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Scottish health service set for gruelling winter as Emergency Department performance deteriorates for fifth consecutive month

The latest Emergency Department performance figures for Scotland published by the Scottish Government today for September 2021 show a deterioration in performance for the fifth consecutive month. The data show the worst four-hour performance on record and both the highest number of 12-hour and eight-hour stays since records began.

In September 2021 there were 113,998 attendances to major Emergency Departments across Scotland, the number of attendances dropped by 3,500 patients (3%) compared to the previous month, August 2021.

Despite the slight decrease in attendances data show that four-hour performance reached a new record low, with 73.8% of patients being seen within four-hours, this is 1.5 percentage points lower than the previous month, August 2021. It is the second time in 2021 that performance has fallen below 75%.

In September 2021 1,840 patients spent 12-hours or more in a major Emergency Department, this is an increase of 31.5% compared to the previous month, August 2021. This number increased for the fifth consecutive month and is once again the highest number of 12-hour stays since records began.

Data also show that 6,413 patients spent eight hours or more in a major Emergency Department. This is an increase of 20%, equal to over 1,000 patients. The number of patients delayed by eight-hours or more increased for the fifth consecutive month and once again this is the highest number of eight-hour stays since records began.

Dr John Thomson, Vice President of the Royal College of Emergency Medicine Scotland, said:

“The consistent fall in performance is seriously worrying. What we are seeing: ambulance handover delays; dangerous crowding; long stays; put patient safety at risk and can lead to harm or avoidable deaths. Data show that for every 67 patients waiting 8-12 hours, one of them will come to avoidable harm therefore we can estimate in Scotland between January and August 2021 there have been 231 excess deaths directly caused by a long wait due to a crowded Emergency Department.

“These are unconscionable practices and both ambulance crews and Emergency Medicine staff are under pressure to resolve the problem – together with the College of Paramedics we laid out this guidance. The problem is poor flow throughout the hospital and exit block, this will not be resolved in the Emergency Department, it is a system-wide problem and requires system-wide solutions and collaboration.

“Boards must safely expand capacity where possible, provided doctors and nurses and other healthcare workers are available to staff the beds. Same-day emergency care can help to reduce unplanned hospital admissions, maximising the delivery of this service may alleviate some pressures. Discharge to assess, ensuring that patients can be discharged in a safe and timely way where they have the support they need to recover in the community, can help free up beds to increase flow throughout the hospital. Lastly, it is vital that adequate support and resources are given to social and community care so vulnerable patients do not face successive trips to the Emergency Department or hospital.

“Clear communication between Clinical Leads and senior Board management about the reality of ambulance handover delays; dangerous crowding; and long stays is also vital. Stating the threat these practices pose to patient safety and both reporting and escalating incidents as they occur should guide leadership to take swift action.

“It is a very difficult time, and we are preparing for a gruelling winter. The past five months of performance figures suggest that more deterioration is set to come. In Emergency Medicine we must continue to work towards collaborative solutions and work with other departments, specialties, and management. But we continue to call on the Scottish government to set out a long-term workforce plan. In Emergency Medicine (EM) in Scotland there is a vital need to both recruit new and retain existing staff, we need at least 113 EM consultants along with sufficient numbers of both junior and supporting staff and nurses.”


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