Winter pressures, Covid and Strep A: What the future has in store for the NHS in Scotland

The NHS has weathered the storm of the past couple of years with admirable tenacity, saving countless lives during the coronavirus pandemic and making heroes of our healthcare professionals – but the future looks bleak.

The pressures in hospitals over this winter is likely to reach a terrible crescendo, with the flow of patients in and out of hospital causing problems, and the threats of Covid, Strep A and delayed cancer diagnoses heaping further pressure on a fragile health service.

Primary Care

Starting with the places most people interact with the NHS – their local GP surgery – the problems are already evident and likely to continue. Anyone who has tried to get a GP appointment recently will know just how hard it is to see a doctor face to face.

Covid, Strep A and staffing strikes are among the challenges ahead for Scotland's NHS. Picture: Christopher Furlong/Getty

That doesn’t mean GPs aren’t working. In fact, GPs have been working flat out, coping with increased demand and a vacancy crisis that is crippling local practices.

The Scottish Government’s failure to retain and recruit GPs has led to doctors implementing “never-before-seen” emergency measures in surgeries, according to the Royal College of General Practitioners (RCGP) Scotland.

More than a third of practices surveyed by the RCGP have a vacancy, despite the Government pledging to hire 800 new GPs by 2027.

The chair of the British Media Association's Scotland GP committee, Dr Andrew Buist, has also said some GPs are “facing abuse from frustrated patients”, and called for recent Government funding cuts of up to £70 million to be reversed.

The Government says it has recruited more than 3,220 healthcare professionals into multi-disciplinary teams working alongside GPs. However, without further sustained recruitment of new GPs, and crucially, the retention of existing GPs, the next year could be brutal for community care.

A&E

The urgent side of primary care is also experiencing enormous pressure. Emergency departments throughout Scotland are struggling to manage the inflow of patients, which has been increasing steadily since the pandemic, and the outflow into hospital beds, which are in short supply.

In the first week of winter, accident-and-emergency (A&E) figures showed 3,048 patients had waited more than eight hours and 1,276 more than 12 hours in the week to December 4.

This has led one of Scotland’s top medics to warn lives will be lost this winter due to spiralling A&E waiting times, with patients suffering from a “lack of dignity” under an NHS system in crisis.

Dr John-Paul Loughrey, vice-president of the Royal College of Emergency Medicine (RCEM) Scotland, said the medical body was “deeply concerned” about this winter, with the college estimating one in 72 patients waiting between eight to 12 hours in an emergency department could die.

A&E attendance peaks in the winter months, due to weather-related injuries (such as falls) and the spread of contagious diseases. The spring may bring NHS Scotland some much-needed respite, and a chance to improve the service before the next winter.

Delayed Discharge

The delayed discharge of patients from hospitals to community care continues to be a problem, as the outflow of patients is causing blockages for the inflow of patients, who can’t be admitted to beds.

Data from Public Health Scotland shows the number of beds occupied by people who no longer require acute hospital care are at the highest level since 2016, with almost 1,900 people waiting to be discharged from hospital.

Other figures show that in 2021/22, one in 11 bed days were occupied by patients who were delayed in their discharge – a figure that will have only grown worse as we head into the middle of winter.

The problem is yet another vacancy-crisis for the Scottish Government, only this time in community care. Patients with vulnerabilities can’t be discharged from hospital without an adequate care plan.

Carers work long hours, for a barely liveable wage. Added to this, care homes were the setting for some of the worst tragedies of the coronavirus pandemic, leaving behind a traumatised and vulnerable staff still having to work in the places they bore witness to such tragedy.

The number of staff leaving the profession, and the struggle to attract new workers, is one of the key contributors of NHS pressure. Without a change to the pay and conditions of these workers, employers will continue to struggle to attract new talent.

Strep A

Strep A infections have continued to rise in Scotland, with at least 19 children sadly dying from the infection across the UK. Whilst GAS infections, which commonly present as scarlet fever, are common, the more serious Invasive Group A Streptococcal (IGAS) infections are rare.

While infections are rising in Scotland, there is concern around the supply of antibiotics – namely the syrup versions of penicillin and amoxicillin given to children.

Pharmaceutical bosses have insisted Scotland, along with the rest of the UK, is experiencing a shortage of antibiotics to fight the growing threat of strep A infections, despite the assurances of both Holyrood and Westminster.

Scottish health secretary Humza Yousaf initially reassured parents there was “no shortage of supply” of the antibiotics needed to treat strep A, but pharmacies say they are running out and anecdotally, parents have reported having to try several pharmacies to get prescriptions filled. Without a reinforced supply chain of antibiotics, the number of deaths in the UK may rise.

Covid

Coronavirus is expected to again rear its ugly head in Scotland, with a noticeable uptick in infections and hospitalisations already being observed during the first week of winter.

On average there were 735 patients in hospital with Covid-19 in the week ending December 11 – an 18.2 per cent increase from the previous week (622). There were seven new admissions to intensive care units (ICUs) with a laboratory-confirmed test of Covid-19.

Although the next wave of coronavirus is expected to be much less deadly than previous waves, thanks to the miracle of the various vaccines produced, the virus is likely to still cause hospitalisations and deaths over coming months.

Cancer

A knock-on effect of the pandemic has been a growing waiting list for cancer diagnosis and treatment, leading to worse outcomes for patients and ultimately more deaths.

During the second quarter of this year, just 74.7 percent of referrals started treatment within 62 days – a fall from 76.3 per cent in the previous quarter and the worst performance against the target since 2012. The target was not met by any NHS health boards.