Doctors: NHS emergency plan will not halt winter crisis

An emergency action plan to reduce bed blocking and ease record A&E waiting times will not take affect in time to ease the looming crisis this winter, doctors warn.

The warning came as ­figures revealed waiting times in the country’s A&E departments reached a record high earlier this month.

Dr John Thomson, vice-chair of the Royal College of Emergency Medicine Scotland (RCEM), welcomed measures in the winter resilience plan, including a focus on social care and a commitment to recruit staff, but said: “While these are welcome, they will not be in place in time to prevent further harm to patients and staff this winter.”

Latest NHS figures showed 3,553 people waited more than eight hours to be assessed, treated and discharged from emergency departments in the week up to October 9 – the highest on record. The number who waited 12 hours at A&E stood at 1,506, a reduction of only four in a week.

Thomson said: “These long waiting times are symptomatic of exit block in the hospital when patients ready to be discharged are unable to be due to lack of social care support. We urge the Scottish Government to focus efforts on bolstering the social care workforce to help with the discharge of patients from hospital and with the provision of care in the community.”

He repeated the RCEM’s call for 1,000 more beds in Scottish hospitals before winter sets in and called for a renewed focus on retaining existing staff.

Professor Richard Simpson, of St Andrews University, a former Labour MSP and retired GP, said: “There has been a failure to tackle delayed discharges promised in 2015. Added to that is the catastrophe of the GP out of hours service. Health boards cannot staff these because GPs are overworked with practice commitments. If people become ill at night, there is not room for them in out of hours and they are directed to A&E.”

Health Secretary Humza Yousaf, who faces growing criticism, said: “A&E departments are working under significant pressure and the pandemic continues to impact performance. Recovery from Covid will not happen overnight, which is why we continue to work with boards to reduce pressure this winter. Pressures experienced by A&E are driven by delays in discharge elsewhere in hospitals. That’s why a focus of our winter plan is on social care and actions to encourage integration authorities to help alleviate delays.”

‘I have now been awake for 22 hours and in A&E for almost nine. As I leave, another ambulance arrives’

Staff stretched to breaking; patients waiting for record times; ambulances backed up and relatives forced to wait in cars, Scotland’s A&E wards have never been under greater pressure.

Sunday Post senior writer JANET BOYLE, who had to visit casualty last week, reports.

Slumped in a chair in the corner is a man in his 40s, pale and clutching a plastic supermarket carrier bag.

Resting on either side of his seat are crutches and he tells the woman next to him that he has been waiting six hours and hopes to see a doctor soon. Just feet away is a distressed man in his fifties, anxious, unsettled and apparently unsure of his surroundings. His tracksuit jacket is open and he is oblivious to the biting wind outside. He has just been brought in by two police officers who stand with him as he stares at the floor, occasionally letting out bursts of laughter.

It is 8.40pm in A&E at Hairmyres Hospital, in East Kilbride, and people with medical emergencies from South Lanarkshire and the outskirts of Glasgow are desperately seeking treatment.

I am here because a cough which began on Friday had deteriorated into breathlessness and an asthma attack by Sunday teatime before NHS 24 advised me to go to my nearest A&E department urgently.

I would become one of the 3,553 people who waited more than eight hours to be assessed, treated and discharged from an emergency department in Scotland in the week up to October 9, the highest on record.

A taxi along the motorway, in which I am masked and with the windows down, brings me to the entrance, where five ambulances are stacked up at the front door, doors swung open and patients waiting for a space to become available in the hospital.

Doctors accuse visiting health secretary of dodging A&E

The pleasant but overworked receptionist logs me in. When I ask how long I will wait she points to a screen mounted on the wall. It gives information on various NHS services…and the current waiting time: Eight hours.

Only two seats are free in the clean but well-worn waiting room, so I settle on a hard-cushioned chair next to a middle-aged woman whose baby granddaughter is in the clinical area, being treated by a doctor.

The infant suffered an asthma attack and the grandmother, a nurse who has retired early and exhausted from the NHS, knew to seek medical attention. Behind was a young woman, shivering and wrapped in a blanket.

I pray the waiting time will fall in the early hours, but it stretches to an almost exhausting nine hours of coughing and struggling to breathe.

At 9.30pm I am seen by a nurse who checks my blood oxygen levels which had fallen, but not enough to need oxygen. My blood pressure and other vital signs are not too worrying. In nearby bays sicker patients call out as they struggle with critical illnesses while staff work to stabilise them. All of life’s medical tragedies are played out tonight in A&E.

Patients are triaged shortly after arrival by A&E nurses with the dangerously ill given immediate treatment and others, well enough to endure an eight-hour wait to see a doctor, sent back to the waiting room.

An hour and a half later, the waiting room is filling up. In front is a heavily pregnant mum with her toddler holding her asthma inhaler. For the next hour the wee girl coughs, wheezes and plays, then cries with exhaustion while her tired mum tries to pacify her.

In the corner an elderly couple sit, the wife looking worn and pale. Her husband is anxious that they have been in the unit since early afternoon. A doctor comes through the swing doors and ushers them into the treatment room as she apologises for their long wait.

It is midnight, and the officers accompanying the distressed patient radio their HQ and discuss relief for their break. They have been on for hours without food and call for back-up to relieve them. Two new police officers arrive, look at the waiting time and settle into seats beside the patient.

At 1am, a woman in a hospital wheelchair is clutching her phone in one hand and her inhaler in another. She approaches the desk and asks how much longer she will wait and, on hearing that it will be several hours, she leaves A&E. She calls someone to pick her up and disappears into the night. Now I am wondering how she will fare without drugs to relieve her breathing problems. She has already been triaged but walked out in despair.

Through the window I can see another ambulance arriving and offloading a desperately ill patient. Its blue lights flicker against the dark sky. I have not slept for 14 hours and try to grab a few minutes’ rest but the upright seat makes for little comfort. The patient on crutches struggles to stand when his name is called and he leaves clutching medicines. His golden ticket. “It’s an infection and these antibiotics should work,” he tells the waiting room.

Just after 3am and a man in his 20s rushes in and asks for his dad. He has been told to get to the hospital as soon as possible. He stands against the wall scanning the waiting room until a nurse comes out and ushers him back to the clinical area. The anxious man under police escort calls out once more, laughing at nothing in particular. He suddenly gets up and leaves the unit with the officers close behind, only for all three to return 15 minutes later.

Half an hour later, and I am called through for a heart trace and blood tests for infection and all is well. The nurse is upbeat and apparently unbowed by her workload. A previous job in a challenging South African hospital has prepared her for the rigours of A&E in the NHS. Back in the waiting room a man is clutching his head and his wife is urging for him to be seen now. She drove him here when his vision became disturbed.

At 4.30am, a family is crying in front of me as they take turns to go in to see a desperately ill mum. “They say this could be it. We have to prepare ourselves” says a daughter. The youngest, just a teenager, is consoled by an older brother. More family members arrive and they go in pairs to see their mum. More ambulances arrive.

It is 5am and I am called through to see the doctor who examines me and sends me for an X-ray to check for pneumonia. She is kind and hugely efficient. As I make my way along the corridor, I hear a call come in from an ambulance crew that a critically ill patient is en route on the motorway from the south-east of Glasgow, expected time of arrival in 10 minutes.

A doctor tells another that they have been on shift since 2pm the day before, 15 hours of ill patients and they are still working.

My X-ray is clear and I can leave at 5.45am with antibiotics and steroids to reduce the effects of asthma – almost nine hours after arriving. As I leave the waiting room, the anxious man and his police escort are nowhere to be seen, but other patients who have waited with me for hours remain.

The kindly receptionist orders me a taxi and tells me to get some sleep. I have been awake for 22 hours. The taxi driver pulls aside to let another ambulance in as we leave.