Level four 'red alert' declared as Scottish patient waits in ambulance outside A&E for 12 hours

The service increased its resource escalation action plan (Reap) to level four – the highest available, which reportedly could see leave cancelled and call all available staff to the front line.

The Daily Record reported on Tuesday that one patient waited for 12 hours in an ambulance outside accident and emergency (A&E) in Edinburgh as trade unions feared the situation this winter could be worse than expected. But the Government said the service was still able to urgently treat patients in a critical condition.

A spokesman for the Scottish Government said: “Patient safety remains our top priority. The Scottish Ambulance Service has implemented a level four resource escalation action plan to ensure that all available resources are used to respond to 999 calls.

“Despite continued increased levels of high priority calls, crews responded to 514 of the highest priority calls across Scotland last week in an average time of seven minutes 41 seconds.

“The Scottish Government is committed to ensuring that there are no unnecessary delays in transferring patients to hospital and we continue to work closely with health boards and the SAS to maintain a fast response to the most critically unwell.

“We continue to invest in supporting SAS staff and patients, recruiting an additional 1,388 staff since 2020, with further recruitment under way this year.”

An SAS spokesman told the Daily Record crews were dealing with “significant pressure”, adding: “We are working with health boards to do everything we can to get our crews back on the road to help patients.

“Our staff are working extremely hard and we continue to prioritise patients who are most critically-ill. Patients who are not critically-ill may have to wait longer for an ambulance than usual. We will get to them as quickly as we can.

“We would like to remind people if you need urgent care, but it’s not life-threatening, you can visit NHS Inform online, call NHS 24 on 111, day or night, or your GP during opening hours.”

NHS Lothian has been contacted for comment.

The escalation to level four comes as Health Secretary Neil Gray said the Government was “working intensely” to improve Scotland’s emergency departments, as A&E faces “sustained pressure”.

Figures released by Public Health Scotland on Tuesday show just 60.1 per cent of patients were seen and subsequently discharged, admitted or transferred within four hours in the week to December 15 – a slight improvement from 59.6 per cent the previous week.

The Scottish Government aims for the figure to be at 95 per cent. In the same week, 1,619 people waited more than 12 hours in A&E – 6.3 per cent of all attendances – down from 1,814 the previous week.

Some 3,657 – 14.3 per cent – waited longer than eight hours, a drop from 3,911.

The figures come after opposition parties accused the Government of presiding over a “permanent crisis” in the NHS, with both Labour and the Tories suggesting long waits in A&E have contributed to at least 2,000 deaths.

Citing research from the Royal College of Emergency Medicine which says that there will be one additional death for every 72 patients who wait between eight and 12 hours in A&E, the Tories claimed there could have been a “shocking” 2,181 excess deaths this year.

The Conservatives said they based their calculations on the 226,328 patients who waited more than eight hours in the emergency room for treatment in 2024.

Meanwhile, Labour claimed 147,223 Scots had waited more than eight hours to be seen in A&E and then be admitted, transferred or discharged over the period January to October this year – with the party calculating this would equate to as many as 2,045 excess deaths.

Responding to Tuesday’s figures, Mr Gray said: “This winter, a record number of NHS 24 call handlers will be available to direct people to the most appropriate care, helping reduce unnecessary A&E attendances.

“To help relieve pressure on services, I would ask people to consider whether their condition is an emergency before going to A&E. For non-emergencies, NHS 24 can be contacted on 111 but for life-threatening emergencies always call 999.

“Local GPs and pharmacies will be closed over the public holidays, so people should also ensure that they have the prescriptions they need.

“Services continue to face sustained pressure – an issue which is not unique to Scotland. However, performance is not at the level that we wish to see and we are working intensely with health boards to drive improvements.

“The Scottish Government’s Budget will provide record funding to our NHS – which will transform patients’ experiences and everyone working on the front line. I am asking Parliament to unite and back this record investment.”