Record numbers waiting over 12 hours in Scotland's A&E units

Camley's Cartoon: A&E waits

The increases far outstrip the rise in A&E attendance, which has climbed by 14 per cent from just over 94,000 in December 2015 to just under 107,500 last month.

It comes as the A&E statistics for November also reveal that only 85.5% of patients were seen, treated and either admitted or discharged within the four-hour target, well short of the Scottish Government's 95% benchmark.

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Dr David Chung, vice president of Royal College of Emergency Medicine (RCEM) Scotland said a lack of available hospital beds meant more patients requiring admission were stuck longer in A&E.

He said: “We are now witnessing record levels of eight hour and 12 hour waits in Scotland’s emergency departments.

“Poor performance cannot be solely linked to increasing attendances, there’s clearly an urgent need to build capacity in the system through restoring the number of staffed beds and building a primary and social care system that meets the demand of Scotland’s growing and ageing society.

“Long waits mean patients on trolleys and care delivered on corridors. We must do better by our patients."

In the past decade, the number of beds in NHS Scotland has been cut by nearly a fifth, from 25,751 to 20,791.

Dr Helene Irvine, a public health consultant who retired from NHS Greater Glasgow and Clyde last year, said she believes the reduction in beds in Scotland's largest health board has been too sharp during a period of growing demand.

NHS GGC has reduced its bed numbers by 19.5%, to 5,613 last year, but around 20% of its hospital admissions are patients referred for specialist treatment or procedures from other health boards such as Forth Valley, Highland and Dumfries and Galloway.

"You have to bear that in mind when you're calculating your bed requirements," said Dr Irvine. "I think they probably don't have enough beds now based on how much work they're doing. You have all these elderly people from GGC, then you have all these extra people coming in from other health boards."

Compliance with the four-hour A&E target was consistently below 79% for NHS GGC throughout December.

For Scotland as a whole, 3,405 patients spent more than eight hours in A&E in December 2019, compared to an average of 1300 in the previous four Decembers, from 2015 to 2018.

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The picture was even starker in relation to the numbers waiting more than 12 hours, which were 1,022 last month compared to an average of 242 for Decembers 2015-2018.

Dr Irvine said the deterioration in A&E performance dates back to 2010, when many councils responded to budget cuts by reducing funding for elderly social care.

However, her own research also shows that A&E dips are clearly linked to a spike in attendance by better-off, elderly patients.

She said: "In GGC and other parts of the west of Scotland, what I found was that in the weeks when we had very poor compliance with the four-hour, eight-hour or 12-hour A&E waiting times, we also had a spike in the 'elderly-affluent'.

"They come in, they're demanding, there isn't maybe that much wrong with them, but their children don't want to take them home and they're putting pressure on staff to admit them. A lot of time is spent to-ing and fro-ing in the A&E to decide what to do with them.

"That can easily end up being a four-hour, or an eight-hour or a 12-hour breach.

"This is one of the reasons I tell people not to get so hung up on A&E compliance. Invest in social care for the elderly, in general practice, in district nurses. What you need are community-based staff to deal with all this."

Miles Briggs, Scottish Conservative health spokesman, said: “These significant increases in the numbers of patients waiting an extreme amount of time in A&E are truly shocking.

“It is particularly dreadful that these waiting times are so long when average attendance hasn’t changed very much at all.”

Monica Lennon, Scottish Labour’s health spokeswoman, added: “Emergency medicine experts have been warning for months about a lack of preparedness in our NHS for winter pressures. No one should have to spend half a day in A&E and these worrying trends can’t continue."

A Scottish Government spokesman said: “Scotland’s core A&E departments continue to be the best performing in the UK and have been for more than four and a half years despite experiencing continued high attendance levels.

"In 2019, we have seen more patients within four hours than in any other year since 2012. We continue to work closely with those health boards facing the greatest challenges to minimise long delays and help drive improvements.

“To support the impact that winter pressures can have on performance, we have invested a further £3.4 million bringing the total additional investment to £13.4m to ensure quality of care, patient safety and access to services are maintained over the winter period.

"This is in addition to the £6.3m previously allocated to support unscheduled care throughout the year."