A SUPPORT team is being drafted in to an accident and emergency department as it emerged a patient has been injured falling off a trolley for the second time in six months.

Staff and politicians have been raising concern about the pressure on the Royal Alexandra Hospital (RAH) in Paisley with reports of patients spending up to 21 hours waiting on trolleys for beds.

Now it has emerged two people, who were already unwell, have been hurt tumbling from the trolleys in the A&E, with the most recent incident taking place in January.

An investigation has been launched by the health board and Health Secretary Shona Robison said she was "very concerned" about the incidents, adding: "I will be closely monitoring this investigation to make sure lessons are learned."

Within hours of The Herald contacting the Scottish Government about the falls, the chief executive of the Scottish NHS, Paul Gray, announced a support team is being sent into the RAH to help improve the department.

Scottish hospitals have experienced a surge in demand this winter, with clinicians across the country describing queues of patients waiting in A&Es because of bed shortages. The RAH appears to have been particularly badly affected. Stories include ambulance staff being detained at the hospital unable to handover patients and the latest figures show nearly a quarter of patients delayed in the A&E for more than four hours - the Scottish Government target says it should be no more than five per cent.

Neil Bibby, a West of Scotland Labour MSP based in Paisley, said: "I am hearing concerns about the pressures facing the RAH on a daily basis from both patients and staff. Increased waiting times, cancelled operations and a lack of beds at the hospital continue to be major issues.

"The staff at the RAH are working really hard but there are concerns that they simply can't keep up with demand. It is very concerning to hear about the two serious incidents involving patients on trolleys over recent months and they should be investigated fully."

The Royal College of Emergency Medicine has warned repeatedly that A&Es are less safe when they are too full.

Dr David Chung, vice chair of the Scottish board of the Royal College of Emergency Medicine, said: "We know that overcrowded A&E departments will be unsafe and there will be a risk of this sort of thing happening.

"All kind of mistakes can occur. I know places where there have been maybe 30 or more patients waiting on trolleys for a bed in Scotland."

When ward beds are full A&E staff have to nurse those waiting to be admitted as well as the new casualties arriving at the door. Those lying on trolleys may need regular medication and assistance using the toilet as well as food and water. Dr Chung said patients getting off trolleys unaided and not receiving drugs on time were among the issues that could arise when A&E staff were stretched.

He said: "I think the public recognise staff are doing their best, they say 'it is ok it is not your fault.' They never complain. When they do phone, they say that staff were trying their hardest."

In a statement NHS Greater Glasgow and Clyde said: "In August 2014 an incident was reported involving a patient falling from a trolley. The incident was fully investigated and it was concluded that the staff had taken all appropriate precautions to safeguard the patient but it was an unavoidable accident.

"In January 2015 an incident was reported involving a patient fall from a trolley. This incident is still being investigated.

"These two incidents occurred five months apart and are in no way connected."

Announcing that "unscheduled care managers" have been asked to go into the RAH and help staff take immediate action, Mr Gray apologised to all patients across Scotland who have experienced long waits this winter.

He said: "I recognise that all staff have been working extremely hard in our NHS to ensure patients get the best possible care.

"However, I'm concerned that performance is not recovering as quickly as it should at the RAH and it is clear to me, through our performance monitoring and management, that the board needs support to help them ensure patients are seen and treated in A&E within the appropriate timescale."