‘One in, one out’ policies implemented in overstretched Scottish hospitals, doctors say

Scottish hospitals have been forced to implement nightclub-style ‘one in, one out’ admissions policies because of a lack of capacity, doctors have warned.

Lailah Peel, the deputy chair of the British Medical Association in Scotland, claimed the situation had become so bad that many hospitals have implemented informal systems meaning new patients are not admitted until others have left. 

She claimed the system was “maybe fine for a nightclub”, but “not so great if it’s your granny sat outside your local A&E in an ambulance”.

Her warning came as new statistics published on Tuesday set yet more record highs for A&E waiting times and bed blocking, in which people are well enough to leave hospital but have nowhere to go due to a lack of social care capacity.

Problems discharging patients are strongly linked to chaos in A&Es, as bed shortages mean doctors have nowhere to send sick patients, who are often left to lie on trolleys.

In the week ending January 1, 2,506 people - roughly one in ten A&E patients - were forced to wait 12 hours or longer to be dealt with. In the same week in 2019, only 50 people waited 12 hours or longer.

The average number of beds occupied by patients well enough to leave hospital also hit a record high for a third month in a row. There were on average 1,950 beds every day occupied by patients waiting for a care package in November, the figures revealed.

'We’re all running at maximum capacity'

Dr Peel described the statistics as “awful” and pointed to research which suggests the delays in A&Es would have caused 60 avoidable deaths in the final week of 2022.

She added: “We often can’t get patients into A&E until we can transfer a patient to a ward, and they can’t accept a patient until they’ve discharged someone, inevitably leading to delays for many of our acutely unwell patients getting the care they need within inpatient ward areas.

“That just demonstrates that we’re all running at maximum capacity across the NHS, and beyond a level at which we can consistently provide safe and effective care to everyone who needs it.

“We are hearing that many emergency departments are currently sitting far in excess of 100 per cent of their patient capacity, simply due to exit block."

At Holyrood on Tuesday, Humza Yousaf, the under-fire Health Secretary, announced that £8 million would be made available to pay for another 300 care home beds, which will be purchased at up to 25 per cent above the normal rate.

However, he said that there were currently 1,700 people in hospital awaiting care packages, meaning the extra beds would cover less than a fifth of those waiting to leave hospital.

'Carnage in our A&E departments'

Sandesh Gulhane, the health spokesman for the Scottish Tories and a GP, said: “Humza Yousaf is presiding over carnage in our A&E departments, with patients waiting longer and longer to be treated. These record figures are truly terrifying.

“My burnt out colleagues simply cannot give any more than they are currently doing for suffering patients. They are being let down at every turn by Humza Yousaf’s flimsy recovery plans which have failed despite his desperate claims to the contrary.

“How much more damning evidence does the First Minister need to accept that the hapless health secretary is out of his depth in this role and should be sacked immediately? He has to go now.”

On Monday, Nicola Sturgeon announced that more cash would be made available to buy extra care home beds and more staff taken to work on an NHS helpline. However, doctors said the plans were not enough to address the major crisis that has developed in hospitals.

Graham Ellis, Scotland's deputy chief medical officer, acknowledged that major delays in A&Es were costing lives and did not dispute claims from the Royal College of Emergency Medicine that dozens of people a week are dying as a result of the turmoil.

'Fighting for its life'

Jackie Baillie, Scottish Labour’s education spokeswoman, said that the NHS was “fighting for its life”, but that the SNP had failed to grasp “the scale of the challenge”.

“In a single week thousands of Scots were stuck waiting more than half a day in A&E, putting lives at risk and putting staff in an impossible position,” she said.

“Delayed discharge continues to spiral and pile pressure on services, despite one empty SNP pledge after another to end the practice.”

Mr Yousaf said that an additional 200 extra staff for the NHS 24 telephone helpline would also be recruited by the end of March.

He added: “We are ensuring all possible actions are being taken to support services, and the additional measures I have outlined will help relieve some of the extreme pressure health boards are facing.

“We know one of the most significant issues our NHS is facing is delayed discharge, that is why I have announced further support to buy additional capacity in the care sector.

“Emergency care will always be there for those who need it, but for many people, the best advice and support might be available on the NHS Inform website or the NHS 24 App, or by calling NHS 24.”