“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.”
YOUSAF: ‘this winter will be one of the most challenging our NHS has ever faced’
Additional funding of £8 million for overseas nurse recruitment and increased flexibility for Health Boards to retain staff are among new measures to support the health and care system through what is anticipated to be an extremely challenging winter.
Health Secretary Humza Yousaf has outlined a number of actions for the coming months backed by more than £600 million of funding. The announcement comes on the back of the latest awful performance figures – August’s waiting times were the worst on record.
Measures to support services include:
recruitment of 1,000 additional staff over the course of this winter, including £8 million to recruit up to 750 nurses, midwives and allied health professionals from overseas as well as 250 support staff across acute, primary care and mental health;
flexibility for Health Boards to offer ‘pension recycling’, where unused employer contributions can be paid as additional salary, to support the retention of staff;
£45 million for the Scottish Ambulance Service to support on-going recruitment, service development and winter planning;
£124 million to assist health and social care partnerships expand care at home capacity;
extension of the Social Care Staff Support Fund to 31 March 2023, to ensure staff receive full pay when in COVID isolation;
Writing to GPs to communicate the expectation that pre-bookable appointments are made available in every practice, alongside same day, face to face and remote appointments;
The first annual update has also been published on the NHS Recovery Plan which highlights significant progress made in the last year, including increasing NHS workforce to historically high levels, the success of the COVID vaccination programme, and a marked reduction in outpatient waits of over two years.
Mr Yousaf said: “NHS Scotland’s staffing and funding is already at historically high levels, but as we approach the winter period it is crucial that we look to maximise, and enhance where we can, the capacity of the NHS.
“Given the scale of the escalating cost of living crisis, combined with the continued uncertainty posed by COVID and a possible resurgence of Flu, this winter will be one of the most challenging our NHS has ever faced.
“These measures will support winter resilience across our health and care system, ensuring people get the right care they need at the right time and in the most appropriate setting. We will also expand our workforce, particularly registered nurses to assist with the expected increase in workload.
“We have jointly agreed a number of overarching priorities with Cosla which will help guide our services this winter. We are on course to double our virtual capacity this year and so far have avoided or saved bed days equivalent to adding a large district general hospital.
“We have published the first update on our NHS Recovery Plan which highlights just how much progress we have made in the past year, I am determined to build on this and we will report on progress annually.
“Our NHS and social care staff have shown remarkable resilience in the face of sustained pressure on services and I would like to thank them for their continued commitment and hard work. As we approach the Winter period their efforts will be vital in ensuring we deliver high quality care for the public.
“To help relieve pressure on services, people should continue to consider whether their condition is an emergency before going to A&E. Local GPs and pharmacies can be contacted during the day for non-critical care, NHS 24 is also available on 111 for non-emergencies.”
Scotland Emergency Department performance falls for the third consecutive month as Health Secretary announces winter plan
Responding to both the latest Emergency Department performance figures for Scotland for August 2022 and yesterday’s announcement by the Health Secretary of the Winter Resilience Overview 2022-23, Dr John-Paul Loughrey, Vice Chair of the Royal College of Emergency Medicine Scotland, said:“The latest Emergency Department performance figures for August show a fall in performance for the third consecutive month.
“We are heading into a very dark and grim winter. Staff are exhausted and are anxious about the months ahead, patients are deeply worried about facing long and dangerous waits for emergency care.
“The Health Secretary yesterday announced the Winter Resilience Overview 2022-23. We welcome the focus on and investment in social care, it is imperative that we bolster the social care workforce to ensure the timely discharge of patients and improve flow throughout our hospitals.
“However, the scale of patient harm occurring as a result of these extremely long waits for admission require more meaningful and urgent intervention and engagement by those empowered to make changes.
“Measures that focus on the avoidance of low acuity patients attending Emergency Departments will not work. The priority must be on increasing the available bed base and a medium- to long-term vision for increasing staff numbers across all grades with an NHS workforce plan for Scotland.
“We appreciate the challenges that the Scottish Government face and we would welcome the opportunity to discuss measures to mitigate patient harm and limit the impact of the looming winter crisis with them.”
“Once again, the figures show the worst performance since records began, meaning record numbers of patients facing extremely long waits. March 2022 also saw the highest number of attendances since September 2021.
“There are immense pressures on our health system. Patient safety is compromised, staff are burnt out, ambulance services are severely struggling, and Emergency Departments are dangerously over-crowded.
“During this difficult time, we commend all staff in our Emergency Departments for their resilience and hard work. These are unprecedented and extremely challenging circumstances, a result of a broken health system in dire crisis. We know morale is very low right now, and we know the challenges in providing effective care, but frontline staff across all grades continue to do their very best to keep patients safe.
“Opening 1,000 beds in the health system in Scotland and addressing the staffing crisis in social care is urgently needed to begin to tackle the current situation and to move patients appropriately and timeously through the system. This is an unsustainable situation, month-on-month performance deteriorates, and patients are coming to harm as staff face severe moral injury.”
The latest Emergency Department performance figures for Scotland published by the Scottish Government yesterday for September 2021 show a deterioration in performance for the fifth consecutive month. The data show the worst four-hour performance on record and both the highest number of 12-hour and eight-hour stays since records began.
In September 2021 there were 113,998 attendances to major Emergency Departments across Scotland, the number of attendances dropped by 3,500 patients (3%) compared to the previous month, August 2021.
Despite the slight decrease in attendances data show that four-hour performance reached a new record low, with 73.8% of patients being seen within four-hours, this is 1.5 percentage points lower than the previous month, August 2021. It is the second time in 2021 that performance has fallen below 75%.
In September 2021 1,840 patients spent 12-hours or more in a major Emergency Department, this is an increase of 31.5% compared to the previous month, August 2021. This number increased for the fifth consecutive month and is once again the highest number of 12-hour stays since records began.
Data also show that 6,413 patients spent eight hours or more in a major Emergency Department. This is an increase of 20%, equal to over 1,000 patients. The number of patients delayed by eight-hours or more increased for the fifth consecutive month and once again this is the highest number of eight-hour stays since records began.
Dr John Thomson, Vice President of the Royal College of Emergency Medicine Scotland, said: “The consistent fall in performance is seriously worrying. What we are seeing: ambulance handover delays; dangerous crowding; long stays; put patient safety at risk and can lead to harm or avoidable deaths.
“The problem is poor flow throughout the hospital and exit block, this will not be resolved in the Emergency Department, it is a system-wide problem and requires system-wide solutions and collaboration.
“Boards must safely expand capacity where possible, provided doctors and nurses and other healthcare workers are available to staff the beds. Same-day emergency care can help to reduce unplanned hospital admissions, maximising the delivery of this service may alleviate some pressures.
“Discharge to assess, ensuring that patients can be discharged in a safe and timely way where they have the support they need to recover in the community, can help free up beds to increase flow throughout the hospital.
“Lastly, it is vital that adequate support and resources are given to social and community care so vulnerable patients do not face successive trips to the Emergency Department or hospital.
“Clear communication between Clinical Leads and senior Board management about the reality of ambulance handover delays; dangerous crowding; and long stays is also vital. Stating the threat these practices pose to patient safety and both reporting and escalating incidents as they occur should guide leadership to take swift action.
“It is a very difficult time, and we are preparing for a gruelling winter. The past five months of performance figures suggest that more deterioration is set to come. In Emergency Medicine we must continue to work towards collaborative solutions and work with other departments, specialties, and management.
“But we continue to call on the Scottish government to set out a long-term workforce plan. In Emergency Medicine (EM) in Scotland there is a vital need to both recruit new and retain existing staff, we need at least 113 EM consultants along with sufficient numbers of both junior and supporting staff and nurses.”
Today’s statistics revealed the worst weekly and monthly A&E statistics since records began.
The statistics show that only 65.6% of attendances at A&E services in NHS Lothian were seen and resulted in a subsequent admission, transfer or discharge within 4 hours for the week ending on the 24th of October.
This is lower than the previous record low of 66.3% recorded in week ending 12th September. Furthermore, 508 patients in NHS Lothian waited more than 8 hours, with 240 not being seen for 12 hours.
Scottish Labour MSP Foysol Choudhury said: “A&E services in the Lothians are in crisis, with the situation rapidly deteriorating with every passing week.’’
“Hard-pressed frontline staff have been sounding the alarm for months, but the Health Secretary has spectacularly failed to take action. Patients in the Lothians are being put in danger thanks to the SNP’s catastrophic failure to support A&E services.
‘’The Health Secretary is without a workable plan, so we have a health service in freefall. Action must be taken now. Our NHS deserves better’’
