The Talking-up Scotland fund raiser primarily to enable the recruitment of some research assistance, in order to take pressure off me [74 in June and tiring] and hopefully to further improve the blog, has made a good start. To contribute, only if you can (!) go to: Talking-up Scotland - a Politics crowdfunding project in Ayr by Professor John Robertson
By Professor John Robertson OBA, former Chair Faculty Research Ethics Committee, UWS
From BBC Scotland today:
The Scottish government has been urged to take immediate action to address “unacceptable” and “dangerous” A&E waiting times by an industry body. The Royal College of Emergency Medicine (RCEM) said the number of patients waiting for more than 12 hours in A&E is 99 times higher than it was 14 years ago.
The statistics, based on figures from Public Health Scotland, external (PHS), show 76,346 patients waited over 12 hours in A&E in 2024, compared with 784 in 2011. In the week-ending 2/2/2025, across Scotland’s 30 Type 1 A&E departments, 1 967 people waited more than 12 hours. That’s around 281 per night and 9 per department, across Scotland.
Dr John-Paul Loughrey (above), the RCEM’s vice-president for Scotland, said: “When you look at the data over the past 14 years the reality of the number of people now facing extremely long waits in this country is shockingly clear.
There is a well-established triage system, I’ve seen it operate more than once, to make sure that those at risk to life are seen very quickly, before even the 4 hour target.
Is there a shortage of staff in Scotland’s hospitals?
Staffing levels across NHS Scotland are at a new record high, 23.5% up on 2007, when the SNP came to power, and have increased for 10 consecutive years. This includes record high numbers in each of the nursing and midwifery, medical and dental consultant and allied health professions. 1
How does Scotland compare with England?
NHS England has 1.36m staff.2
All things being equal with one tenth of the population, NHS Scotland might be expected to have 136 000 staff but has 180 0003, 44 000 more, 32% more.
Why are more waiting longer?
I’m sure it’s more complex than just this, but:
More people are turning up in A&E with minor ailments such as coughs and a blocked nose. NHS England data shows more people going to A&E with complaints such as headache, hiccups, insomnia, backache and feeling sick. Difficulty accessing a GP has also been linked to increasing numbers of people attending A&E to request medication. 4
Sources:
- https://x.com/scotgovhealth/status/1534110214588403715/photo/1
- https://digital.nhs.uk/data-and-information/publications/statistical/nhs-workforce-statistics/october-2024
- https://www.gov.scot/news/nhs-workforce-at-new-record-high/#:~:text=The%20NHS%20Workforce%20statistics%20show%20total%20staff%20paid,since%20September%202006.%20That%20is%20a%2022.6%25%20increase.
- https://www.mirror.co.uk/news/uk-news/more-people-turning-up-ae-34393722
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Talking-up Scotland 
Patients admitted to hospital from A&E are included in some of the following hospital statistics.
From 24 September 2024
“Acute hospital activity and NHS beds information (annual)”
(Excludes admissions to maternity wards and mental-health hospitals)
Year ending 31 March 2024
“Data presented for 1 April 2023 to 31 March 2024 are provisional and subject to change in future publications as submissions may be updated to reflect a more accurate and complete set of data from NHS Boards. This release includes the NHS Fife, NHS Golden Jubilee (GJ), and NHS Highland National Treatment Centre (NTC), locations”
https://publichealthscotland.scot/publications/acute-hospital-activity-and-nhs-beds-information-annual/acute-hospital-activity-and-nhs-beds-information-annual-year-ending-31-march-2024/
“Around 0.7 million Scottish residents (one in eight of the population) were admitted to hospital in 2023/24. Of these, three out of ten patients (31%) had more than one admission. There were just over 1.1 million admissions into hospital in 2023/24 – a 4% increase compared to last year (2022/23) and a 6% decrease compared to five years ago (2018/19).”
“The average length of stay has been decreasing. In 2023/24, the average length of stay for inpatients was 6.7 days compared to 7.1 days last year (2022/23). Patients admitted as emergencies generally stay longer than elective hospital admissions. In 2023/24, the average length of stay was 3.4 days for elective inpatients and 7.3 days for emergency inpatients.”
“In 2023/24, there were just over 1 million main procedures performed – a 3% increase on last year (2022/23) and a 11% decrease compared to four years ago (2019/20). NHS GJ and NHS Highland NTCs performed 11,704 and 2,689 Ophthalmology procedures respectively in 2023/24. NHS Fife and NHS Highland NTCs performed 2,089 and 1,734 Trauma & Orthopaedic procedures respectively in 2023/24.’
“Bed numbers and percentage occupancy have generally been increasing in recent years. In 2023/24, the average number of available staffed beds for acute specialties was 13,755 – a 0.4% increase on last year (2022/23) and a 5.2% increase compared to five years ago (2018/19). Of these, 9,861 (71.7%) were for medical specialties and 3,894 (28.3%) were for surgical specialties. The percentage occupancy for acute specialties fell from 88.1% in 2022/23 to 87.5% in 2023/24.”
“Nearly 1 million Scottish residents (one in six of the population) visited an outpatient department in 2023/24 as a new outpatient. During the same period, 7.4% (104,176) of new outpatient appointments were not kept without prior notification (‘Did Not Attends’). There were just over 4 million total outpatient attendances (around 1.3 million new and 2.7 million returns) in 2023/24 – a 2% increase on last year (2022/23) and a 6% decrease compared to five years ago (2018/19).”
Re the Royal College of Emergency Medicine demand for the Scottish Government to address the “unacceptable” and “dangerous” A&E waiting times it will be interesting compare the Hospital Standardised Mortality Ratios following admission to hospital for all the years between 2011 to 2025.
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It is always difficult to identify what RCEM are saying by the time, once it has gone through editing by BBC Scotland.
As you highlighted, triaging on arrival as well as everything else has come a long way since 2011, so pardon my scepticism on how “dangerous” the situation is now versus then, before considering the accuracy of data.
The “dangerous” assertion relies on RCEM’s previous statistical analysis which arrived at an implied correlation between waiting times and deaths, which has been abused by every two bit politician and journalist in Scotland pronouncing ‘wir doomed’ ever since.
You can bet that unnecessarily high waiting times are “unacceptable” to hospitals as much as the patients, but we’re in danger of ignoring the wait being for clinical reasons – eg someone being monitored overnight following a stroke could easily breach the 12 hour window – Should the patient be discharged to take their chances simply to meet a time target, or would that be even more “dangerous” in the eye of consultant doing the afternoon rounds ?
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Interestingly, this BBC Scotland story is on the UK main page (Furrners version)…
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The RCEM’s Vice President refers to a time period of 14 years. The RCEM’s own ‘performance tracker’ shows that up until the pandemic, 12 hour stays in Scotland’s A&E departments were at a very low and relatively stable level. By contrast, 12 hour waits in A&E in England, NI and Wales have over these same c. 14 years not only been substantially higher than in Scotland but were on an upward trajectory BEFORE the pandemic. And the percentage of 12 waits is STILL substantially lower in Scotland that in the NHS elsewhere in the UK.
The ’99 times higher’ statistic is probably accurate but ‘benefits’ from further explanation. The change actually occurs not over 14 years – (was this an attempt at attribution to one party of government?) – but from just before to after the pandemic.
Calculating a similar statistics for England, NI or Wales may result in a figure less than 99 (i.e. one apparently ‘better’ than NHS Scotland) but ONLY because A&E outside Scotland had been performing much less well on 12 hour waits before the pandemic than NHS Scotland, i.e. for the Scotland calculation the denominator is lower.
Source https://rcem.ac.uk/data-statistics/
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