Health services in Tayside and Fife are facing “unparalleled” challenges with increased pressure on A&E waiting times, a surge in so-called bed blocking and more than half of patients facing delays for drug and alcohol services.
NHS leaders say recent weeks have been “as challenging as our services have ever faced” following a sharp rise in winter viruses, along with growing numbers of Covid and Strep A cases.
We launched a landmark data project in August which revealed soaring waits for key services across the region.
Now, six months on, the latest figures show the situation has worsened in many areas.
A&E waiting times
NHS services across Scotland fell to a record poor performance on A&E waiting times in the latest available data for November.
Only 67.%% of patients were seen within four hours – far short of the 95% target.
This is despite the number of people trying to access A&E now being similar or lower than pre-Covid levels.
NHS Tayside has had a good record on waiting times and was one of the few areas in Scotland still meeting the 95% target as recently as May 2021.
However, recent pressures proved too much and in September 2022, the percentage of people seen within four hours fell below 90% for the first time on record.
The number of very long waits – people waiting more than eight or even 12 hours – has remained low in Tayside compared to other areas and both are below 1%.
NHS Fife has a worse track record, reaching a record low of 67.7% of patients seen within four hours in September 2022.
More than one in 10 had to wait more than eight hours.
Bed blocking
Official figures for A&E and cancelled operations show the number of people attending hospital has not increased.
But one of the factors contributing to the strain on services is “bed blocking”, formally known as delayed discharges.
These are patients who are clinically ready to be discharged but are unable to leave because appropriate follow up care and services are unavailable.
The number of delayed discharges was supressed during the first lockdown but since then has been increasing rapidly in Scotland, overtaking pre-pandemic levels in October 2021 and continuing to reach new heights since then.
The main reasons are patients awaiting placements in care homes or for complex cases such as when the person is undergoing an Adults with Incapacity assessment.
In NHS Tayside, it reached a record 159 daily delayed discharges in October 2022.
There were around 81 a day in 2019.
NHS Fife reached peak bed-blocking in August 2021 with 137 daily delayed discharge days compared to around 120 pre-pandemic.
Although the number has since come down, Fife registered an increase in the latest data to 121 daily delays in November 2022, compared to 114 in September.
Mental health services
Patients diagnosed with a range of mental health conditions may be referred for psychological therapies including counselling and other interventions.
The target is for 90% of those to be seen within 18 weeks of referral.
The latest data for NHS Fife shows 2,400 adults waiting for psychological services, half of which have been delayed more than 18 weeks.
Some 209 children and young people are waiting for services, with more than a third breaching the target time.
NHS Tayside fares better with services for young people.
Fewer than one in 10 of the 383 patients waiting for treatment have been doing so for more than 18 weeks.
However, more than a quarter of the 1,056 adults awaiting treatment have been.
Drug and alcohol services
Tayside is one of the worst performing health board areas in Scotland when it comes to drug and alcohol treatment times.
Of the 60 people waiting to access drug services in Dundee, three quarters were waiting more than the three-week target.
The average wait was more than 48 weeks for treatment.
While a smaller number were trying to access alcohol services, the average waiting time was even longer, at 54 weeks.
Some 92 patients are currently on the waiting list in Dundee, with 73% waiting longer than the three-week target.
Long waits
Targets for musculoskeletal services are not being met in Tayside.
Of the 4,153 patients waiting for physiotherapy, 80% have been on the list for more than four weeks.
Meanwhile, three quarters of the 941 awaiting orthotics, which covers treatments such as specialised footwear and braces, have been doing so for longer than the target.
NHS blames ‘unparalleled’ challenges
NHS Fife’s director of acute services, Claire Dobson, said health boards across Scotland faced unprecedented level of demand.
“Hospitals across Fife have remained incredibly busy over the whole of last year with our additional surge capacity, which would have previously only been required over the winter months, remaining open for the whole of 2022,” she said.
“This demand for inpatient beds coupled with the recent sharp rise in winter viruses like flu, RSV and norovirus, and of course rising Covid and Strep A cases, have made the last few weeks as challenging as our services have ever faced.”
Teams are working daily to reduce any potential delays in discharging patients.
A spokesperson for Fife Health and Social Care Partnership said it is taking “a range of actions” to reduce the length of time people wait for services.
They noted this includes increased investment in services, a focus on recruitment of specialist staff and working with partner organisations.
NHS Tayside was asked for comment.
Humza Yousaf under pressure
Health Secretary Humza Yousaf has faced calls at Holyrood to resign.
A Scottish Government spokesman said it is still an “incredibly challenging time” but stressed this is “certainly not unique to Scotland”.
He said: “Our NHS is going further to expand capacity so that it is not just matching pre-pandemic activity, but exceeding it, with the average available number of staffed beds up in the last year.”
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