Tag: waiting times

Tip of the Iceberg: New report exposes real number of A&E waits

Over 1,000 patients faced a 12-hour wait in A&E every day in 2021

A new report by The Royal College of Emergency Medicine ‘Tip of the Iceberg: 12-Hour Stays in the Emergency Department’ reveals that on average 1,047 patients waited 12-hours or more from their time of arrival every day in a major Emergency Department in 2021 in England, equalling a total of 381,991 patients experiencing these 12-hour waits in 2021.

There is a total of 124 NHS Trusts in England. The College received responses from 74 NHS Trusts that were contacted. The figures above are only representative of 60% of NHS Trusts in England. The true total figure of 12-hour waits from time of arrival in major Emergency Departments in England in 2021 will be even higher.

These figures show the deep crisis facing the NHS and the Urgent and Emergency Care system. The alarming number of 12-hour waits are an indicator of the serious and dangerous levels of crowding occurring in Emergency Departments.

Crowding is unsafe, inhumane, and undignified for patients, our previous report Crowding and its Consequencesfound that patients can come to associated harm and even death.

The NHS in England currently measures 12-hour waits from decision to admit (DTA). The Decision to Admit is the decision to admit a patient to a hospital bed made by a clinician. Measuring from decision to admit is a gross underrepresentation of the reality of patient waits, as many patients will have already waited for a long period in a busy Emergency Department before this decision is made.

12-hour DTA waits have been increasing substantially, so much so that in the first four months of 2022 alone (January – April 2022) there were a total of 79,610 12-hour DTA waits; nearly as many as the cumulative total of the 11 years since data collection began (82,746 12-hour DTA waits between August 2010 – December 2021). It is evident that while the pandemic has contributed to the current situation somewhat, long waiting times have clearly been rising for over a decade.

Our recent report Beds in the NHS found that 25,000 staffed beds have been lost since 2010/11 and this has contributed to the steady increase in long waiting times in Emergency Departments since 2010/11 as detailed in Tip of the Iceberg.

Commenting on the FOI findings, Dr Adrian Boyle, Vice President of The Royal College of Emergency Medicine, said: “These figures are staggering and show the critical state of the Urgent and Emergency Care system.

“They also make clear that measuring 12-hour waits from decision to admit masks the reality facing patients and staff. Clearly, it is misleading to measure 12-hour waits in this way, and it is detrimental to staff efforts to improve A&E waiting times.

“NHS England have previously promised to make 12-hour data measured from time of arrival in the Emergency Department public and publish it alongside monthly NHS performance figures. We are still waiting for them to fulfil their promise.

“We recently wrote to Amanda Pritchard, Chief Executive of NHS England, about this, questioning why the data has not yet been published and when it will be. We have not received a response. Until it is published the NHS cannot hope to drive meaningful change and improvement in Emergency Care. Publishing this data will bring about greater accountability, and help all stakeholders understand the extent of crowding, long stays, and corridor care.

“NHS England must publish 12-hour data from time of arrival as a matter of urgency, this is the first step towards meaningfully tackling this crisis. At present, we fear that the full scale of this crisis is either being ignored or inadvertently misunderstood by the government.

“To truly tackle the problem, you must understand the scale of the task at hand. This data should facilitate better understanding of the challenges facing Urgent and Emergency Care and the wider health system and allow us to take the steps towards tackling it.

“In the short-term, the government must set out a meaningful plan for social care that includes recruitment and investment in the social care workforce and paying a wage that values and reflects significance of their role.

“In the medium-term, the government must finally commit to publishing a fully funded long-term workforce plan that recruits new staff into the health service and includes measures to retain existing staff who are burned out and questioning their careers. Then will it be possible to open the 13,000 staffed beds required to drive meaningful improvement within the health service.

“The health service is failing, and failure to act will take it deeper into crisis and inevitably lead to another ‘worst winter on record’ and further patient harm. The government can talk about phantom new hospitals all it likes, but political unwillingness to tackle the deepest health crisis in NHS history costs; the cost is both deteriorating patient health and patient lives, and an undervalued workforce struggling to deliver.”

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Mental health emergency as child referrals increase by more than 22%

Over 1,300 children waiting more than a year for treatment

The Scottish Children’s Services Coalition (SCSC), an alliance of leading providers of specialist children’s services, has warned of a mental health emergency and called for greatly increased investment as the impacts of the Covid-19 pandemic on the young become clearer.

It notes that the mental health of children and young people is set to further worsen given the cost-of-living crisis, as more people are driven into poverty.

The SCSC has also warned of the devastating impact of cuts in public services on those with mental health issues, as outlined in the Scottish Government’s Resource Spending Review, with an estimated £3.5 billion spending shortfall by 2026/27.

The call comes as new figures published by Public Health Scotland yesterday (7th June 2022), indicate that over the quarter covering January to March 2022, 9,672 children and young people were referred to specialist child and adolescent mental health services (CAMHS) for treatment.

This includes issues such as anxiety and depression and represents a staggering 22.4% increase in numbers from the same quarter of the previous year when the equivalent figure was 7,902.

With already under-resourced and overstretched services facing overwhelming pressure due to increased demand, the SCSC has raised concerns over a potential “lost generation” of vulnerable children and young people whose mental health is being impacted by Covid-19. 

Even before the pandemic, cases of poor mental health were at unprecedented levels with services in crisis, and there are a growing number of vulnerable children who cannot access adequate support. The pandemic and cost-of-living crisis has exacerbated this, with more children and young people driven into poverty, with the resulting impact on their mental health. This has led to unprecedented demand and backlogs, with services struggling to keep up.

In total, 5, 016 children and young people started treatment at CAMHS during the period January to March 2022, an increase of 7.7% from the previous quarter (4,659). Just over a quarter (26.8%) were not seen within the Scottish Government’s maximum waiting time for the NHS of 18 weeks from referral to treatment (to be met by at least 90% of patients). 

A total of 1,322 children and young people had been waiting over a year for treatment at the end of March 2022.

In addition to increased investment in specialist CAMHS, the SCSC has called for greater workforce planning and a renewed focus on expanded prevention and early intervention services, reducing the need for referral to costly specialist mental health services. It has also called for greater partnership working between the public, private and third sectors as well as greater awareness of the services on offer, especially those at a community level.

A spokesperson for the SCSC commented: “We have been warning for some time that we are facing a potential lost generation of vulnerable children and young people, whose mental health is being impacted even further by the Covid-19 pandemic and the cost-of-living crisis.

“Adding to this are cuts in public services, which will impact especially on local government and the third sector, responsible for many of the preventative and early intervention services supporting those with mental health problems.

“Faced by such a devastating series of factors, there must be a radical transformation of our mental health services, investing in specialist services and with a renewed focus on preventing such problems arising in the first place through intervening early.

“This is a crisis we can overcome, but as the country comes to terms with the biggest hit to its mental health in generations, it will require a similar energy and commitment to that demonstrated for Covid-19 if we are to achieve this and prevent many young people giving up on their futures.”

Reshaping unscheduled care services

People needing urgent and unplanned hospital care will benefit from a new national improvement programme aimed at reducing waiting times.

The Urgent and Unscheduled Care Collaborative will see health boards adopt a number of measures to reduce A&E waiting times and improve patient experience, including offering alternatives to hospital–based treatment.

People will also be offered scheduled urgent appointments to avoid long waits in A&E. The programme will also determine how the discharge process can be simplified to ensure patients don’t face unnecessary delays in leaving hospital. Health boards will share more than £50 million of funding this year (2022-23) to support this national integrated approach with work already underway in some areas.

Earlier this week the Scottish Government’s Resource Spending Review was published, setting out priorities for the next five years, including investment and 2reform of health and social care services.

Health Secretary Humza Yousaf said: “It is absolutely crucial we ensure people are receiving the right care at the right time and in the right place. That’s why I’m pleased to confirm today’s £50 million investment to help achieve our national urgent and unscheduled care priorities. 

“Our twin approach of investment and reform in urgent and unscheduled care will help boards see people who need urgent attention more quickly. For many, A&E may not be the best place for their healthcare needs and our £50 million improvement programme will offer patients alternative routes to urgent care.

“Last year 4,500 patients received care from a Hospital at Home service – without this these patients would have experienced an acute hospital stay, we are determined to build on this success.”

Royal College: Urgent and Emergency Care ‘in dire crisis’

RCEM urges action to address failing A & E system

The latest monthly Emergency Department (Major EDs) performance figures for Scotland for February 2022 show:

  • There were 95,692 attendances
  • 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.”

Weekly Scottish Emergency Department waiting times are ‘worst on record’

Serious concerns for patient safety

The latest weekly update (w/e 20 March 2022) of Emergency Department activity and waiting time statistics show:

  • There were 25,506 attendances in week ending 20 March 2022
  • Four-hour performance was 66.2%, the lowest on record
  • 8,610 patients were delayed by four hours or more, this is the highest on record and means one third of all patients were waiting for four hours or more in an Emergency Department
  • 2,615 patients were delayed by eight hours or more, this is the highest on record and means more than one in 10 patients were waiting for eight hours or more in an Emergency Department
  • 1,015 patients were delayed by 12 hours or more, this is the highest on record and means one in 25 patients were waiting for 12 hours or more in an Emergency Department

Dr John Thomson, Vice President of the Royal College of Emergency Medicine Scotland, said: “Each week the Urgent and Emergency Care crisis worsens.

“Scotland’s Emergency Care system is failing patients who are coming to harm, and failing staff who are overworked, exhausted, and burned out but are left to cover the widespread shortcomings of the health system. Shortages of beds, shortages of staff, the social care crisis; existing staff do all they can to keep patients safe in these exceptionally challenging circumstances.

“It is an untenable and unsustainable situation. This week saw the highest number of long waits on record yet again. Data show that there is one excess death for every 82 patients delayed for more than six hours.

“This week 2,615 patients were delayed by eight hours or more, from this we can estimate that over 30 patients in this week alone could have come to associated harm or death as a result of their delay to admission.

“The significance of this appalling harm must not go unnoticed and must be met immediately with effective and meaningful action. The Scottish Government must understand the severity and extent of harm befalling our patients, and see that existing staff facing moral injury, going above and beyond, running on goodwill and adrenaline is not reasonable or acceptable.

“This can no longer be the sole answer to the biggest patient safety crisis in Emergency Care for a generation. This must not continue.”

Call for increased investment in mental health as child referrals increase by more than 25%

The Scottish Children’s Services Coalition (SCSC), an alliance of leading providers of children’s services, has called for greatly increased investment in mental health services as the impacts of the  Covid-19 pandemic on the young become clearer.

The call comes as new figures published by Public Health Scotland today (15th March 2022), indicate that at the end of December 2021, 10,021 children and young people had been referred for treatment from specialist child and adolescent mental health services (CAMHS).  

This includes issues such as anxiety and depression and represents a staggering 27.1 per cent increase from the previous quarter (July to September 2021) when the figure was 7,882.

With already under-resourced and overstretched services facing overwhelming pressure due to increased demand, the SCSC has raised concerns over a potential “lost generation” of vulnerable children and young people whose mental health is being impacted by Covid-19. 

Even prior to the pandemic cases of poor mental health were at unprecedented levels and in crisis, and there are a growing number of vulnerable children who cannot access adequate support. The pandemic has exacerbated this, leading to unprecedented demand and backlogs, with services struggling to keep up.

In total, 4, 544 children and young people started treatment at CAMHS over the period October to December 2021. This is an increase of 19.8 per cent from the previous quarter (3,792) and only 70.3 per cent were seen within the Scottish Government’s waiting time target for the NHS of 18 weeks from referral to treatment (met by at least 90 per cent of patients).

This is a fall from the previous quarter when the figure was 78.6 per cent. Eight out of 14 health boards failed to meet this target.

A total of 1,570 children and young people had been waiting over a year for treatment at the end of December 2021.

In addition to increased investment in specialist CAMHS, the SCSC has called for greater workforce planning and a renewed focus on expanded prevention and early intervention services, reducing the need for referral to costly specialist mental health services.

It has also called for greater partnership working between the public, private and third sectors as well as greater awareness of the services on offer, especially those at a community level.

A spokesperson for the SCSC commented: “For some time now, we have raised concerns over a potential lost generation of vulnerable children and young people, whose mental health is being impacted even further by the Covid-19 pandemic. 

“Too many of our young people are waiting too long for the treatment they need and it is more important than ever that children can access the support required, irrespective of where they live.

“While we welcome the attention that the Scottish Government has given to date on this vital issue, a lack of resources and lack of staff mean it’s becoming an impossible situation to manage. There must be a radical transformation of our mental health services, investing in specialist services and with a focus on preventing such problems arising in the first place and intervening early.

“This is a crisis we can overcome, but as the country comes to terms with the biggest hit to its mental health in generations, it will require a similar energy and commitment to that demonstrated for Covid-19 if we are to achieve this and prevent many young people giving up on their futures.”

Waiting times (with adjustments) for people who started their treatment from October to December 2021, by NHS Board of treatment:

Health boardTotal number seen% seen within 18 weeks
NHS Scotland4,54470.3
NHS Ayrshire & Arran35093.7
NHS Borders7067.1
NHS Dumfries & Galloway13347.4
NHS Fife36371.9
NHS Forth Valley11157.7
NHS Grampian37295.2
NHS Greater Glasgow & Clyde Valley1,56157.7
NHS Highland23275.0
NHS Lanarkshire23969.5
NHS Lothian72665.2
NHS Tayside32993.0
NHS Island Boards58100.0

Emergency Departments continue to face severe pressures as RCEM calls for meaningful action

The latest A&E activity and waiting times for major Emergency Departments in Scotland for January 2022 show:

  • 73.7% of attendances were seen and resulted in subsequent admission, transfer or discharge within four hours
  • There were 96,338 attendances, a 1.4% decrease when compared to the previous month, December 2021
  • More than one in four patients were delayed by four hours or more
  • 6,682 patients were delayed by eight hours or more, a 23% increase when compared to the previous month, December 2021
  • This is equal to 6.2% of all attendances
  • 2,155 patients were delayed by 12 hours or more, a 30% increase when compared to the previous month, December 2021
  • This is equal to 2.1% of all attendances

Dr John Thomson, Vice President of the Royal College of Emergency Medicine Scotland, said: “The health service in Scotland continues to face severe system pressures.

“Emergency Departments remain dangerously crowded with many patients facing extremely long waiting times as ambulances still face delays in offloading patients. These long waits are leading directly to harm for our patients.

“Despite the challenges of widespread bed shortages and staff shortages, Emergency Medicine staff continue to do all they can to keep patients safe. It is the hard work and dedication of EM staff who are preventing urgent and emergency care from tipping over the edge and falling deeper into crisis.

“Frontline workers continue to be pushed to their limit and are experiencing significant moral injury as a result of inadequate bed capacity and patient flow. It is clear that without significant, immediate change, both patients presenting to our Emergency Departments, and the staff working in them, face ongoing harm.

“Emergency Medicine staff will continue to be pushed to their limit unless an adequate urgent and emergency recovery plan is set out by the Scottish Government – this would prevent any threat of derailing elective care recovery.

“In the longer term, the Royal College continues to call for a fully funded long-term workforce plan and for 1,000 additional beds to be opened in the system. The current status quo is not sustainable for patients or staff, it is time to see meaningful action.”

Long waiting times continue to put patient safety at serious risk

The latest A&E activity and waiting times for major Emergency Departments in Scotland for December 2021 show:

  • 73.7% of attendances were seen and resulted in subsequent admission, transfer or discharge within four hours
  • There were 97,644 attendances, a 6% decrease when compared to the previous month, November 2021
  • More than one in four patients were delayed by four hours or more
  • 5,342 patients were delayed by eight hours or more, equal to 5.5% of all attendances
  • 1,605 patients were delayed by 12 hours or more

Responding to these figures, Dr John Thomson, Vice President of the Royal College of Emergency Medicine Scotland, said: “With fewer attendances performance has plateaued but be in no doubt that the health service and its staff in Scotland remain under unprecedented pressure and increasing burnout.

“One in four patients face delays over four hours, while both eight- and 12-hour waits are still at record high levels not seen before 2021. What is deeply concerning is the pattern and the potential for these long waiting times to become the status quo in perpetuity.

“Both our own report Crowding and its Consequences (below) and a recent article in the Emergency Medicine Journal ‘Association between delays to patient admission from the emergency department and all-cause 30- day mortality’ detail the real harm, and in some cases death, that long waiting times can cause patients.

“The impact of this continued poor performance is distress and moral injury to staff and serious discomfort and risk to the safety of patients. This must be an urgent signal and call to action for system change. We have long called on the government to open 1,000 more beds in the system in Scotland, and to commit to publishing a long-term workforce plan. While there remains an urgent need to address the social care crisis to help patients be discharged from hospital in a timely way.

“Quite simply things cannot continue as they are, more patients will come to harm and staff will face increasing distress at the quality of care they are or, more significantly, aren’t able to provide. The government must recognise the severity of the situation and the risk that continued poor performance, long waiting times, patient harm, and sinking quality of care will continue to spiral.”

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Choudhury: NHS Lothian ‘in crisis’

ANOTHER WEEK OF ‘SHOCKING’ A & E FIGURES RECORDED

Lothian MSP Foysol Choudhury has warned that  NHS Lothian is in crisis as another week of dismal A&E figures has been recorded.

Statistics published yesterday show that only 64.8 per cent of attendances in NHS Lothian at A&E in the week ending 31st October were seen within four hours.

  • 363 patients spent over eight hours in A&E, with 132 waiting over 12 hours.
  • 1,504 patients waited over 4 hours.  
  • These are among the worst weekly A&E times on record for NHS Lothian.

Scottish Labour MSP Foysol Choudhury said: “Yet another week of shocking statistics showing the reality of SNP mismanagement of our NHS.

“Lothian patients are in dire need of medical help and they are not receiving the swift attention they deserve. These are truly shocking figures that show once again just how out of depth the SNP Health Secretary Humza Yousef is.

“The SNP has left NHS doctors and nurses over-worked, under-staffed and under-resourced – and it is patients who are paying the price.’’

Waiting times: what’s happening?

During the pandemic, patients have been seen and treated based on their clinical urgency and we will continue to do so whilst we remobilise our NHS.

Patients are being classified in the following groups:

  • Priority Level 1a Emergency – operation needed within 24 hours
  • Priority Level 1b Urgent – operation needed within 72 hours
  • Priority Level 2 Surgery – scheduled within 4 weeks
  • Priority Level 3 Surgery – scheduled within 12 weeks
  • Priority Level 4 Surgery – may be safely scheduled after 12 weeks

NHS Scotland is working hard to increase the services available as safely and as quickly as possible. Clinicians and Clinical Experts are continuously reviewing how they deliver services to provide additional appointments to support your care.

About your appointment

It is important to attend your appointment or to let us know if you no longer need to attend.

Make sure you read any information provided in advance of your appointment so you know what to expect and can make the relevant preparations.

Keeping an eye on your condition

It is important to attend your appointment or to let us know if you no longer need to attend.

Make sure you read any information provided in advance of your appointment so you know what to expect and can make the relevant preparations.

Self Help

If you require further advice on your condition, please contact the hospital team you are awaiting an appointment with.

If your condition or symptoms worsen while waiting, you should contact your GP Practice.

Your local pharmacist or a trained member of the pharmacy team can give you advice and provide over-the-counter medicine if needed.

Call NHS 24 on 111 for further advice on managing symptoms.

If you consider your condition or symptoms to be life-threatening, then you should call 999 immediately.

Other Support

If you’re feeling overwhelmed, or that your mental health and well-being has been affected by the delay in your treatment, you can call:

  • NHS 24 on 111, 24 hours a day, and select the Mental Health option from the telephone prompts
  • Breathing space on 0800 83 85 87 is open weekdays Monday-Thursday, 6am to 2am, and weekends Friday 6pm to Monday 6am
  • Living Life on 0800 328 9655 is open Monday-Friday 1pm to 9pm

Your rights and responsibilities

Under the Charter of Patients Rights and Responsibilities, you have certain rights and responsibilities when using the NHS in Scotland.

For waiting times, It’s important that these be respected if patients are to receive treatment in the shortest time possible.

Your rights and responsibilities apply to waiting times in the following ways:

  • Availability
  • Appointments
  • Attendance

Find out more about how your rights and responsibilities apply to waiting times.