Warning over A&E gridlock
Safety fears as hospital visits head back to pre-Covid level
DOCTORS fear for the safety of patients as it emerged Scotland’s A&E departments are beginning to return to pre-pandemic levels.
The Royal College of Emergency Medicine Scotland is concerned about a return to NHS ‘crowding’, saying the health service must prepare for its next set of challenges as demand rises.
In February 2020, just before lockdown, there were 106,520 visits to Scotland’s major emergency departments. That figure fell to a low of 57,123 in April that year.
But the latest figures, for March 2021, show 90,833 attendances, a 30 per cent increase in a month. Waiting times have also increased.
Dr John Thomson, vice president of the Royal College of Emergency Medicine (RCEM), said: ‘We are beginning to reach pre-pandemic
‘Depleted workforce is exhausted’
levels of hospital activity and demand for urgent and emergency care services.
‘We fear a return of the pre-pandemic crowding that put patient safety at risk. The health service is in recovery, elective care waiting lists are growing, attendances at emergency departments are increasing, and the already depleted workforce is exhausted.
‘As a result, some hospitals are beginning to face pressures with patients delayed for hours.
‘We must rapidly assess and address our resources, capacity and the way we deliver care.’
During summer last year, when A&E departments remained less busy than usual, they were meeting the NHS target of 95 per cent of patients being dealt with within four hours, a benchmark the NHS in Scotland had previously missed.
The March 2021 statistics show that figure down to 87.5 per cent of patients seen within four hours.
Problems that A&E crowding can cause include ‘corridor care’, where people are forced to wait on trolleys because of a lack of beds, and patients deteriorating while they wait hours for treatment.
At the height of the pandemic, attendance at emergency departments and GP practices fell so low it was feared sick people were risking their health by staying away from the NHS to avoid being a burden or risking catching Covid-19.
Hospitals also rolled out initiatives such as video assessments, so that only those who need treatment attended, and emergency departments now have ‘red’ Covid and ‘green’ non-Covid areas.
The NHS, which went onto an emergency footing last March, has resumed mostly as normal but with fewer planned operations. The RCEM has launched a campaign, ‘Summer to Recover: Winter Proofing the Urgent and Emergency Care system for 2021’.
It presents actions the Scottish Government, NHS boards and hospital leadership teams must take to prepare departments for the challenges ahead. Dr Thomson added: ‘There are threats of a further wave of Covid in late summer and a potentially gruelling winter with seasonal flu.
‘We saw how the NHS in Scotland was underprepared and underresourced for the pandemic and the brutal winter which followed.
‘By preparing now... we may cope with system pressures.’
The RCEM is calling for an end to crowding and care in corridors, with better planning, more capacity and more acute hospital beds for A&E patients to be discharged to, with alternatives for those who do not need hospital care.
The Scottish Government has encouraged those with symptoms to come forward for treatment but to go to the right place for their needs rather than go unnecessarily to emergency departments.
Public Health Minister Mairi Gougeon said: ‘We are seeing across the UK the impact the Covid pandemic has had on our NHS’s ability to treat patients as quickly as it would want to.’