The Scottish Children’s Services Coalition (SCSC), an alliance of leading providers of specialist care and education to vulnerable children and young people, is calling on all Scotland’s political parties to come together and make mental health a key focus.
The call comes as new waiting time figures out yesterday (6th June), highlight that 469 children and young people had been languishing on waiting lists for more than a year for treatment from child and adolescent mental health services (CAMHS) at the quarter ending March 2023.1
Indeed, just 74.2 per cent of patients with mental health problems were seen within 18 weeks of referral to CAMHS, with more than a quarter waiting longer than this time. This is short of the Scottish Government’s waiting time target of 90 per cent being seen within 18 weeks. 1
The new figures indicate that it has failed to deliver a key pledge to clear waiting lists by March 2023, as outlined in the NHS Recovery Plan.2
Figures also show that as many as 7,701 children and young people were still stuck on waiting lists to start treatment at the end of the quarter ending March 2023, an increase of 138 on the previous quarter ending December 2022.
The new figures are set against the backdrop of a mental health emergency, which is set to worsen given the cost-of-living crisis and services already at breaking point.
The SCSC is calling on a cross party approach to prioritise spending on mental health, avoiding a potential lost generation of children and young people with mental health problems, such as anxiety, depression and self-harm.
Even before the Covid-19 pandemic, cases of poor mental health in children and young people were at unprecedented levels, with under-resourced services struggling to keep pace with growing demand, leaving an increasing number of vulnerable individuals unable to access support. Children and young people are still battling with the long shadow of lockdown, and the rising cost of living is adding to the pressure.
A spokesperson for the SCSC commented: “The latest figures highlighting that more than 460 of our children and young people have been languishing on waiting lists for treatment more than a year is extremely alarming.
“Disturbingly, this means that the Scottish Government has totally failed to achieve its pledge to clear waiting lists by March 2023, leaving many thousands of children and young people waiting for treatment.
“Even before the Covid-19 pandemic demand for already overstretched and under-resourced mental health services was increasing. The mental health of our children and young people has deteriorated markedly over the past decade, and both the pandemic and the cost-of-living crisis are making matters even worse, creating a potential lost generation of vulnerable children and young people.
“We are facing a mental health emergency and many of our children and young people are at breaking point, with stress and anxiety reaching alarming levels as they battle with the long shadow of lockdown and the rising cost of living.
“We must make the delivery of adequately resourced mental health services for our children and young people an absolute priority and would urge all of Scotland’s political parties to come together and make this a reality.”
The Scottish Government’s resilience committee (SGoRR) met again yesterday to discuss the challenges facing health and social care this winter.
Chaired by First Minister Nicola Sturgeon, the meeting focussed on hospital occupancy, and the measures being taken to reduce levels of delayed discharge and find care placements and packages for those clinically fit to leave hospital.
The most recent A&E statistics have shown a continued improvement in performance, with 70.1% of people being admitted, transferred or discharged within four hours – the best performance since May.
Additional funding has also been made available Health and Social Care Partnerships who have the responsibility of providing care packages for those in their locality, to provide 300 interim care home beds for people who no longer need to be in hospital. So far, 162 people have entered interim care facilities paid for using this additional funding.
The SGoRR meeting was also attended by the Health Secretary, other cabinet ministers, the Chief Medical Officer and senior representatives from NHS boards, COSLA, Integration Joint Boards and the Scottish Ambulance Service.
The First Minister said: “The continued improvement in A&E performance is something to be welcomed, but there is still much work being done on safely freeing up hospital capacity and easing pressures elsewhere in the system. That is why we are continuing to pursue a range of measures to enable people to leave hospital as soon as possible when it is clinically safe for them to do so.
“We remain indebted to the health and social care staff in all parts of Scotland who have continued to do an outstanding job, despite the extra challenges that winter has presented.”
Humza Yousaf must be sacked for ‘dangerous negligence’, Scottish Labour MSP Sarah Boyack has said, as the party revealed that the number of patients waiting over 12 hours to be seen in Accident and Emergency in Lothian has soared.
Statistics have shown that, in the year from November 2021 to October 2022, a shocking 15,936 people in NHS Lothian spent more than 12 hours in A&E waiting to be seen – despite an SNP government commitment to see 95% of patients within four hours.
This figure has spiralled in recent years, with the number of people waiting more than 12 hours now around 18 times higher than the same period in 2018/19.
With A&E services in disarray and the situation only worsening throughout the winter, Scottish Labour is warning that lives will be lost due to the SNP-created A&E crisis.
Scottish Labour MSP Sarah Boyack said: “The facts are plain for all to see – NHS Lothian’s A&E services have been plunged into a deadly freefall by Humza Yousaf’s dangerous negligence.
“Despite the efforts of hardworking staff, the number of patients spending a shocking 12 hours waiting in A&E has soared this year.
“The SNP’s mismanagement of our NHS is putting lives at risk – we urgently need a real plan to put a stop to this chaos and protect services in Lothian.”
The Scottish Conservatives are also calling for Yousaf’s sacking. A spokesperson said: “With each passing week, Humza Yousaf continues to preside over complete chaos in our A&E departments.
“His tenure as Health Secretary has been nothing short of a disaster and Nicola Sturgeon must sack him immediately.”
Number of A&E patients waiting more than 12 hours:
More than 90 dentists withdrew from NHS Lothian dental list from 2021 to June 2022, a Freedom of Information request submitted by the Scottish Labour has revealed.
Sarah Boyack warns of a health crisis as waiting times for A&E and NHS dentistry continue to spiral, while delayed discharges have gone up.
Scottish Labour’s FOI request revealed that between 2021 and June 2022, 92 dentists withdrew from NHS Lothian dental list. As at beginning of June this year, out of the 163 general dental practices in Lothian, only 51 confirmed that they are accepting patients, with some accepting children only.
Since 8th May 2022 and up until 11th December, there has been only one week during which the percentage of people seen within Scottish Government’s 4-hour target was above 70 per cent – in the week ending 11th December more than 1,756 people were stuck in A&E for more than four hours – only 63.6 per cent of those attending NHS Lothian’s emergencies were seen within 4 hours. In the same week, 353 people were stuck in A&E for more than 12 hours.
This comes as the recent monthly report on delayed discharge shows rates in NHS Lothian for October 2022 soaring to 1,644 compared to 1,420 in September 2022.
This makes NHS Lothian the second-worst performing health board in Scotland, only topped by NHS Greater Glasgow and Clyde, with 3,848 delayed discharges in October 2022.
October recorded the highest average number of beds occupied per day due to delayed discharges in Scotland since the current guidance came into place in July 2016.
Scottish Labour MSP for Lothian Sarah Boyacksaid: “Another month, another set of damning statistics from NHS Lothian.
“On top of the cost of living crisis, which is taking its toll on people’s mental and physical health, we see piling pressure on our NHS, worsening patients outcomes and huge waste of public money.
“With the freezing cold, people will get sick and they will require care. That’s why we need support to GPs to allow them to respond to the rising demand and handle cases, whenever possible, at primary care level.
“These are not just figures – it is someone’s dad, friend or life partner; it’s the NHS staff who is overworked and underpaid; it’s the people who left our health service because they simply couldn’t cope.
“With a general election approaching, now is the time focus on what really matters and make a difference for millions of people.”
“We are deeply concerned about this winter; the crisis continues to escalate. Patients continue to face exceptionally dangerous long waits. We estimate that one in 72 patients waiting between eight to 12-hours in an Emergency Department can die as a result of these waiting times (30-day all-cause mortality).
“But these are data, the reality is Emergency Departments are overcrowded and in extremis. Patients with an array of different needs and care are packed in, facing high-risk and uncomfortable waits on trolleys in corridors. There is a lack of privacy, a lack of dignity, staff are stretched thinly meaning patients find it difficult to get the things they need – be it food or water or bathroom facilities, while they wait hours for a bed. Meanwhile, ambulances queue outside our Emergency Departments with more patients waiting to simply get in.
“Emergency Medicine staff and ambulance crews and paramedics are highly skilled, highly trained competent professionals, but the inability to move patients through the system means they are overstretched and overwhelmed, and unable to provide the high-quality care that they are trained to provide. Patients are worried and anxious, staff are increasingly distressed, unable to provide the real care that they want and should be providing.
“The solutions are simple; bolster the social care workforce to ensure the timely discharge of patients; tackle the recruitment and retention crisis among all health workers; increase capacity by opening an additional 1,000 beds in the acute system across Scotland. These will begin to address the root of the crisis.”
Addressing the concern around Strep A and the increase in attendances at Paediatric Emergency Departments in Scotland, Dr JP Loughrey said:“In recent weeks we have seen a marked increase in the number of children attending our Paediatric Emergency Departments, cases of Strep A remain high.
“Emergency Departments remain open to those who need it. If children have symptoms, or parents are unsure, please seek care first through NHS 24, your GP or local pharmacist. If the symptoms are severe or your child’s condition worsens, do not hesitate to seek the necessary emergency care. We are here to help.”
One third of children not being seen within waiting time target
The Scottish Children’s Services Coalition (SCSC), an alliance of leading providers of specialist children’s services, has called on the Scottish Government to deliver a budget for mental health as new waiting time figures out yesterday (6th December) highlight that a third of children and young people are not being seen within its waiting time target.
Figures published by Public Health Scotland indicate that over the quarter covering July to September 2022, a third (32.1 per cent) of children and young people had been waiting more than 18 weeks from referral before starting treatment at child and adolescent mental health services (CAMHS).1
The Scottish Government target is that 90 per cent of children and young people should start treatment within 18 weeks of referral to CAMHS.
A total of 4,990 children and young people started treatment at CAMHS in the quarter ending September 2022, an increase of 30.2 per cent from 3,833 starting treatment in the quarter ending September 2021.
The figures however come on the back of a planned £38 million cut to planned mental health spending by the Scottish Government in its forthcoming budget, to be revealed on 15th December.
This cut in spending is despite a mental health emergency, which is set to worsen given the cost-of-living crisis and services already at breaking point.
The SCSC has called on the Scottish Government to reverse its decision and prioritise mental health spending, avoiding a potential lost generation of children and young people with mental health problems, such as anxiety, depression and self-harm.
Even before the pandemic, cases of poor mental health in children and young people were at unprecedented levels, with services struggling to keep pace with growing demand, leaving an increasing number of vulnerable individuals unable to access support. The Covid-19 pandemic and the cost-of-living crisis have further exacerbated this situation.
The SCSC also noted that without increased spending it is unlikely the Scottish Government will be able to achieve its target, as outlined in the NHS Recovery Plan, to clear waiting lists by March 2023 and ensure that at least 90 per cent of children and young people referred to CAMHS start treatment within 18 weeks.
A spokesperson for the SCSC commented: “The latest figures highlighting that a third of children and young people are not being seen within the Scottish Government’s 18-week waiting time target is extremely alarming.
“Since the pandemic, demand on services has increased and the cost-of-living crisis is only going to make matters worse, creating a potential lost generation of vulnerable children and young people.
“We are facing a mental health emergency and many of our children and young people are at breaking point, with stress and anxiety reaching alarming levels because of the effect of the cost-of-living crisis.
“However, this concerningly comes against a background of a proposed cut to mental health budgets, meaning that some of our children and young people simply won’t get the help they desperately need, with potentially catastrophic consequences.
“We would urge the Scottish Government to reconsider its proposed cuts to the mental health budget and make this a budget for mental health.”
1 Public Health Scotland, Child and Adolescent Mental Health Services: Waiting Times in Scotland, Quarter Ending September 2022, 6th December 2022.
Devolved governments call for more cash for NHS pay
The UK Government has been urged to increase the amount of funding available for NHS pay.
Ahead of the Autumn statement, Scottish Health Secretary Humza Yousaf and Welsh Health Minister Eluned Morgan have written to UK Health Secretary Steve Barclay to ask for additional funding to help avert strike action this winter in the NHS.
The letter reads:
“We wanted to write to you in advance of the Chancellor’s Autumn Statement on 17th November to once again make the case for additional funding for our hardworking NHS staff.
“In recent weeks the Deputy First Minister of Scotland and the Welsh Government Minister for Finance and Local Government have written to His Majesty’s Treasury to make clear the need for additional funding for public services.
“The Royal College of Nursing have announced a sweeping legal mandate for industrial action across the UK. In Scotland, they have joined several other unions representing NHS staff in gaining a legal mandate for industrial action with ballots expected to confirm a mandate in the rest of the UK.
“The risk to the NHS of industrial action this winter is profound, and we all need to do all we can to avert industrial action in any form. The NHS across the UK continues to feel the effects of the pandemic as it recovers and remobilises, and any action is likely to have catastrophic effects in all parts of the UK.
“We are experiencing a cost of living crisis and the anger of NHS staff is entirely understandable. Sky rocketing inflation combined with high interest rates, a direct result of the havoc caused by the UK Government’s mini-budget, means that we are simply unable to come close to matching the expectations of NHS staff across the country. While the support provided by the UK Government on areas such as support for energy bills is welcome, it has not gone nearly far enough.
“Media reports suggest that the Chancellor is considering reimposing austerity on the people of the UK again, for which there is no mandate, through extensive spending cuts. That would be a disaster for our public services, including the NHS, at a time when they need more investment, not less.
“We would therefore implore you to work with us to make the case to the Chancellor in advance of his Autumn Statement for increased funding for the NHS and the devolved governments as a whole, primarily to pay our hard working NHS staff a fair pay rise in the face of the cost of living crisis this winter, and avoid what could be catastrophic industrial action in the NHS.”
Responding to the latest Emergency Department performance figures published by NHS England for October 2022, Dr Adrian Boyle, President of the Royal College of Emergency Medicine, said: “The crisis in Emergency Care is dire. October saw nearly 44,000 patients face a 12-hour DTA wait – we know 12-hour waits measured from decision-to-admit are just the tip of the iceberg and hides the reality.
“We know far more patients wait for 12-hours measured from their time of arrival. NHS England and the Department of Health and Social Care will still not commit to publishing this data, despite it being collected by all Trusts. We believe this is a barrier to tackling the root of the crisis.
“We know excessively long waits and dangerous crowding are associated with patient harm and increased risk of mortality. Scientific studies have shown that there is one death for every 67 patients waiting between eight and 12-hours from their time of arrival in the Emergency Department.
“The ONS continue to report worryingly high excess mortality figures and we believe that dangerous crowding, long delays, and the crisis in urgent and emergency care are contributing to a significant proportion of these excess deaths.
“We are increasingly concerned about the winter and the health system’s ability to cope. We are already at 94.3% bed occupancy for all general and acute beds and each month patients face the longest waits on record. The system is failing in its core function – the quick and effective delivery of emergency care.
“We need meaningful action now – sticking plasters like setting up tents or handover units will do nothing to resolve these long-waits and may actually cause more harm to patients. We know we need to be able to admit patients, we know ambulances need to handover patients quickly, we agree that it is vital that ambulances must return to Urgent and Emergency calls in the community – but to achieve this we must tackle the issue of poor flow in our hospitals.
“Many patients in hospital no longer meet the criteria to reside, they are occupying beds to which we could be admitting patients. Around 13,000 people are in hospital unable to be discharged. We urgently need an effective social care workforce to help with the discharge of these patients, so we can admit patients, receive patient handovers promptly, and get ambulances back out to the community.
“It is crucial that those in power understand that this is not a demand issue, attendances are not causing crowding and long waits. Crowding and long waits are a consequence of the inability to move patients through the hospital, a consequence of patients who are unable to be discharged because of severe cuts to social care.
“If you can’t discharge patients, beds are indefinitely occupied and the whole system is blocked. The government must get a grip of the social care crisis to fix flow.”
Commenting on the news that the RCN have voted in favour of strike action, Dr Adrian Boyle said: “In Emergency Medicine there is a retention crisis, particularly amongst our nursing colleagues.
“Emergency Medicine nurses are a critical part of the workforce – EM is a team sport. We know and understand that many EM staff, including nurses, are burned out, exhausted and overwhelmed.
“They are skilled, competent professionals who deliver excellent care for our patients. It is vital that our nursing colleagues feel valued and appreciated.”
Last month there were 97,350 general and acute beds available, an increase of 0.71% from September. The occupancy rate was 94.3%, 0.7 percentage points higher than September, the highest monthly figure on record
The occupancy rate for adult general and acute beds was 95.6%, also the highest figure on record.
Patients leaving the department before being seen stood at 5.2%. This is a decrease of 0.2 percentage points from August 2022, but a decrease of 0.7 percentage points from September 2021.
Unplanned reattendance rate was 8.5%. This is 0.4 percentage points lower than September 2022, but 0.3 percentage points higher than September 2021.
Median time in department for admitted patients was 404 minutes. This is an increase of 29% compared with September 2021 (314 minutes). For all patients, the median wait was 192 minutes.
Responding to the latest Emergency Department performance figures for Scotland for September 2022 Dr John-Paul Loughrey, Vice President of the Royal College of Emergency Medicine Scotland, said:“The situation as we enter winter is dire. Month-on-month, more and more patients face longer and longer waits – that we know are associated with patient harm and even death.
“Emergency Medicine staff and our paramedic colleagues are doing all they can to ensure the urgent and emergency care system continues to function and patients continue to receive care. We want to thank health care workers for their hard-work and diligence at this incredibly challenging time.
“We know that patients are deeply worried about the crisis. Emergency Medicine staff are worried too, distressed that they are unable to move patients through the hospital or take in patients from ambulances to the Emergency Departments.
“The difficulty in discharging patients from hospital when they are medically fit to be discharged is causing exit block in hospitals. The lack of social care is preventing these patients from being discharged.
“This is leading to a lack of flow throughout the hospital and leading to long waits in Emergency Departments, long waits in ambulances outside Emergency Departments, and long waits for an ambulance in the community.
“The Scottish Government must get a grip of this crisis and urgently boost the social care workforce, only then will we be able to discharge patients, free up beds and reduce these long waits throughout the system.”
Responding to the latest figures showing the Royal Infirmary of Edinburgh sees only 40.6% of A&E patients within 4 hours, Foysol Choudhury MSP said:“The figures for patients being seen at A&E within 4 hours in Edinburgh remain alarmingly low, even before the anticipated winter crisis hits.
“The Cabinet Secretary for Health has said that ‘recovery from Covid will not happen overnight’, but we are yet to see any evidence of recovery at all. The 4-hour figures for NHS Lothian last averaged above 90% in March 2021, while the figures for Edinburgh Royal last averaged above 90% in October 2020. The trend has been downwards since then.
“Hard-working NHS staff are doing their best for patients in very difficult circumstances, but they are being let down by long-running structural failures which remain unresolved by this SNP-Green government.
“The Scottish Government needs to take urgent action now to arrest two years of decline in our health service, or risk putting patient safety in jeopardy over winter.”
The Scottish Conservatives said: “This week, A&E waiting time figures showed 1506 patients waiting more than half a day in emergency departments.
“Hardworking NHS staff are being pushed beyond their limits and patients are suffering needlessly as a result of SNP inaction.”
Mr Yousaf said: “A&E departments are working under significant pressure and, in common with other healthcare systems across the UK and globally, the pandemic continues to impact performance.
“Recovery from Covid will not happen overnight, which is why we are continuing to work with boards on a number of measures to reduce pressure this winter.”
Responding to Scottish Labour Leader Anas Sarwar raising his late constituent Anne Sinclair’s case at First Minister’s Questions this week, Foysol Choudhury MSP said:“I am grateful to Anas Sarwar for raising the case of Anne Sinclair with the First Minister.
“I raised the case with the First Minister in February and was told that the seven months of delays she had faced in her cancer diagnosis were ‘not at all acceptable’. I agreed with that assessment.
“Unfortunately Anne passed away this summer. Throughout her journey with cancer she was determined that I raise her story in the Parliament, find answers for the delays she faced, and fight so that nobody else was left in the same position. Her sons, who were in the gallery of the Scottish Parliament for FMQs today, have kindly given me permission to continue that fight on their mother’s behalf.
“Anne’s case starkly demonstrates the real people behind the numbers we hear every week in the Scottish Parliament. There are faces behind all the waiting lists, the people waiting in ambulances, and the people who cannot get the care they need. These are not just statistics, they are human beings who deserve dignity in their healthcare.
“Unfortunately Anne was let down, and her sons deserve answers and an apology for the delays in their mother’s diagnosis.
“I want to thank my office staff for pursuing what has often been an emotional case. We all want to see that Anne’s family can be assured that lessons are learned and nobody else will be left in the same position.”
The family of Anne Sinclair, 64 from Edinburgh, said:“We are happy that Foysol Choudhury MSP and Scottish Labour have continued to raise our late mother’s case at the Scottish Parliament.
“We do not wish for any other families to go through what our mum and our family have gone through. Our mum was a fighter and she would want her questions about her late diagnosis to be answered.”
