Progress in tackling waiting times

The national roll-out of specialist frailty services at all 30 A&E departments will build on recent progress to clear long waits and help reduce hospital stay length for the most vulnerable people.

Frailty Units are specialist beds that focus on intense assessment of older people with frailty – the services offer access to specialist skills and care plans, accelerate early discharge and look to reduce delays and length of stay.

The expansion, supported through the £200 million announced as part of the 2025-26 Budget, will be a key focus of the Scottish Government’s new Operational Improvement Plan for the NHS, due to publish this Spring. This will include changes to the way acute services are delivered to help reduce waiting times. In recent weeks Health Boards have reported significant progress against long waits, including:

• the pledge to carry out 64,000 procedures through £30 million additional funding by the end of March 2025 has already been exceeded – with boards reporting to have 75,500 delivered by end of January 2025.
• a 4% decrease in the total waiting list size for diagnostics – with waits now at their lowest since October 2021
• a 12% decrease from a recent peak in April 2024 in total ongoing waits for eight key diagnostic tests combined
• 90.6% of Child and Adolescent Mental Health Services (CAMHS) referrals being seen within 18 weeks from October to December– the standard is 90%.

On a visit to Glasgow Royal Infirmary, Health Secretary Neil Gray outlined the Scottish Government’s plans to build on this progress by installing a frailty service in every site with a core A&E by the summer.

Mr Gray met staff working in the hospital’s dedicated frailty service which has reported significant progress in the last 18 months – with average length of stay for vulnerable patients reducing by 3 days, without any increase in readmission. The service has also reported enhanced co-ordination and collaboration among healthcare teams leading to improved patient outcomes.

Mr Gray said:

“In recent weeks we have seen good progress in reducing waits and there are encouraging signs that our plan is working. However, we know there is more to do and we want to drive further improvement. That is why we are investing £200 million to help clear waiting list backlogs, improve capacity and reduce delayed discharge.

“I was pleased to meet the team working in the Glasgow Royal Infirmary frailty service and see first-hand the positive impact their crucial work is having – with the service allowing speedier assessment of vulnerable people presenting at A&E and reducing length of stay for patients significantly.

“We want to replicate this success across Scotland and shift the balance of care from acute, to community. Through a portion of our £200 million investment, we will deliver direct access to specialist frailty teams in every A&E by this summer. This will enable people who experience frailty to be referred directly by GPs and the Scottish Ambulance Service to specialist frailty services as an alternative to attending A&E or admission.”

Laura Duffy, Consultant Geriatrician at the Glasgow Royal Infirmary, said: 

“Working with our colleagues in the Emergency Department and Acute Assessment Unit, we have created a process which identifies people living with frailty. This enables us to direct and prioritise these people to receive care from a specialist team, in specialist areas and initiate early Comprehensive Geriatric Assessment. A key part of developing this service has been ensuring that we identify the priorities and concerns of our patients and their carers promptly and work in partnership with them to develop a plan for their care.

“We have also worked at further developing and enhancing our links and interface working with our colleagues in the community and in social care. We have developed daily CGA Huddles which can be attended by a variety of acute, community and social care teams. These allow the early exchange of key information and collateral information gathering about patients, which helps provide more effective, timely and patient centred care.

“The results so far have been promising with 74% of patients admitted through the Acute Medical Receiving Unit being screened for frailty. We have also noted a reduction in length of stay of three days for people with frailty, without an increase in readmissions.”

Background

There are currently five frailty units - these have been set up during the Focus on Frailty programme led by Health improvement Scotland across Ayrshire and Arran, Lanarkshire, Tayside, Glasgow and Dumfries and Galloway. There is variation in these services with no standard model. The services provide a dedicated closed unit or area staffed by frailty / medicine of the elderly staff with frailty assessment within the first hour of arrival at hospital.

In April 2024 the Scottish Government funded NHS boards to deliver 64,000 procedures (40,000 diagnostic procedures, 12,000 surgeries and 12,000 new outpatient appointments) by March 2025. By 31 January 2025, 56,500 diagnostic procedures, almost 9,200 surgeries, and over 9,800 outpatient appointments had been delivered.