The Society for Acute Medicine (SAM) in Scotland is calling on all political parties to place urgent reform of acute and emergency care at the centre of their plans ahead of the 2026 Scottish Parliament elections.
Recent work from partner organisations has highlighted the severe consequences of front-door overcrowding and dangerous delays.
A joint report by the Royal College of Emergency Medicine Scotland, the Royal College of Physicians of Edinburgh and the British Geriatrics Society has demonstrated long waits, associated excess mortality, and the disproportionate impact on older patients.
The RCEM Scotland election manifesto further sets out priorities for improving urgent and emergency care.
However, SAM Scotland emphasises that this challenge does not stop at the doors of the emergency department.
Acute medical units (AMUs) and rapid assessment and care units (RACUs) are also operating under extreme pressure, with many RACUs routinely “bedded down,” preventing them from functioning as intended.
“Overcrowding is not solely an emergency department issue. Our AMUs and RACUs are equally affected and patients experience delays and poorer outcomes across the whole front door of our hospitals”
— Dr Claire Gordon, SAM Scotland
Whole-system problem driven by social care delays
The most significant barrier to improving hospital flow is the inability to discharge patients who are medically fit to leave hospital due to gaps in social care capacity.
This was highlighted by the Royal College of Physicians of Edinburgh’s letter to the First Minister in December 2024.
“Until social care reform becomes a genuine political priority, hospitals will remain gridlocked. Patients who are ready to go home cannot leave, downstream beds stay full and this pushes risk and delay directly onto AMUs, RACUs and emergency departments.”
Workforce: a pressing challenge across Scotland
SAM Scotland supports calls for a long-term workforce plan.
Staffing pressures are particularly acute in rural areas, where services rely on multidisciplinary teams including advanced clinical practitioners and physician associates.
“Safe staffing underpins patient safety, but it also underpins staff morale and retention. Scotland needs a credible workforce plan that supports every member of the acute medical team, with structured career pathways in acute medicine.”
Digital modernisation must be joined-up and clinically usable
Many acute medical services in Scotland continue to rely on paper-based notes and prescribing systems.
SAM Scotland warns that digital transformation will only succeed if systems are interoperable, user-friendly and supported by responsive IT services.
“Digital tools must help clinicians deliver care, not slow them down. We need modern, connected systems and real-time IT support.”
A call to every party ahead of the 2026 election
SAM Scotland urges all political parties to commit to:
- Modernising digital infrastructure with strong clinical support
- Reducing overcrowding across ED, AMU and RACU
- Delivering meaningful social care reform and reliable discharge pathways
- Investing in a sustainable multidisciplinary workforce.
“These challenges are shared across the four nations, but Scotland has the opportunity in 2026 to take decisive action. We cannot afford further years of overcrowding, avoidable harm and exhausted staff.”