The latest overall A&E waiting times performance statistic against the 4-hour standard in Scotland is disappointing. It is less poor than the latest for NHS England but its still poorer than one would have hoped/wished for.
Intuitively, it seems to me (a non-expert in this field) that the variability in this statistic both across Scotland in any given week and between hospitals/ Boards over relatively short periods of time merits closer analysis than opposition politicians or the corporate media deploy when issuing their ‘scandal’ cries. Candidly, this variability merits closer analysis and explanation than NHS Scotland or the Scottish Government put into the public domain. From ‘rough’ inspection, it seems that substantial changes in performance can occur without always commensurate, large changes in number of attendances.
Digging into the data seemingly odd details are apparent. As an example, Monklands Hospital (NHS Lanarkshire) has recorded performances against this 4-hour standard of 91% falling to presently 61.2% over a 3 week period. The weekly attendances at A&E have risen by 142 over the same period. But the most recent number of attendances, at 1,087 for the week, is the second lowest since 14 March 2021. The performance of 61.2% against the 4-hour target has never been lower during the past 12 months, even when attendances have been higher than at present.
There must be another factor/s involved. One cause of the poorer performance at the Scotland level according to the Cabinet Secretary for Health is staff absences. But given the variability in the waiting times performance across Scotland one would want to know how A&E staff absences vary across NHS Scotland. Is there a correlation, is there good evidence of causation? What about local staff morale, staff exhaustion, local leadership?
Notably, A&E in NHS Tayside continues to deliver performances above 90% against the 4-hour target. Does it have especially low staff absence levels? Might all this variability suggest something more or different from a national system failure?
The BBC News website’s Scotland page tells us today that: ‘The Scottish government’s target of 95% of patients being admitted to the hospital, transferred or discharged within four hours has not been met since July 2020.’
According to the Nuffield Trust and its article ‘Chart of the week: The rise of over four-hour A&E waits across the UK’ published on 15 September, 2021 the last time NHS England met the 95% target was August 2014.
According to NHS England’s latest statistical commentary on A&E performance, the 95% standard – even for ‘all’ its A&E departments in England, not just its Type 1 (main) sites – was last met in July 2015.
And yet the BBC News website’s Scotland page chooses to amplify, without perspective or challenge, this from Scottish Conservative health spokesman Dr Sandesh Gulhane. He called the statistics a “shameful indictment” of Health Secretary Humza Yousaf’s stewardship of Scotland’s NHS. What would he say about his party’s stewardship of NHS England and its A&E provision?
By the way, if the BBC was to report the latest statistics for A&E in Scotland using the method it applied recently to the last NHS England performance data release – namely reporting the performance of ‘all’ sites and NOT for the Type 1 (or main) departments – the percentage for Scotland would be 75.9%!