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.”
Latest data show that more than 4,000 patients faced 12-hour delays in Scottish A&Es as RCEM calls on the Scottish government to increase bed numbers and avoid ‘devastating winter’.
In September 2023, there were 113,864 attendances at major A&Es in Scotland.
66.50 % of patients were seen within four-hours at major A&Es (Type 1 EDs)
38,114 (33.5%) patients waited over four-hours in major Emergency Departments, this is a 1.7% increase from the previous month and a 2.3% decrease from September 2022.
This is a decrease of 1.4 percentage points from the previous month.
The number waiting more than four-hours has increased by 145.5% compared with September 2019 (15,526).
11,788 (10.4%) patients waited eight-hours or more in an Emergency Department
This is an increase of 1.1 percentage points from the previous month, and a 1.5 percentage point decrease compared with September 2022.
The number waiting more than eight-hours has increased by more than eight times (701%) compared with September 2019 (1471).
4263 (3.7%) patients waited more than 12-hours before being seen, admitted, discharged, or transferred.
This figure has increased by 0.4 percentage points from the previous month. And has decreased by 1 percentage point compared with September 2022.
The number waiting more than 12-hours has increased by 14 times (1307%) compared with 2019 (303).
There were 1,811 beds occupied due to delayed discharges, the second most for any September on record.
Commenting on these data, RCEM Scotland Vice President, Dr John-Paul Loughrey said:“As we head into winter, we expect many people to attend A&Es with a multitude of conditions and illnesses, and many of them will require admission to hospital for further care.
“It is vital that with this clear expectation comes the necessary winter planning to resource A&Es, and support both clinicians and their patients through the colder months.
“We are concerned that the Scottish government’s winter plan fell short of delivering what is needed ahead of what will likely be a difficult period for emergency care.
“We desperately need to see an increase in bed numbers. This will help to reduce the dangerously high levels of bed occupancy, reduce long and dangerous delays in A&Es, and help to ensure patients are admitted to a bed more promptly.
“We continue to engage with the Cabinet Secretary and his team in good faith and raise the concerns of our members.
“To avoid what could be a devastating winter, we again urge the Scottish government to heed our calls to adopt our priorities to #ResuscitateEmergencyCare.”
The data come as figures obtained through Freedom of Information requests revealed that nearly 4,000 people faced 24 hour waits in Scotland A&Es in the six months up to June this year.
As Dr Loughrey said: “24 hours in A&E belongs on TV, not in daily reality for patients and staff”.
In June 2023, there were 116,244 attendances at major (Type 1) Emergency Departments across Scotland.
69% of patients were seen within four-hours at major Emergency Departments.
This is an increase of 1.8 percentage points from the previous month.
36,015 patients waited over four-hours in major Emergency Departments, this is a decrease of 7.7% from the previous month and an 3.8% decrease from June 2022.
It is encouraging to see performance improving but it is still well below the target to see 95% of patients in four-hours or less. This is the second worst June on record. The number waiting more than four hours was an increase of 296% compared with June 2021.
9,489 (8.2%) patients waited eight-hours or more in an Emergency Department
This is a decrease of 16.5% from the previous month, and a 0.9% decrease compared with June 2022.
2,991 (2.6%) patients waited more than 12-hours before being seen, admitted, discharged, or transferred
This figure has decreased by 24.2% from the previous month, and an increase of 30.6% compared with June 2022.
Responding, RCEM Scotland Vice President Dr John-Paul Loughrey, said:“A&E performance in Scotland is slowly trending in the right direction. Our members continue to work hard to reduce delays, mitigate dangerous overcrowding and improve patient care and these figures are in no small part thanks to them.
“To capitalise on these improvements, we hope to have continued engagement with the Health Secretary and support from Scottish Government. Now is the time to plan and prepare for winter and provide adequate resources and beds as well as measures to retain staff.
“Our #ResuscitateEmergencyCare campaign lays out the necessary steps we need to take to ensure the health service is equipped to deliver effective, high-quality care and prevent another catastrophic winter.”
‘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.”
“Patients continue to face long and dangerous waits as staff continue to be stretched to their limit. Ambulance queues, poor patient flow throughout our hospitals, exit block – where patients are stuck in the system in a ‘traffic jam’ – these remain prevalent across Emergency Departments in Scotland.
“We congratulate the First Minister for Scotland, Humza Yousaf MSP, on his appointment to his new role, and we welcome Michael Matheson MSP (above) to the role of Cabinet Secretary for Health and Social Care.
“We hope to continue and increase our engagement with the Scottish Government to improve patient care and staff conditions in Emergency Medicine and the wider health service.
“We urge the new Cabinet Secretary to build on the constructive engagement of his predecessor and increase focus on investing in adequate and sufficient social care to discharge patients in a timely way to free up beds.
£Alongside this, we ask him to prioritise expanding acute bed capacity across Scotland and retaining existing staff. These are the short-term priorities for Emergency Care. It would be wrong to take measures to manage demand and reduce attendances on the front door – such measures do nothing to tackle the root causes of long-term problems.
“In the long-term, we urge the new Cabinet Secretary to look at workforce planning and sustained and continued funding and investment in health and social care to ensure we do not reach the troughs of performance and patient care that we saw in 2022.
“We must reduce and eliminate dangerous and unacceptable delays to patient care that we know are associated with patient harm and patient deaths. We would welcome an opportunity to meet with the new Cabinet Secretary to discuss our Five Priorities for UK Governments for #ResuscitatingEmergencyCare.”
“Staff faced increasingly difficult conditions, with huge numbers of patients facing long and dangerous waits throughout the system. We know these long waits are associated with patient harm and even patient deaths, it is increasingly distressing for staff and patients.
“Exit block – where patients are unable to be admitted to a bed because other patients are unable to be discharged – was the worst it has ever been, meaning the entire Emergency Care system has been gridlocked – like a traffic jam.
Patients spending far longer in Emergency Departments than they should be, often in inappropriate or inadequate areas, on trolleys in corridors, in small, cramped spaces with a lack of privacy and lack of dignity.
“We welcome the gravity with which the First Minister and the Cabinet Secretary are taking the current crisis in Emergency Care. We have had constructive meetings with the Cabinet Secretary and do feel that there is recognition of the root of the issues and a political will to tackle it.
“We especially welcome the focus on social care and the whole system capacity. It is critical that we sort out discharges, ensuring patients who are medically fit to leave are able to return home or to the community in a timely way. We must continue to focus on this to free up beds so we can increase flow throughout hospitals and admit patients from Emergency Departments into a bed on wards.
“While these are the right initiatives, the green shoots of hope are not translating to big enough or fast enough improvements. Without significantly increasing capacity across Scotland, we will continue to borrow from tomorrow to cover today.
“This means cancelling elective surgery so we can admit Emergency Care patients to a bed, but at the cost of further delaying what may be serious surgery for patients who have already waited for a long time. We should not be in a position where decisions like these need to be made.
“It is wrong for specialties to compete for beds for their patients. What is better is to increase the number of staffed beds throughout the system, where safely possible, so we do not need to compromise on which patients are able to be treated.”
