Why frightened Scottish doctors are warning of 'ugly' winter for NHS
The Royal College of Emergency Medicine described the state of departments going into winter as ‘terrifying’
The warnings could not be more stark. "I think we're really scared about how ugly this winter is going to be,” said Dr Fiona Hunter, vice president of the Royal College of Emergency Medicine in Scotland.
Summer A&E waiting times have been the worst on record, she said. Last weekend, a critical incident was declared at emergency departments in Aberdeen and Elgin due to "extreme pressure".
Dr Hunter said the state of emergency departments is “terrifying” and government action to prepare for the winter feels like “too little too late”. Patients are languishing in corridors and on floors, she said, while staff sickness rates are “at a level I have never seen”.
Figures show 11,398 patients waited more than the four-hour standard at A&E departments across Scotland in the week ending September 20, while 4,498 waited more than eight hours and 1,935 waited for longer than half a day.
Speaking to Scotland on Sunday, emergency doctors have now raised serious concerns about the ability of the NHS to cope this winter.
“There can be some help with the public getting vaccinated against flu and seasonal illnesses, and similar for staff to be well vaccinated going into this season, but it all feels like it's going to be too little too late and I wouldn't be surprised if there are more [NHS] boards that are certainly asking and if not declaring critical incidents going into this surge period that we're about to face,” Dr Hunter said.
The consultant in emergency medicine painted a grim picture of the pressures facing A&E departments across Scotland.
"5,000 patients waited 12 hours or more just in July,” she said. “Ten years ago, 12-hour waits were what we called a 'never event', so when one did happen, it was exceptional - there was reporting done and investigations and questions were asked on how that could possibly happen.
"And now, day to day, we see hundreds of these patients across Scotland and we simply just accept that that is the status quo, and it is to me unacceptable and I'm sure unacceptable to the people who have to experience that or have to experience it for their loved ones.”
She added: "We are seeing [emergency] departments running at over 500 per cent capacity. They have far more patients than they have space for, cubicles for, beds for, trolleys for, and so they are being managed on recliner chairs, stools.
"Waiting rooms across Scotland have patients languishing on the floor, they've got patients waiting in their cars outside because there is simply no more room in the waiting room, and that's now. That's this week, that's now - that's not the peaks of winter.
“Where do we go when the numbers increase and we have lots of flu and perhaps Covid there, and other respiratory viruses, and we have completely overfull waiting rooms? How do you implement infection control standards? The reality is you just can't. It's not practical; it's not realistic."
She continued: "And that's the terrifying state of our emergency departments going into this winter."
Dr Hunter said concerns are growing about staff burnout.
"We're already seeing staff sickness rates at a level I have never seen, and although I don't know the details of each individual person, there is a really high rate of burnout and nursing staff and medical staff who just simply are finding it really, really difficult when they went into a career where they wanted to care for patients, and they are just not able to do that,” she said.
"And in fact, we know there's evidence that there's harm happening to these patients because we're not able to provide the care they need. That's really hard to digest and really hard to face, day in, day out, shift in, shift out, and they are simply not able to do it.
"So some of our more resilient staff have already gone off and you could say we're not even in the peaks of winter yet, so what will that number look like when we're really in the depths of it? It's a real worry."
The consultant said a variety of issues are putting pressure on the system, not least the growing number of elderly people.
"We know that our population is becoming more elderly, so a lot more of us are living longer and we have longer health conditions that get associated with that, and so have increased need to attend emergency departments and get unscheduled care visits that we didn't have before,” Dr Hunter said.
“However, we have also reduced the number of beds in hospitals across Scotland and we don't have enough social care to meet the demands of our population.
"We don't have enough carers in the community, we don't have enough nursing home beds, we don't have enough community beds for patients who are medically well enough to discharge from hospital but perhaps need some extra additional personal care.
"There aren't enough of these things and so patients get stuck in hospital when they don't need to be there, and that means we have no space to admit more patients too.”
However, Dr Hunter said the NHS could “also be more efficient with the beds that we currently have in hospital”.
She accused the Scottish government of “a real lack of any substantial, proper winter or surge planning that will save us from having more staff off this winter, more patients coming to harm, [and] higher numbers of excess deaths from prolonged waits in emergency departments”.
She said ministers should commit to ending all so-called corridor care.
"Perhaps sharing the risk across wards and outpatient environments and community care beds is more acceptable than concentrating the risk into an emergency department for this winter,” Dr Hunter said.
"It's hard to stomach - nobody wants to have an extra patient on their ward. But perhaps that's less worse than having 500 per cent extra patients in an emergency department not receiving care."
Dr Lailah Peel, an A&E doctor and deputy chair of BMA Scotland, the doctors’ union, said: “As NHS Scotland heads towards the winter period, there are numerous worrying signs across the system that it will likely be even more challenging than it has in the past.
“The declaration of a critical incident in NHS Grampian, long waits in A&Es across the summer, continued issues with capacity across hospitals and the ongoing pressures on social care all point to the very real possibility that things will become exceptionally difficult when winter illnesses like flu hit.
“Indeed, pressures on the system all year round are now unrelenting. Winter is a time this often comes into the spotlight, but we should be under no illusion that the difficulties in our NHS are confined to just this period.
“All this indicates that waiting times in A&E, including the longest waits which we know from evidence are the most harmful to patients, are only going to get worse. And this is a warning light for everything else that is going wrong in the NHS.
“Unfortunately, there is no overnight fix, but that simply highlights the urgent need to address the challenges the NHS faces, including a plan to shift the balance of care to the community while protecting secondary care and the publication of a comprehensive workforce plan. It is also vital that we free up bed capacity by ensuring there are sufficient resources in social care to ensure people can be discharged in a timely and safe manner.
“It seems every year we warn of these things heading into winter, yet we find ourselves back here again. The answer is a properly resourced and staffed NHS and social care system, and it is high time politicians focussed on delivering exactly that.”
Scottish Labour health spokeswoman Jackie Baillie said the “grim warnings” must be taken seriously by the Scottish government.
She added: “We have seen before the dire impact on our health service when SNP ministers have failed to take the necessary action to avoid winter chaos, and we must avoid any repeat.
“Scotland’s NHS already faces severe pressures, with A&E stretched to breaking point, corridor care normalised, and ambulances getting stuck in queues outside of hospitals.
“It is imperative that the Scottish government comes forward with a credible, long-term plan that ensures patients get the best care possible and which safeguards staff wellbeing.”
Scottish Conservative health spokesman Miles Briggs said: “While emergency doctors are warning of a terrifying winter, [First Minister] John Swinney is more interested in separatist summits and plotting the break-up of Britain.
“That is a disgraceful dereliction of duty when A&E departments are already in crisis and saw record numbers during the summer.
“Exhausted staff cannot take much more and frontline services could completely collapse in the coming months if the SNP do not act now.
“The SNP need to ditch their constitutional obsession and focus on protecting patients and supporting the frontline staff facing another brutal winter”.
Health Secretary Angela Constance said: “The Scottish government is committed to improving A&E performance, delayed discharge and tackling long delays.
“Our dedicated health and social care staff are the cornerstone of our winter response every year. They show great resilience and determination to meet pressures on our healthcare system – which are not unique to Scotland – head on and we remain focused on ensuring people get the care they need, as quickly as possible.
“I am clear that the status quo cannot continue. That’s why I published a new national plan in August to improve the flow of patients through hospitals and I will be setting out a further range of winter planning measures that we have been working on with NHS boards and local authorities in a statement to Parliament next week.”
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