Emergency Departments in Scotland are struggling against the combined pressures of extreme weather and a rise in hospital admissions from flu.
The Royal College of Emergency Medicine (RCEM) has described the country’s health service as being “in the depth of a winter crisis” as Scotland braces itself against snow and ice.
Yesterday, after coming under increasing pressure regarding the condition of Emergency Care in Scotland, Health Secretary Neil Gray said A&E demands had been “exacerbated by higher than normal levels of influenza infection in the community”. Data released last week showed hospital admissions caused by flu increased by 12% in a week.
The Health Secretary’s comments come as data released yesterday by Public Health Scotland revealed last November 6,429 patients waited 12 hours or more in Emergency Departments – the highest proportion of 12 hour waits for any November since records began in 2011.
Dr Fiona Hunter, Vice Chair of RCEM Scotland said: “Today’s data, and every previous month’s data, shows just how much pressure Scottish EDs were under coming into this winter.
“The system was already under extreme pressure, and this huge flu surge and cold spell are likely to be the straw that breaks the camel’s back.
“But it cannot – and must not – be blamed as the sole cause of the crisis we are currently experiencing.
“My colleagues are working flat out in very difficult conditions with some departments nearing 400% capacity- four times as many patients as there are cubicle spaces for. We are running on hard work and goodwill, and our patients are receiving unacceptable, undignified and unsafe care in corridors and in the back of ambulances.
“The main issue is that we can’t move our patients who desperately need admission to a hospital bed in to wards or high dependency units. These wards have the highest level ever known of patients who are ready to be discharged but have no available social support to allow them to do so.
“We are predictably gridlocked, in the depth of a winter crisis, and our patients and staff are the ones suffering.”
The Royal College of Emergency Medicine has joined calls for the Scottish government to address ‘delayed hospital discharges’ in the upcoming budget announcement.
Delayed discharges are when people are considered medically fit enough to leave hospital but are unable to, often because the required social care support is not available.
This issue means that the whole system for admitting people grinds to a halt and people can end up stranded in A&Es often waiting hours and even days for a ward bed to become available.
The latest data release comes as the Auditor General of Scotland published a damning report into the state of the Scottish health system which concluded that the Scottish Government has no clear plan to reform the country’s NHS, or to address pressures on the service.
Auditors found:
commitments to reducing waiting lists and times have not been met
the number of people remaining in hospital because their discharge has been delayed is the highest on record
and NHS initiatives to improve productivity and patient outcomes have yet to have an impact and lack clear progress reporting.
The issue of delayed discharges has also been highlighted by the Royal College of Physicians Edinburgh (RCPE) which has written an open letter to the First Minister calling on him to address this ‘urgent issue’ in his Government’s budget which will be unveiled tomorrow (4 December 2024).
Dr Fiona Hunter, The Royal College of Emergency Medicine’s Vice Chair for Scotland said yesterday: “Delayed discharges are a key reason that patients get stuck in Emergency Departments, often on trolleys in corridors – often experiencing extreme waits which are dangerous.
“So we join, and fully support, the calls from RCPE, and the Auditor General to address this issue. It must be prioritised as a matter of urgency.
“Today’s data is another timely reminder of scale of the issue. Just think about what it shows. More than 2,000 people every single day stranded in in hospital when they are well enough to go home.
“People – through no fault of their own, lying in beds which could be used for other patients who need to be admitted – who themselves are probably on a trolley in the Emergency Department, waiting for that bed to become available.
“We have to be able to move patients through our hospitals and out again when they are well enough. To do that takes a functioning and resourced social care system working alongside a functioning and resourced health system. They are inextricable.
Dr. Hunter concluded:“Tomorrow’s budget is an opportunity for the Government to #ResuscitateEmergencyCare, ahead of the depths of winter which is shaping up to be a gruelling several months ahead, for both patients and staff alike. They must take it.”
As winter poses increasing demand on our healthcare system, NHSGGC is encouraging family members to help get their loved ones ‘Home for Lunch’.
Almost all patients that are ready to go home are discharged on the same day, but a number remain in hospital causing flow issues throughout the health care system.
Doctors are reminding families of patients who are ready to be discharged to help make the required arrangements to get them back to their own home or care setting, at the earliest opportunity.
NHS Greater Glasgow and Clyde ward staff and discharge teams work in parallel to create pathways for families to ensure that, when their loved ones are healthy enough to return home, they are supported in doing so.
As part of NHSGGC’s ABC winter campaign, the health board are attempting to ease pressure on our services and staff from the emergency department, through to patients being discharged.
Dr Scott Davidson, Deputy Medical Director for Acute Services, said: “Winter places increasing demands on our health care services and families play an important role in helping to ease those pressures.
“Our staff are working extremely hard to ensure we provide the best possible care for our patients and we are looking for your help to get loved ones home at the earliest opportunity.
“We do not want patients spending any longer than they need to within our hospitals and want people to be in the comfort of their own home, without the risks associated with lengthy hospital stays.
“I would like to thank families and members of the public who are doing their best to support our patients and staff as we continue to tackle winter pressures.”
New remote monitoring tools to support people with Covid to stay safely at home, and free up hospital beds are among a range of steps being put in place to support the health and care workforce and maximise capacity.
Measures include £500,000 to fund 25,000 remote monitoring kits, including additional pulse oximeters, and a dedicated team which will support the early identification of patients who would benefit from antivirals treatments and get these started as soon as possible. This will free up beds in acute hospitals.
COVID admissions are rising at a rate 45% faster than they did last winter, and this combined with existing winter pressures is creating significant demand on hospitals. A large spike in staff absence relating to COVID is also significantly impacting NHS service provision.
In addition to the investment in remote monitoring, the Scottish Government will also expand existing programmes, including Hospital at Home, Outpatient Parenteral Antimicrobial Therapy (OPAT) services for managing infections and Community Respiratory pathways. These services allow patients to be treated in their own home and to receive the relevant treatment without admission to hospital.
Health Secretary Humza Yousaf said: “The next few weeks will probably be amongst the most difficult our NHS has ever faced in its 73 year existence. We are facing pressure on a number of fronts.
“Modelling suggests that infections and associated staff absences due to the coronavirus could peak by mid-January. Treating more people who previously may have been admitted to hospital at home with anti-virals and suitable support is essential to free up capacity in our hospitals.
“We know Discharge Without Delay has made a significant impact in some parts of the country and rolling it out to all health boards will make a major difference. Local contingency plans are in place to focus on the redeployment of available clinical and support services staff to essential services.
“All of this builds on work already underway as part of our £300 million investment in health and care services as part of winter preparations, to help maximise capacity, support the wellbeing of our fantastic health and care staff, support flow through the system and improve outcomes.”
Survey by NHS Providers reveals fears over waiting lists, COVID-19 and winter pressures
A survey by NHS Providers sets out in stark detail how NHS leaders are grappling with challenges on multiple fronts as they seek to meet rising demand for health services alongside a rapidly growing waiting list and a worrying surge of COVID-19.
The health service is coming under concerted pressure with recent figures revealing a record 5.1 million people on waiting lists, over 2 million A&E attendances in the last month and a steep increase in demand for mental health services.
Trusts and frontline staff are working at full pelt to clear the backlog of care that has built up during the pandemic, with 90% of pre-pandemic levels of operations now being carried out and a small, but welcome fall in the number of people now waiting over 52 weeks for treatment to begin.
But our survey reveals widespread concerns amongst trust leaders that winter pressures and further surges of COVID-19 will derail plans to deal with the backlog of care and undermine hard-won progress.
These findings come just days after the chief medical officer warned of a further wave of COVID-19 this winter and the prime minister was forced to delay plans to further ease restrictions following a sharp rise in infections and hospital admissions because of the Delta variant.
The survey responses reveal:
A large majority of leaders (88%) said it was likely that another surge in COVID-19 cases would place additional pressures on their services.
89% said they were worried these additional pressures would come during the challenging winter months.
Almost three quarters (73%) of respondents raised concerns that plans to clear the backlog of care over winter risked being disrupted because of the need to prioritise demand for urgent and emergency care.
Almost half (48%) of respondents said they have seen evidence of staff leaving their organisation due to early retirement, COVID-19 burnout, or other effects from working in the pandemic. Respondents are concerned that juggling winter, flu, COVID-19 and ambitious recovery plans will once again put pressure on the workforce.
Commenting on the survey results, the deputy chief executive of NHS Providers, Saffron Cordery said: “Our survey reveals the sheer scale of the challenge facing trusts right now. They are battling on multiple fronts as they try to recover care backlogs, deal with increased demand for emergency care and treat patients with COVID-19.
“This is difficult at the best of times but as we saw last year, could become even more challenging during the hard winter months, particularly with the expectation that flu will return and there will be increased respiratory viruses among children.
“Trusts are committed to clearing the backlog of care that built up during the pandemic. We are confident vaccines are breaking the chain between infections and hospital admissions, but the reality on the frontline is that even a small increase in COVID-19 admissions or emergency care pressures could affect our ability to deliver non-COVID services.
“Trust leaders are doing all they can, but there are three steps the government can take immediately to ease the current pressure trusts are facing.
“First, the government must provide much needed short-term capital funding so trusts can direct it to the services that need it most. Trusts tell us they need capital quickly to expand intensive care units, to invest in digital to transform pathways to see patients more quickly, and to adapt estates to create more capacity.
“Second, trusts need to maintain patient flow and maximise their capacity. We’re urging the government to commit to permanent, dedicated funding for the discharge to assess programme, which ensures patients who are ready to leave hospital are placed in a more appropriate setting freeing up hospital beds.
“Third, we need national bodies to work with NHS leaders to get the planning for winter pressures right to help manage the risk ahead. We know the NHS faces a perfect storm of COVID-19, flu and other respiratory illnesses as well as a growing backlog of care. We must act now.”
‘The threat of winter is tangible’
RCEM supports NHS Providers call for action
Responding to the latest survey from NHS Providers about the challenges facing Trusts, Dr Adrian Boyle, Vice President of the Royal College of Emergency Medicine, said:
“The health service is facing serious pressures: with the backlog of elective care reaching 5.1 million patients; and the urgent and emergency care system facing record breaking attendances.
“It is an incredibly challenging time, but we support our Trust Leaders and recognise that they are doing what they can to manage the current situation.
“We support NHS Providers and their three steps the government can take to ease pressures currently facing Trusts. We particularly welcome NHS Providers call for action ahead of winter and the likely increase of pressures that covid, flu and respiratory illnesses will bring, in tandem with the urgent tackling of elective care.
“Since April 2021, the College has warned of the threat of winter and the need to prepare the health service and ready Emergency Departments. It is absolutely essential that we ensure there is adequate capacity, adequate access to alternative care, departments have the right resources, and that staff are prepared.
“We welcome the recognition from NHS Providers of this threat ahead, now we wait for the urgent action and leadership from government that is desperately needed.”
