Scotland recorded its third consecutive week of record lows for A&E performance last month, as the country’s biggest health board said people should only go the emergency department in a life-threatening situation.

Dr John Thomson, an A&E consultant who is Vice President Scotland of the Royal College of Emergency Medicine, says these warning lights are evidence of a healthcare system that is not just under stress but “failing” as it struggles with the kind of pressures normally only seen in the winter months.

This analysis is backed up by the number of patients who regularly face dangerously long waits to be seen, and then admitted, discharged or transferred.

Nearly 1,200 people spent more than eight hours in emergency departments in the third week of August. To find similar figures you have to go back more than two years, to January 2019.

“What was traditionally a winter surge, with some easing at other times of the year, is the norm now,” Dr Thomson says.

“We are, and the staff in particular, having no respite from the significant pressures and intensity on a day-to-day basis…this is all-year round now.”

RCEM Scotland estimates there was a shortfall of 600 hospital beds before the pandemic and infection control measures such as spacing beds out have increased that figure by an additional 400.

What this mean, is that delays because staff cannot find a bed elsewhere in the hospital to transfer a patient from A&E – known as ‘exit block’ – have become “endemic”.

Another phenomenon that has become more apparent during the pandemic is the queuing of ambulances that are unable to offload patients into emergency departments that are already at-capacity – putting that ambulance off the road and out of action for other calls.

There is little prospect of a quick fix for any of these challenges because of the time it takes to train new staff.

Dr Thomson says there is a shortage of around 135 consultants who act as senior decision makers in A&E – and replacements would take a “minimum of ten years to train”.

“The other issue of course is nursing staff,” he says.

“There are significant nursing shortages across the country, which means that even if hospitals suddenly created capacity – if they managed to magic up another 1,000 beds across the country – we don’t have the nurses to staff them.”

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