12-hour waits plague NHS Lothian’s emergency units

Accident and emergency waiting times have become a problem. Picture: Julie Bull
Accident and emergency waiting times have become a problem. Picture: Julie Bull
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FEARS have been raised that the Royal Infirmary’s A&E is heading towards “meltdown” as it emerged that a record number of patients are languishing for at least 12 hours in emergency departments in the region’s hospitals.

New figures have revealed that 75 patients were stuck in Lothians A&Es for half a day or more in January – well over double the figure in the same period just one year ago.

The findings have been branded “obscene” by patient representatives, while MSPs have called for immediate action to resolve the problem, saying the situation was “unacceptable”.

Medical evidence shows that long waits in A&E impact on the quality of care, while they can also cause distress and anxiety, particularly for patients with dementia.

The figures are the worst since records began in 2007, and show that with another month to go in the current financial year, the total waiting for 12 hours or more hit 276 – almost twice the previous high over a 12-month period.

More people are being forced to wait at least eight hours than before, with 1610 sitting in A&E for the period between April 2012 and January, compared with just 470 in the whole of 2008-09 and the previous record of 1108, set in 2011-12.

The Scottish Government expects emergency patients to be discharged, transferred or admitted to hospitals within four hours.

NHS Lothian is in the process of implementing a series of measures to improve its unscheduled care performance, and said the number of patients waiting more than 12 hours had fallen to eight last month.

However, a senior source within the health board said that the Royal Infirmary’s A&E had been in turmoil as recently as Wednesday last week and that hard-working staff members were becoming increasingly exasperated.

“Patients are clearly massively disadvantaged by sitting there for that length of time,” the source added.

“The situation hasn’t been helped by Liberton Hospital being effectively shut because of norovirus, but the fundamental problem is that NHS Lothian does not have enough frontline staff or frontline beds. Just last week, the department was in meltdown.

“These 12-hour breaches is what the government is really annoyed about as they can expose patients to serious risk.”

The figures for eight- and 12-hour breaches relate to the accident and emergency department at the ERI, which is the busiest in Scotland, as well as the A&E at St John’s, the minor injuries clinic and acute receiving unit at the Western General Hospital and emergency department at the Sick Kids.

Margaret Watt, the Scotland Patients Association’s chairwoman, said the high number of long waits was “obscene” and called for an overhaul of emergency departments. “We’ve got to find out where these failings are,” she said. “If we need more staff, get more staff, but I think it’s a much more complex problem than that.”

It is understood that the majority of patients waiting excessive lengths of time in A&E become stuck as they need to be admitted to beds in other areas that may not be available.

NHS Lothian’s chief executive, Tim Davison, said that the health board’s capacity remained inadequate to deal with both emergency and
elective cases.

“It’s a challenge every hour of every day in Lothian,” he said. “You can’t wave a magic wand and give the answer overnight. We are making really good progress in addressing capacity issues but these are really complex, major changes that will take time to bed in.”

But in light of the A&E figures which show a far worse situation than at any time since recording began in June 2007, MSPs called for immediate action.

Scottish Tory health spokesman Jackson Carlaw said: “All over Scotland, A&E wards are failing to process patients quickly enough and that is unacceptable. But the problem appears to be particularly bad in the Lothians, where patients are being failed badly.

“NHS Lothian has gone from being one of the best-performing boards in Scotland to one of the worst, and that is not acceptable given the resources and expertise it has at its

Melanie Hornett, NHS Lothian’s nurse director, paid tribute to the efforts of staff but accepted some patients had waited too long and apologised to those affected.

“Patients who have the longest waits will already have been seen and assessed and, in most cases, will be awaiting transfer to an inpatient ward,” she added.

“Where we know there is likely to be a long wait, patients receive ongoing care and will be transferred on to a bed to ensure greater comfort.

“The situation this year has been exacerbated due to the higher prevalence of winter illnesses and delayed discharges, whilst a prolonged outbreak of norovirus at Liberton Hospital has resulted in a number of wards being closed to new patient admissions and this has also impacted on the system.”

Divided opinions on twitter

We asked what your experiences were on Twitter. Here are some of the replies:

@maguire_conor: A few months ago I waited 6 hours to get my swollen finger checked up! Ridiculous waiting times!

@ ColinAMcDougall: Place is understaffed & over run with drunken bums. Give the staff credit, they deserve it.

@TobyHarris2012: I need an X-ray on my potentially broken ankle. Royals A&E waiting time...3.5 hours! #terrible

@consensusinidem: my one experience of ERI is – taken quickly with caring staff.

@mtsmith81: Waited a few hours for an ankle injury/x-rays last year. In US, it would have been the same time and a few grand.