Scotland’s emergency departments are now facing ‘unprecedented risks’ because of underfunding and overcrowding, the Royal College of Emergency Medicine has warned.

A reduction in beds as well as the need to physically distance and staff having to wear restrictive PPE has exacerbated the pressures piling up on emergency care putting extra strain on already stretched staff.

Now there are further concerns that patients who have had elective treatment cancelled or postponed in recent months may head to emergency departments for help at a time when seasonal norovirus and flu hit their peak, all as covid-patient capacity reaches its limits in Scotland’s hospitals.

By October last year, over 100,000 planned operations had not taken place because of the pandemic.

In November the Scottish government published new guidance for prioritising patients as the health service looked to restart routine treatments, but within weeks the President of the Royal College of Surgeons of Edinburgh sounded a warning over the scale of the backlog facing diagnostic services.

In a manifesto published by the Royal College of Emergency Medicine that it wants parties to adopt ahead of the Scottish Parliament elections in May, the emergency care representative body warns that despite years of outperforming other UK nations a lack of resources mean Scotland’s emergency departments are deteriorating.

Eight and 12-hour waits hit record highs at the start of 2020, and more people were left waiting longer than the four-hour target than ever before.

Transferring patients from A&E to wards in a timely way has frequently become ‘unachievable’ – largely because of a lack of bed capacity elsewhere in acute care – meaning many are being cared for in corridors, leaving emergency departments ‘unconscionably’ overcrowded.

The document states eliminating crowding in Scotland’s emergency departments ‘must be the number one priority’ of the next Scottish government to reduce errors and improve conditions for staff and patients.

Already ‘stretched to the limit’ by normal patient care alongside treating people infected with covid-19, services are simply ‘not resourced to match the demand’ facing emergency departments, according to the College, which estimates at least £1.8bn needs invested across health and social care services by 2024 to address funding gaps and accelerate the integration of both sectors.

The manifesto also calls for significant investment in adult social care so patients can be discharged safely and promptly with the follow-on support that they need after their medical care has finished.

It adds that mental health services also need urgent investment to reduce the number of people having a mental health crisis who end up in A&E.

‘Crowded NHS emergency departments can be a frightening experience for people with dementia or those suffering from a mental health crisis,’ the College says.

‘High demand, inadequate space, and poor departmental infrastructure create a volatile environment. Patients who are suffering a mental health crisis often report having a poor experience, with long waits in an environment that is stressful and stigmatising.

‘Across the UK, Liaison Psychiatry teams play a crucial role in the parallel assessment of mental health patients that attend emergency departments who might also need medical care.

‘Expansion of Liaison Psychiatry must go hand-in-hand with investment in preventative services, Child and Adolescent Mental Health Services, community support schemes and good telephone triage.’

In the summer clinicians warned of the economic and health shocks of covid and the likelihood that health inequalities were only set to get worse.

Well-resourced and safe emergency departments are a key means of addressing the ‘alarming levels of inequality’ exposed by the pandemic, the College says, given that Scotland’s deprived communities use emergency departments much more than those in the least deprived areas.

When it comes to covid, the College is calling for a rapid review of how prepared Scotland is for future waves, including next winter.

It adds appropriate PPE must be provided for all staff as well as regular and rapid testing for them and their families so more people do not isolate at home unnecessarily and can get back to work.

 

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