Revealed: A&E safety fears raised months before crisis

It included a survey of the clinical leads in every emergency department. Fifteen of them reported their department was unsafe weekly and six said their unit was unsafe monthly because patients were backing up there, waiting for ward beds.

Ms Sturgeon and her successor Alex Neil, as well as Chief Medical Officer Sir Harry Burns, held meetings with the college about the problem and some steps were taken. The following winter hospitals across the country began struggling to cope with the surge in seriously ill patients who needed a bed.

Dr Jason Long, chairman of the Scottish board of the College of Emergency Medicine, said: "It was exactly the sort of thing we said was going to happen. It was even worse than we expected."

He said the college had decided to conduct its survey and send the report to the Scottish Government because so many medical staff were turning to him concerned about the pressure on their departments.

"People were almost finding that they were reaching a limit," he said.

The report told the Scottish Government there was an urgent need to address the problems so the service could be delivered safely.

Dr Long explained when hospital wards were full, patients who arrived in A&E stayed there instead of transferring to the appropriate department. As the hours went by the A&E staff had to look after these people, who were often lying on trolleys, at the same time as dealing with new patients arriving at the front door.

Those waiting on trolleys need on-going medical treatment, help using the toilet and eating meals, and skin care because of the risk of pressure sores.

Dr Long continued: "That impacts on other patients in the department because there is not enough staff to do other things. There is also literally not enough space to bring other patients in. If your emergency department is full of patients awaiting admission you have to spend time finding space.

"When you are spending five minutes for every patient finding a room, you are losing time."

He said these were the circumstances which had given rise to safety concerns.

Dr Long attributes the apparent bed shortage to multiple factors including the growing elderly population and cuts in the number of hospital beds.

He said: "The people we are seeing are much more frail and have more comorbidities [multiple health problems]. It is not as easy to send these people home. They need to stay in longer once they are on the wards.

"The other thing is there has been a push to reduce beds. That has happened through changing models of care and more day surgery, which is right. But some of that has impacted on the ability to use beds for emergencies."

It was, he said, "a perfect storm" which led to the winter capacity problems that occurred despite relatively good weather and unexceptional levels of flu.

Dr Long stressed the college was looking for solutions with the Government. He said: "That is why we have gone away and worked very closely with the Government to try and put things in place. It cannot all be short-term fixes. There has to be a lot more medium and long-term fixes, but for patients we cannot have another winter like the one past."

Asked about the need to review hospital capacity in Scotland, he said: "We would welcome any review of what beds are available for admissions of emergencies and how that impacts on the emergency department's ability to function. But it is not just about the number of beds, but what the beds can be used for and how patients flow through those beds."

Dr Jean Turner, executive director of the Scotland Patients' Association, said the findings of the college survey were shocking. "I would like to know how quickly the Scottish Government is going to make these departments safe," she said.

Dr Neil Dewhurst, the president of the Royal College of Physicians of Edinburgh, also raised concerns about the college report. He said: "In these circumstances we would be concerned about the quality of assessment of patients in A&E and care of patients with critical medical conditions such as heart attack and stroke."

Theresa Fyffe, director of the Royal College of Nursing Scotland, said: "People who present at A&E are at their most vulnerable and deserve and expect to be treated safely.

"Yet all those who work in A&E are under increasing pressure because there are just not enough staff to care for the increasing number of people arriving at hospital."

Jim Crombie, national programme director and head of the Unscheduled Care Action Group, dismissed the report as old.

He said: "Since that point we have worked closely with the College of Emergency Medicine to take significant action to improve unscheduled care in Scotland and make sure our patients are seen and treated in our hospitals as quickly as possible. To ensure progress on this important issue we have established a national Unscheduled Care Programme.

"This is now well established and is working closely with key stakeholders and NHS boards to effect improvement across NHS Scotland. The College of Emergency Medicine are a key part of this programme and are contributing to the strategic direction being taken."