If A&E attendance is still lower why are waiting times getting longer?

Here’s an uncomfortable thought.

In August 2019, 152 514 people attended A&E in Scotland. In August 2022, it was 135 700, 11% fewer.

In August 2019, 90.6% were seen within 4 hours. In August 2022, only 69.6% were seen in that time.

A negative correlation? Fewer admissions but longer waiting times?

What the…is going on here. I can think of four explanations quickly.

  1. There are fewer staff employed in A&E today than there were three years ago.
  2. A&E staff are less efficient now than they were then.
  3. The patients are worse than they used to be.
  4. The figures are due to different ways of reporting and calculating.

As an only partly-healed sociologist, I like the thought that it might be the fourth but can find no evidence that it is. Could they, until say 2020, have been using the English trick of starting the clock again once you’ve decided what to do with them and then had to switch to the proper way of counting from when they first come in the door?

I can find no evidence for the third and, given that I might have to attend myself, I’m going nowhere near the second.

On staffing, NHS Scotland, overall, has currently the highest staffing level on record so Sandy Gulhane blaming the SNP seems out, once more – 28.5 per 1 000 people compared with only 21.4 in England.

Staffing within departments is surely a local decision. I can find no research on this.

prjohnston below suggests bed-blocking.

See:

Certainly higher but enough compared with 2019 to cause deaths in A&E?

Sources:

https://www.publichealthscotland.scot/publications/ae-activity-and-waiting-times/ae-activity-and-waiting-times-month-ending-31-october-2022/

https://www.gov.scot/news/nhs-workforce-at-new-record-high/

https://www.publichealthscotland.scot/publications/delayed-discharges-in-nhsscotland-monthly/delayed-discharges-in-nhsscotland-monthly-figures-for-october-2022/#section-2

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31 thoughts on “If A&E attendance is still lower why are waiting times getting longer?”

  1. It might be useful to write to service which compiles these statistics with your observation and your puzzlement.

    On occasions in the past when I have had some uncertainty about a particular datum I have written seeking clarification and received replies promptly, which addressed the concern pretty fully. Indeed, I got the impression that they were happy to receive a query from a member of the public with a sincere concern rather than from a journalist or politician with an axe to grind who was seeking some way of misrepresenting the particular datum.

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      1. Usually about one quarter of attendees at A&E require hospitalisation. If you look at the weekly or monthly reports then you can see that that approx figure has held even during the pandemic. If they cannot be immediately transferred to a ward then they have to be cared for in A&E thus staff are redirected to an extent from dealing with those coming thru the door.

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          1. Yes but again that diverts staff to look after those patients. Staff that are already short handed- Brexit, Covid. Plus even if they are seriously ill if there are no beds then they can’t be transferred out of A&E so staff will do their utmost to care for them.

            I should imagine that patients in the high priority groups would be in the 4hr group but again circumstances may delay their removal to a ward. What would be interesting, and help to inform changes designed to address these issues, would be research on the profile of the types of conditions presenting at A&E now compared to pre-Covid. Also identify which conditions are in the delayed groups.

            It is a complex situation with multiple interlinked causes. If it is to be resolved then I feel a lot more research/data is required.

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    2. You mean wearing a mask which is the universal recommendation in health care settings in Scotland’s NHS? That is not going to hold things up significantly if at all.

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  4. A good question, and as prjohnston suggests bed blocking may have a role, though this is limited to those patients who are being admitted rather than those sent home after treatment. So not all patients would be directly affected by this.
    My own, very tentative, hypothesis is that it could still be our old pal Covid who is responsible. I dont mean this in the sense of staff being off ill, but that during the pandemic, and I suppose still, hospitals devised new work protocols to keep patients separated and both they and staff safe.
    My own experience of this was in 2021 when I found I had a very large lump on my left ankle. The GP sent me off to see an orthopaedic surgeon at the local hospital. We can all remember when we would go off to these appointments – place would be heaving with folk, waiting “their turn”. When I got along to see this surgeon there was only me. My initial reaction was that I had come on the wrong day, but they were scheduling things so that patients never met.
    As a result of this consultation in March, I was sent off for a ultra-sound scan which took place the following August at Stobhill. Perhaps not as desolate as the previous appointment, but still not many folk there.
    My point is that such protocols, while justified for the safety of staff and patients, will slow down progress of patients through the system. This will be particularly difficult to manage in A&E which is demand driven – its all very well having protocols in place, but making them work/ keeping to them, is much harder when the dept is heaving with folk, and the protocols make dealing with them that much more time consuming, however justified by safety concerns.
    I’m sure the problem will manifest itself differently in each specialty, but equally sure that Covid protections will, cet par, reduce the number of patients who can be seen at any one time and slow their progress.

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          1. What’s it to do with flu? We’ve high levels of covid in the community which makes some people seriously ill. The msm are pretending it’s flu. Up till covid flu was thought to be droplet transmission so probably fewer precautions in A&E

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  6. Could it be the fact that there are less A&E departments within smaller hospitals and the larger hospitals are getting clogged with people from a larger area. I know that my local hospital doesn’t see children, they have to go to Glasgow.

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    1. This from PHS:
      “”There are 91 locations providing A&E services across Scotland. Of these, 30 are classed as Emergency Departments – larger A&E services that typically provide a 24 hour consultant led service. The 30 Emergency Departments are responsible for more than 8 out of every 10 A&E attendances, 19 out of 20 breaches of the four hour standard, and 19 out of 20 admissions from A&E to hospital.””

      Community hospitals have a more limited range of services that may include a minor injuries unit but not a full blown, consultant led Emergency Department. You can get more detail/background info from the weekly report on A&E activity eg this report for the week before Christmas

      https://publichealthscotland.scot/publications/nhs-performs-weekly-update-of-emergency-department-activity-and-waiting-time-statistics/nhs-performs-weekly-update-of-emergency-department-activity-and-waiting-time-statistics-week-ending-18-december-2022/

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      1. Don’t think so. More minor injury units to deal with minor injuries thus by-passing A&E. Surgical Assessment units are another possibility. My husband had a recurring problem over a number of years and went straight to SA by-passing A&E. Out of hours GP services. All ways to reduce load on A&E depots.

        Raise awareness of community Pharmacies and the range of services they offer. Takes pressure off GPs, at least during the day, and by extension A&Es because people are by-passing GPs and going straight to A&E for conditions great and small. In part, and you may argue the degree, this by-passing of GPs may be the result of spill over of the relentless media criticism of GPs down south which many took to include GPs in Scotland. At the end of 2020/ beginning of 2021 there was constant criticism from UKGov amplified by the media about GPs not doing face-to-face appointments. Then it turned on a sixpence to telling them to stop doing face-to-face and concentrate on vaccinations! Of course this aimed at English GPs became publicised up here via the English papers on sale here so became lodged in people’s minds as ‘all GPs’. The consequence was more people going to A&E.

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  7. In one major hospital Covid restriction meant 3 reception areas available,. Instead of six. Half available which could have caused delays. Except for acute emergencies. People going to A&E instead of a Doctors consultation. People found more difficult to arrange by not following recommended procedures.

    The heajthcare staff also had Covid. That caused delays. More stafff off sick. Any acute emergency or threat to life was attended to quickly. To try and save lives. Non life threatening conditions had to wait. People appreciated that. Go to hospital and die. Or wait for treatment for manageable non life threatening conditions. Most people understand and have patience. Knowing of problems bought by Covid. Have non essential treatment and die with underlying conditions, Or wait and stay alive with manageable conditions, Sod’s choice. Most people want to survive.

    Thanks to the wonderful SNHS keeping people alive. They need the appropriate remuneration for the essential services.

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  8. I’ve tried twice to post on the previous and this article, failed.
    Out of curiosity it was a WordPress issue I just posted on WGD, no problem.

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  10. Hardly scientific I know but my daughter works in A&E and after many months battling Covid and with no sign of any marked improvement from the continuing demands and incessant backlogs many staff are physically and mentally exhausted. The feeling also that many imrovement suggestions from the ground up are not being taken seriously by management all adds to the general feeling the NHS is in a race to the bottom with moral very low which in turn impacts on performance.

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