Emergency Treatment (Waiting Times)

– in the Scottish Parliament on 22nd September 2022.

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Photo of Douglas Ross Douglas Ross Conservative

1. This week’s health figures revealed that more people are waiting longer than ever for emergency treatment. In the past week, almost 10,000 people across Scotland waited for more than the target four hours at accident and emergency departments. Those are the worst waiting time figures on record and it is only September.

Our doctors, nurses and staff are doing outstanding work, but we know that the pressures on our national health service will only get worse over the winter. What action is the First Minister’s Government taking now to reduce the time that people are waiting for emergency treatment here in Scotland?

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

As the Cabinet Secretary for Health and Social Care said earlier this week, the most recent performance in accident and emergency is not good enough. I am very clear about the need for improvement. Of course, the most recent performance reflects the very significant pressure across health and social care arising from the two-year pandemic and from some pre-existing factors, such as our country’s changing demographics.

There is a sharp focus on doing what is required to improve that performance, which takes me to the specific question. In addition to what has been a 263 per cent increase in the number of accident and emergency consultants since this Government took office, we are investing more to support further recruitment, including overseas recruitment, and are taking action through the £50 million urgent and unscheduled care collaborative. That work includes a range of strands offering alternatives to hospital where those are appropriate, such as hospital at home; directing people, where appropriate, to better urgent care settings; and scheduling some urgent appointments to avoid long waits in accident and emergency. This week, the chief operating officer of the NHS wrote to health boards with five additional specific actions that we expect boards to take. We expect to see improvement and we want it to start to become visible immediately.

I will make one final point to put the issue into context, for the sake of those who are working so hard in our national health service. Our NHS is facing significant pressures, but the NHS in every part of the United Kingdom is doing so, too. Although performance needs to improve here in Scotland, our accident and emergency departments are performing better than those in England, Wales and Northern Ireland. For context—it is important to put it in context—in the last complete month for which we have figures, performance against the four-hour target in Scotland was 66.5 per cent, which is not good enough and needs to improve, but it compares with 57 per cent in England, 55.2 per cent in Wales and 45.7 per cent in Northern Ireland. The pressures exist everywhere and this Government is focused on ensuring that we support those in our health service to tackle them.

Photo of Douglas Ross Douglas Ross Conservative

Context may be important for the First Minister and her members behind her but, for people who are waiting hours and days for A and E treatment, those are hollow words.

We are now more than a year into the health secretary’s recovery plan, but the situation is getting worse, not better. The First Minister spoke about A and E consultants, but I will tell her what doctors on the front line are saying.

This week, Dr Peel, the deputy chair of the British Medical Association Scotland said:

“As an A&E doctor I often tell people that A&E is a safe space, you can come here if you’re in pain, if you’re sore, if you don’t know where to go.”

However, Dr Peel continued:

“Our A&E departments are no longer safe and what’s really concerning is our government just aren’t acting ... and they are turning a blind eye.”

New information that we have uncovered shows just how horrendous waiting times in Scottish hospitals are just now. A response to a freedom of information request has revealed that one patient at a hospital in Ayrshire had to wait 84 hours for treatment. That is three and a half days; the equivalent of turning up for emergency treatment right now and not being seen until next week, in the early hours of Monday morning. Is that really what anyone in Scotland should go through in 2022?

The First Minister:

No—that is clearly an unacceptable situation, but it is also an exceptional situation. I am more than willing to look into the particular circumstances around that.

I have been very clear that the current performance is not acceptable. I would not, and do not, shy away from saying that. I have also been very clear about the action that the Government is taking to support those on the front line, to ensure that there is much speedier access to accident and emergency and to healthcare services more generally.

I have also made the important contextual points, because that is part of giving people confidence that we are taking action to address the issue. The performance against the four-hour waiting time target is not good enough, but it is better than it is in counterpart parts of the United Kingdom. With regard to long waits, there are 50 times more 12-hour waits in England than there are in Scotland, and they are four times higher in Wales than they are in Scotland.

That does not mean that performance in Scotland is good enough, but Douglas Ross and others often come to the chamber and pretend or suggest that those issues are unique to Scotland. They are not unique to Scotland; they are pressures that all health services are facing. I am rightly setting out the action that we are taking to support the health service in tackling the pressures with regard to recruitment, investment and changing the pathways of care to ensure that people not only get speedier access but access to the right part of the health service at the right time. We are taking action across all those strands and will continue to do so.

Photo of Douglas Ross Douglas Ross Conservative

Unbelievably, the First Minister just said that 84 hours is not good enough but is better than the situation in other parts of the United Kingdom. How does the person—[


.] How does the person who was waiting for 84 hours, and their friends and family, feel when they hear that?

Although that was the most extreme example that we found, it is not the only time that someone has waited for days at A and E. Our FOI responses revealed that another patient waited 79 hours earlier this year, another waited 66 hours, and another waited 53 hours. There are thousands of people waiting each week for longer than the Government’s target time.

A constituent wrote to us about their grandmother. They said:

“My nana took a turn for the worse last week and could not stop vomiting. Due to her type 2 diabetes and blood pressure this is very serious indeed. She was admitted to hospital after a lengthy wait then sent home. This happened several times over a number of days.”

Finally, she had to be rushed to A and E, and her grandson told us:

“What I was faced with was utter chaos. I felt so sorry for the doctors and nurses and helpers. They are literally at breaking point, there were beds and people everywhere. I wish I had taken a picture but the image is etched in my memory forever. The beds were wall to wall and my nana had to stay in her mobility chair as there was nowhere for her to go.”

First Minister, this cannot go on any longer, and it certainly cannot go on through the winter. When will people in Scotland get access to the emergency treatment that they deserve when they need it?

The First Minister:

As I said, we expect to see, and we are supporting what it will take to deliver, immediate improvements in accident and emergency waiting times. These are really serious issues, as the case that Douglas Ross has narrated illustrates—I would not say otherwise—but it does not do anybody any service at all to deliberately twist, and indeed misrepresent, what I said in my previous answer. It is really important to be clear here: I did not say that 84 hours was not good enough but better than anywhere else in the UK; I said that our four-hour performance was not good enough but was better than in other parts of the UK, and I said that about our longer-wait performance, too. I said that 84 hours is clearly unacceptable, but cases like that are exceptional, and it is important that, where such cases occur, they are properly looked into.

I turn to our performance against the 12-hour target. In the most recent week, which was very challenging, there was the lowest four-hour performance on record, and it is important to be clear about that. However, more than nine out of 10 patients—95.4 per cent of patients—were seen within the 12-hour target time. Clearly, exceptional cases should not happen. When they do, lessons should be learned. It is important, however, not to misrepresent the situation or to misrepresent what I have said.

On the action that we are taking, which is obviously what matters, I have referred to support for recruitment, and it is important to point out the 263 per cent increase in the number of A and E consultants. We are also investing £11 million to support further domestic and international recruitment. Of course, international recruitment has been made significantly harder because of Brexit—I just put that on record. A thousand healthcare support workers were brought in last winter. I have already referred to the £50 million of investment to examine alternatives to accident and emergency where they are more appropriate for patients.

We will continue to focus on improving performance. To end my answer where I started, we expect to see performance improve immediately.

Photo of Douglas Ross Douglas Ross Conservative

We have been told before that there will be immediate improvements, but people are waiting for 84, 79, 66 or 59 hours. The First Minister says that those are exceptional cases, but let me give her another one, as there are so many.

We spoke to another patient, who attended Monklands hospital. She was stuck at A and E again, again and again, waiting for emergency treatment. She went to A and E with severe abdominal pains. She was left waiting, vomiting and in extreme pain for nine hours. She was told to come back the next day at 9 am. This time, she waited a further six hours.

Two days later, her condition had worsened to the point that her general practitioner told her to go back to A and E for urgent treatment. On this occasion, she again waited nine hours. That is a total of 24 hours’ waiting for emergency treatment in just four days, all of it in extreme pain. That patient wants to ask one simple question to the First Minister: “How can you allow this to continue?”

The First Minister:

We are not allowing this to continue. We are recognising the significant pressures on our national health service. An experience such as that is completely unacceptable, but there are significant pressures on our national health service, and significant action is being taken to address those pressures. We will continue to take steps around recruitment, investment and redesigning pathways of care. I do not know whether it is the case in the particular instance that Douglas Ross has just narrated, but there will be many people who end up in accident and emergency departments who would be better seen and treated in other parts of our national health service.

Photo of Douglas Ross Douglas Ross Conservative

Her GP said that she should go there.

The First Minister:

That is why I said that I did not know whether that was the case in that particular instance. However, many people would be better treated in other ways, and that is why we are investing in hospital at home, in different urgent care settings and in scheduling urgent appointments in A and E, so that people do not have to have long waits. That work takes time, and it requires the investment in recruitment that I have spoken about, but the health secretary and the Government are focused on ensuring that we do that and on supporting those working at the front line of the health service, as they support patients who need treatment on the national health service.