An NHS consultant's plea to the Scottish Government: A&E crisis demands bold action, not rhetoric
The fact that patients can be left waiting on trolleys in hospital corridors for hours or days is unacceptable
As vice-president of the Royal College of Emergency Medicine in Scotland, and a consultant working in A&E who sees the daily reality of our hospitals, I write to the new Scottish Government with a clear and urgent message: be bold.
For too long, emergency medicine has been asked to survive within a healthcare system designed for a very different Scotland – one with a younger, less complex population. That system no longer reflects the reality we see every day on the frontline. Our patients are older, frailer, and often living with multiple long-term conditions. Yet the infrastructure, staffing, and flow through our hospitals has not been adapted to meet this need.
Much attention is given to the four-hour standard, an expectation that patients are discharged, admitted or transferred within four hours of arrival into an emergency department.
It is scrutinised, reported, and debated. Those of us working in emergency departments are acutely aware – every minute of every shift – how far from that target we are. For years, policymakers have been too focused on reducing the number of people who turn up to our EDs.
A safe hospital, not a risky one
But this focus on the front door alone misses the real problem. The emergency medicine crisis is not simply about demand. It’s about the flow of patients through the entire hospital.
We must shift attention to the back door, the ‘exit block’. This is the obstruction in the system that prevents patients from moving out of EDs into appropriate hospital beds or onward care. It is the reason patients are treated in corridors, cupboards, and the backs of ambulances. It is why putting patients into escalation spaces – areas never designed for care – has become the norm.
If you are serious about improving emergency care, then be bold: make ‘exit block’ a term associated with getting out of shop car parks during January sales, not with the NHS in Scotland.
We already know what good looks like. Hospitals function safely and efficiently when bed occupancy sits at around 85 per cent. Yet too often, our hospitals operate at or beyond 100 per cent, relying on spaces never intended for patients. This is not resilience; it is risk.
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Acutely unwell patients unable to rest
We need transparency and accountability. Monitor and publish hospital occupancy data with the same frequency and visibility as the four-hour target. Shine a light on the true pressure points in the system. Only then can meaningful change follow.
And crucially, do not be distracted by quick fixes. Redirecting patients away from EDs alone will not solve this crisis. It does nothing for the frail, acutely unwell patients who already need hospital care – patients who are left waiting on trolleys for hours or days, often in corridors, without dignity, privacy, or even the ability to rest properly. This is not the standard of care any of us would wish for our families, and it should not be acceptable for the people of Scotland.
Emergency medicine does not need rhetoric. We need politicians to take decisive action to improve patient flow, increase capacity, and invest in the systems that allow patients to move safely through hospital care. The challenge is clear. The evidence is clear. The consequences of inaction are visible every day. Now is the time to act. Be bold.
Dr Fiona Hunter, vice-president, Royal College of Emergency Medicine Scotland
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