Two Glasgow hospitals came close to collapse last week with ambulances left queuing outside and patients being treated in corridors.
Health board bosses have been described as being 'too scared' to declare critical incidents at the hospitals, despite calls from top accident and emergency medics to do so.
On Thursday, 27 ambulances were reported to the queuing up outside Glasgow Royal Infirmary while at nearby Queen Elizabeth University Hospital 64 patients were crammed into an assessment unit with just 28 beds, reports the Daily Record.
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As the situation surpasses crisis point, Health Secretary Humza Yousaf faced demands from Royal College of Emergency Medicine (RCEM) leaders to allow health boards to declare a "critical status" emergency in the NHS.
The measure would allow health boards to target resources at under-pressure locations, such as accident and emergency wards.
Scottish RCEM leader Dr John-Paul Loughrey claims the crisis at emergency departments is growing every day. He told how in times of extreme pressure, offices had to be used for patients and some treatments were being carried out in relatives’ rooms.
He said: “Many hospitals have more patients in wards than beds - a number of health boards are using every available space. Some patients are being treated in relatives rooms or in office space.
"We haven’t had a hospital declare critical incident status in Scotland yet but I know three or four hospitals who have been having these discussions. We discussed this when we met with the Health Secretary on Wednesday and encouraged him to empower health boards to make that decision if required.”
He said calling a critical incident would enable hospitals to call in senior staff from other specialties to help manage patients and that “lower acuity patients” may be asked to leave the hospital and come back later. Ambulances would divert from a particular hospital and wards would be asked to take extra patients.
He said: “This would mean, for example, rather than 20 extra patients in the emergency department, 20 wards could be asked to take one extra patient which would arguably be better.” Loughrey said critical incident status would also mean non-emergency operations and clinics could be cancelled.
But he admitted: “It does carry some risk of a shortage of staff in the aftermath, but some hospitals with a very acute problem need to escalate to that status and take that risk. Ambulances should spend 15 minutes at hospital, but that is rare now.
“And patients can be spending 24-48 hours on trollies in emergency departments. It is impossible to function efficiently when the department is under so much pressure. It is not ideal for long-term care, particularly for the elderly who have had falls or who have delirium.
"We use a four-hour-safety standard in emergency departments to make sure patients flow into the system in time but after five or six hours there is increased risk of harm or even death.
“The four-hour standard is the standard, we never want emergency departments to end up counting in days rather than hours.”
Hospital insiders sent text messages to the Daily Record as the crisis began to spiral out of control on Thursday. One nurse at the Glasgow Royal Infirmary said: “Glasgow Royal Infirmary - burst. 27 ambulances waiting outside. Patients being treated in corridors in A&E. Senior management too scared to declare a critical incident.”
By Thursday evening ambulances continued to queue outside the hospital. Once all the hospital’s ambulance bays were full, crews were forced to queue up to the mini roundabout on the approach to the hospital and further back along the road.
A few miles away in the QEUH hospital another nurse messaged: “I’m at the Immediate Assessment Unit that has 28 beds. Currently there are 64 patients in the unit. It is a receiving unit for people sent in by a GP in an ambulance or their own transport.
“They have drafted in staff from the operating theatres to deal with patients. Management are flapping.”
A NHS Greater Glasgow and Clyde spokesman stated: “Our services, like the whole of NHS Scotland, are facing major pressures including significant covid, flu and norovirus cases and our staff are doing all they can to meet this demand.
“Waiting times can fluctuate on an hourly basis and NHSGGC is taking a number of actions to support our A&E departments and our assessment units at this time including recruiting staff as available and creating additional inpatient capacity.”
First Minister Nicola Sturgeon chaired a meeting of the Scottish Government resilience committee to tackle the ongoing winter pressures on the NHS on Friday.
Afterward, she announced a number of measures to alleviate pressures on the system.
Sturgeon said: “It is clear that health and social care is currently experiencing a period of intense and indeed unprecedented pressure.
“Staff are working exceptionally hard and have been doing so throughout the Christmas and New Year period. This comes after nearly three years of pandemic-related demands on the system, and we are all incredibly grateful to them for their efforts.
“I am clear that the Scottish Government must and will do everything it can to support our health and care service throughout the next few weeks. We will leave no stone unturned to explore and implement any additional measures that could be taken to help alleviate pressures.
“This will include actions to reduce unnecessary attendances at A&E - ensuring people get care in more appropriate settings, and those who need hospital care get it quickly, and also on effective discharge arrangements to reduce pressure on hospital occupancy.”
Measures announced include the use of Flow Navigation Centres as part of the redesign of urgent care, more treatments offered at home and ambulance service staff providing treatment, where appropriate, to help avoid hospital admission.
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