Quantifying the impact of the COVID-19 pandemic on the Scottish accident and emergency landscape

Abstract

BackgroundThe COVID-19 pandemic, declared in March 2020, is suspected to have greatly impacted Scotland’s accident and emergency (A&E) services. Stringent public health measures, including lockdowns, heightened pressures on A&E departments, but their long-term effects remain understudied. This study examines how the pandemic influenced A&E attendances over a broader time-frame.MethodsSecondary data from Public Health Scotland (2018–2022) on monthly A&E attendances was analysed, standardised per 1,000 population using census data. Choropleth maps visualised A&E attendances and wait times across health boards during key pandemic periods. A Poisson generalised linear model (GLM) assessed the influence of COVID restrictions, demographics, and service factors on attendance rates.ResultsA&E attendances dropped from 2018 to 2022, with NHS Lanarkshire (-32.7%) and NHS Borders (-27.9%) seeing the largest declines. Despite reduced attendances, the percentage of patients seen within four hours also dropped (-29.4% in NHS Lanarkshire). The Poisson GLM confirmed that COVID-19 restrictions influenced attendance rates with a lower incident rate (IRR: 0.89, 95% CI: 0.88–0.90) during lockdowns and an increased incident rate (IRR: 1.04, 95% CI: 1.03–1.05) during easing periods. Health board-level effects varied substantially.DiscussionCOVID-19 disrupted A&E services, causing fluctuating attendances and worsening wait times. Large health board-level variations suggest local policies, behaviours, and existing pressures significantly influenced outcomes. These findings highlight the need to address systemic issues alongside localised strategies for future resilience.