The Royal College of Emergency Medicine has highlighted a significant jump with long A&E waits before admission in Scotland last year. 

The Royal College of Emergency Medicine (RCEM) has highlighted more than 800 deaths associated with long A&E waits before admission in Scotland last year. This is an increase of a third – 202 people – from the figures in 2023. 

Over the warmer months (1 June until 31 July 2025) one in 24 people (9,881) endured a stay of 12 hours or more from their time of arrival at an Emergency Department in Scotland. This is 7,003 more patients than the entire year of 2018. 

When looking at July alone, 4,686 people experienced this extreme wait – over 2,400 more than in the winter month of January 2022 (2,266).

Meanwhile, further analysis for last year reveals a record 76,510 patients waited 12 hours or more to be admitted, discharged or transferred from A&E. That’s 20,432 more people who endured an extreme wait compared to 2023.

Using the Standard Mortality Ratio – a method which calculates that there will be one additional death for every 72 patients that experience an eight to 12-hour wait prior to their admission – RCEM estimates that there were 818 associated excess deaths related to stays of 12-hours or longer before being admitted in 2024.

A national tragedy 

Calling the deaths “a national tragedy”, RCEM Scotland’s vice president Fiona Hunter said: “It doesn’t have to be this way – the crisis is fixable and it comes down to patient flow in hospitals – getting people out of A&Eand into a ward bed and getting them out of hospital when they are well enough to go home.”

Responses for the census were received from 28 major emergency departments, along with three rural and remote hospitals. 

It found that there is one whole time equivalent consultant for every 4,692 attendances. While it’s a significant improvement compared to RCEM’s census in 2021, it’s still below RCEM’s recommended figure of 1:4,000.

There were 16 gaps in the consultant rota – the same when compared to RCEM’s last census in Scotland. Meanwhile, there were 32 in the specialist rota, up from 23, and 26 in the resident doctor rota, down from 28 compared to four years ago. Recruitment issues were highlighted among the main reasons for rota gaps.

The average weekday consultant presence was 14 hours a day, down from 15 hours in 2021. Given RCEM’s recommendation that consultants are present at least 16 hours a day in all medium and large systems, this decline is a worrying find.

“While there have been some slight improvements compared to our first census in 2021, it is still abundantly clear that A&E are not adequately staffed with senior decision makers to deliver high-quality patient care,” said Hunter.