ARE “unnecessary A&E attendances” clogging up Scotland’s hospitals?

The First Minster’s statement referred to paramedics “literally preventing hundreds of people every week having to go to hospital” by treating more than half of patients they saw over the festive period at the scene.

Bolstering the numbers of NHS 24 call handlers over the coming weeks and Saturday openings for more GP surgeries were also presented as means of easing pressure on the NHS by reducing the numbers who turn up at A&E instead.

This is welcome, of course, but anyone working in emergency medicine will tell you this is a red herring. The problem is “exit block”- not attendances.

Read more: Care homes 'may not be able' to provide the extra beds needed to free up hospital wards 

During the four weeks running up to Christmas, a total of 101,038 people were seen in Scotland’s emergency departments (6,215 spending over 12 hours there) compared to nearly 116,000 for the same period in 2019 when the number waiting over 12 hours was just 291.

The Herald: A&E attendances since 2020 (black line) versus weekly averages in 2018 & 2019 (green dotted line)A&E attendances since 2020 (black line) versus weekly averages in 2018 & 2019 (green dotted line) (Image: PHS)

For years before the pandemic, performance against the four-hour A&E target - effectively a dashboard warning light signalling how well the system as a whole is functioning - had been steadily deteriorating.

This told us a few things.

Firstly, that hospital beds were being cut too quickly at a time when care home bed numbers were also falling and social care provision was not growing fast enough to meet demand from an ageing population.

As a result, delayed discharge was already worsening winter-on-winter even before the pandemic - exacerbated even more so by Brexit’s disastrous impact on social care staffing.

Read more: Health boards get 'immediate funding' to buy up care home beds 

Secondly, it told us that primary care resources - from GPs to district nurses and physiotherapists - were too thinly spread to keep the growing proportion of elderly, disabled and people with multiple chronic illnesses well in the community.

Instead, too many were deteriorating and ending up in A&E where they then required admission to hospital.

The Herald: NHS Scotland had been struggling to meet the 95 per cent target for the four-hour A&E waiting times standard since 2017NHS Scotland had been struggling to meet the 95 per cent target for the four-hour A&E waiting times standard since 2017 (Image: PHS)

The pandemic made a bad situation worse by causing waiting times for treatment to spiral, and leaving a legacy of ill health (people recovered from Covid are more likely to suffer strokes, for example).

Read more: Chaotic A&E conditions playing 'Russian roulette' with patients' lives, warn medics 

The resurgence of flu on top of Covid is also squeezing bed capacity. Getting those 1,700 people out of hospital who no longer need to be there is vital.

Ultimately, however, we simply need more social and primary care.