The proportion waiting this long has increased by 1.6 percentage points from the previous month. And has decreased by 0.7 percentage points compared with October 2022.
The number waiting more than 12-hours is more than 54 times the number waiting in October 2016 (109).
There were 1,831 beds occupied due to delayed discharges, an increase of 20 from the previous month and the second highest October on record.
Commenting, RCEM Scotland Vice President, Dr John-Paul Loughrey said:“These data from October are deeply concerning. Now, in December, the situation has changed, the weather is extremely cold with much of Scotland covered in snow and dangerous ice – and things are much more difficult and precarious for both patients and staff.
“This is the most challenging time of year for the health service. Norovirus and other infections are putting significant pressure on a system already under immense strain.
“Staff continue to do their very best to deliver effective care in a timely way, reduce waiting times and mitigate any risks. However, the NHS in Scotland is not as prepared as it could be.
“We do not have a sufficient number of beds and this is driving these delays for care and the long waiting times in overcrowded A&Es. This has a knock-on effect as ambulances are stuck queuing outside A&Es, unable to attend to calls in the community.
“Our patients deserve better than this, they deserve better than to wait for 12 hours for the care they desperately need. But with no beds available, staff are unable to admit them and move them onto the next stage of their care.
“It is a disheartening situation, distressing for patients and difficult for staff.
“The Scottish government’s winter plan did not go far enough and we urge the Scottish Government to revisit their plan and rapidly open more beds and provide additional resources to help the health service through this challenging time and protect patients.
“We have the priorities to #ResuscitateEmergencyCare, the government must adopt these before we see performance deteriorate drastically and patients come to further harm.”
