NHS Scotland crisis: Top medics warn Scotland to prepare for worst NHS winter on record
The Royal College of Emergency Medicine (RCEM) in Scotland has issued the dire warning, claiming situations in accident-and-emergency (A&E) departments this winter could be as bad – or worse – than last year, without “urgent and significant intervention”.
During last winter’s NHS crisis, the college warned there was an excess mortality of 50 deaths in Scotland every week, due to the pressure on emergency departments.
Increasingly long waiting times lead to poorer outcomes for patients, causing needless deaths which would otherwise have been prevented.
Last winter – “the worst winter ever”, according to former first minister Nicola Sturgeon – Scotland’s hospitals reached 95 per cent capacity, waiting times for A&E soared and ambulances queued up outside. The severity of the situation led Ms Sturgeon to host weekly, televised press conferences.
According to the RCEM, recent A&E figures show Scotland is “heading towards the colder weather with a poorer baseline than a comparable period in 2022”.
The number of people who have had their discharge from hospital delayed increased by 9 per cent between June and July, figures published this week have shown.
On the last Thursday of July – described as the “census point” – 1,897 people were delayed in hospital, mostly due to a lack of health and social care provision or reasons relating to the patient or their family.
This figure was up by 9 per cent from the census point in June, when it sat at 1,738.
Growing staffing issues have also fuelled fears. More than 500 consultants posts were vacant at the end of June – an increase of 17 per cent in a year – leading the British Medical Association to warn Scotland no longer had enough doctors to “effectively staff” the NHS.
Colin Poolman, RCN’s Scotland director, said: “Last winter was recognised as the worst on record for NHS services.
“Lack of capacity in the community health and social care sectors were key factors, with the number of patients delayed in hospital causing lengthy waits in emergency departments and a lack of preventative support in communities resulting in more people being admitted to hospital.
“The latest workforce statistics show just how much pressure our community nursing teams are under, with almost one in ten posts vacant.”
Mr Poolman added: “Our health and care services deserve more than having to rely on short-term fixes. Persistently high vacancy rates mean that nursing staff can’t run fast enough to even stand still. Every single nursing post that is vacant means the staff who remain have to pick up the slack. They also have to do their own job.”
RCEM vice-president for Scotland, Dr John-Paul Loughrey, gave his assessment after appearing at the Scottish Parliament’s health, social care, and sport committee hearing on Tuesday.
During the committee hearing, Dr Loughrey highlighted the need for long-term planning to prevent NHS crises “rather than short-term fixes and winter firefighting”.
He also emphasised the need for a whole-system approach where all levels of care are better connected so patient flow is maintained.
Speaking following the meeting, Dr Loughrey said: “The Scottish NHS winter plan has yet to be released, but unless it urgently and significantly addresses the shortfalls in acute and general capacity and in the workforce, then I have no confidence it will avert a deep and prolonged winter crisis.
“We see from today’s latest performance data that the improvements we hope and previously would have expected to see during the ‘quieter’ summer months have not materialised.
“We are heading towards the colder weather with a poorer baseline than a comparable period in 2022, where conditions deteriorated into the winter and many patients suffered ultra-long delays accessing care, due to overcrowded A&Es and full hospitals.
“This is not due to avoidable attendances, or ‘well’ patients coming to our emergency departments – these are, in the main, patients awaiting admission to appropriate inpatient ward beds, with particular delays previously reported as impacting people facing multiple disadvantage, older patients and those experiencing mental ill health.
“Without a clear strategy for workforce, or for the required expansion of acute hospital capacity to avoid ‘exit block’, the number of patients experiencing significant delays will rise, and we know that long stays and overcrowded emergency departments increases the risk of death.
“Addressing only the ‘input’ of patients to EDs – by attendance avoidance strategies, or by public messaging advising patients to seek alternative care – without viewing the entirety of the patient’s journey through the emergency care system, is inadvisable.
“The number of people who are well enough to leave hospital, but are delayed at this stage is not reducing, and we are seeing many hospitals with extremely high occupancy levels. Solving this is key to protecting our patients from harm this winter.”
A spokesperson for the Scottish Government said: “The Scottish Government has been working closely with NHS boards and partners in social care to ensure proper mitigations are put in place ahead of winter, and that the system is as prepared as possible for the additional pressures the season brings.
“NHS Scotland is a large organisation, and vacancies are inevitable in an organisation this size. Scotland has more qualified nurses and midwives per 1,000 population than England. Proportionately, NHS Scotland has almost a third more nurses per head of population than NHS England.
“We are working hard with health boards and health and social care partnerships to create the necessary capacity to deal with emerging pressures through our Delayed Discharge and Hospital Occupancy Action Plan to ensure patients are assessed and discharged with the appropriate care package as quickly as possible.”
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