PATIENTS are experiencing waits of more than 20 hours in emergency units in Scotland as hospital staff struggle to find beds for them, new data shows.
Figures obtained by Scotland on Sunday reveal that the longest a patient waited in A&E in the last three months was more than 22 hours.
The statistics suggest that long waits are continuing to blight services, despite this winter so far proving less challenging than the previous one, when hospitals were besieged by high levels of flu and vomiting bugs which closed wards.
Last winter’s crisis prompted the Scottish Government to launch a £50 million emergency action plan. But the latest figures show that in many cases bottlenecks elsewhere in hospitals mean patients who need to be admitted are still spending long periods in emergency departments while they wait for beds.
Using Freedom of Information legislation, Scotland on Sunday asked health boards to reveal the longest waits by patients in A&E this winter.
The results varied widely, but NHS Lothian reported the longest wait at 22 hours and two minutes, which related to a patient with chest pain waiting to be transferred to another hospital. Figures for 2012-13 also showed waits of between 22 and 23 hours in Lothian.
The longest waits in NHS Lanarkshire ranged from 17 hours 30 minutes in November to 20 hours 50 minutes in January. The board said these were due to patients waiting for a bed.
NHS Ayrshire and Arran had a longest wait of more than 17 hours in November. The board said the patient was seen by specialists and had been expected to be sent home, but was admitted overnight and discharged the next day with “full home care support”.
The longest waits in NHS Greater Glasgow and Clyde, Scotland’s largest health board, were more than 15 hours. But this compared with waits of more than 18 hours in figures for 2012-13. The longest waits in other boards ranged from five to 11 hours.
Figures published by Information Services Division Scotland last year showed that in September only five out of 14 NHS boards achieved the waiting time target of 98 per cent of patients being admitted, transferred or discharged from A&E within four hours.
While the majority of patients are seen within four hours, more than 5 per cent waited longer, and more than 400 waited more than eight hours in September alone. The latest figures on performance during winter are due to be published later this month.
Doctors called for investment across hospitals – and not just in A&E – to help prevent long delays for patients.
Dr Nikki Thompson, chair of the British Medical Association’s Scottish Consultants Committee, said: “Colleagues tell us that delays in emergency departments are often the result of bottlenecks elsewhere in the system. While investing in emergency departments is important, it is also important to invest beyond the hospital front door.”
Dr Neil Dewhurst, president of the Royal College of Physicians of Edinburgh, said the new figures were “disappointing, but not surprising”.
“Increased waiting times in A&E are a symptom of wider problems further downstream within our hospitals, including the appropriate placing of elderly medical patients,” he said.
“They also indicate an NHS under severe pressure. In recent years bed capacity has been reduced in Scottish hospitals at a time when admissions of medical patients have continued to increase.
“This has restricted the availability of suitably staffed beds for patients and can result in longer waiting times within A&E departments, as delays are encountered in identifying appropriate beds for patients presenting to A&E who require hospital admission.”
Alistair Douglas, president of the Society for Acute Medicine and a consultant in Dundee, agreed that long delays in A&E were often caused by patients waiting for beds, frequently elderly patients with complex problems.
He said another issue was waiting time targets, such as the legally binding 12-week treatment guarantee. “If you have only got so many beds in your hospital, and you must achieve everyone needing cataract or hip surgery getting in within a timeframe, then you have to keep doing that.
“You can’t make those beds flexible when you get surges in demand that happen during winter,” he said.
Scottish Conservative health spokesman Jackson Carlaw said: “When these figures have been disappointing in previous years, we’ve heard the Scottish Government blame the exceptionally challenging winter conditions.
“It cannot use this as a reason this time round, and as such will need to come up with a thorough explanation.”
Scottish Labour’s wellbeing spokeswoman Rhoda Grant added: “Sadly these shocking waiting times are a reflection of the strain that the NHS is under as a result of [health secretary] Alex Neil’s failure to properly plan for service delivery.”
The Scottish Government said while the number of long waits had fallen and was small in relation to the 1.65 million people seen in A&E each year, any delay in care was “absolutely unacceptable”.
A spokeswoman said: “Through our three-year £50m national unscheduled care programme we have worked closely with health boards to put a number of changes in place to reduce the strain on our emergency departments.
“Feedback from the boards shows that this work is already having a strong impact… with A&E performing sustainably better this winter and patients being seen quicker.”
Norman Provan: Holyrood’s action plan is no cure for delays
IT HAS been recognised for some time that Scotland’s NHS is facing not only winter pressures but is now under pressure all year round.
In response, the Scottish Government announced an unscheduled care action plan this time last year to try to limit the number of people entering hospital via A&E and provide them with more appropriate care.
The success or otherwise of this action plan will be revealed when A&E waiting times for this winter are published in a few weeks.
In the meantime, however, it is worth noting that official statistics in September 2013 showed that only five out of Scotland’s 14 health boards met the national target of four hours for treating, discharging or admitting A&E patients.
And any improvement in these figures will be cold comfort to people who have been waiting in some of our country’s A&Es for 20 hours or more when they should have been admitted – as in most cases patients are waiting for a bed to become available – in four hours.
On its own, the unscheduled care action plan is not going to be a panacea for long waits in A&E; especially as demand grows, the number of people living with multiple long-term conditions increases and Scotland’s population ages.
There is no way services can continue as they are with an almost flatlined budget and increasing demand.
The time has come for the Scottish Government to set out what the NHS and other public services are expected to prioritise to balance the books and deliver good-quality care.
Norman Provan is the Associate Director of the Royal College of Nursing
The longest waits in A&E
• NHS Ayrshire and Arran
November: 17 hours 23 minutes
December: 10 hours 55 minutes
January: 16 hours 10 minutes
• NHS Borders
November: 7 hours 28 minutes
December: 8 hours
January: 7 hours 16 minutes
• NHS Dumfries and Galloway
November: 9 hours 12 minutes
December: 9 hours 45 minutes
January: 8 hours 44 minutes
• NHS Fife
November: 8 hours 28 minutes
December: 9 hours 12 minutes
January: 11 hours 55 minutes
• NHS Forth Valley
November: 11 hours 50 minutes
December: 11 hours 57 minutes
January: 11 hours 42 minutes
• NHS Greater Glasgow and Clyde
November: 11 hours 50 minutes
December: 15 hours 43 minutes
January: 15 hours 26 minutes
• NHS Lanarkshire
November: 17 hours 30 minutes
December: 19 hours 39 minutes
January: 20 hours 50 minutes
• NHS Lothian
November: 20 hours 40 minutes
December: 18 hours 31 minutes
January: 22 hours 2 minutes
• NHS Shetland
November: 5 hours 17 minutes
December: 6 hours 50 minutes
January: 5 hours 20 minutes
• NHS Tayside
November: 6 hours 38 minutes
December: 6 hours 54 minutes
January: 6 hours 58 minutes
• NHS Western Isles
November: 8 hours 5 minutes
December: 9 hours 6 minutes
January: 7 hours 14 minutes
• NHS Grampian, NHS Highland and NHS Orkney didn’t respond