– and condemned the Welsh Labour Government by implication?
There are notable features in a research report published recently (9 June 2022) by the health think tank, the Nuffield Trust. It’s entitled: ‘How well is the NHS in Wales performing?’
The first thing to note is the objective of the Trust’s work: ‘to review how waiting times in Wales compare with other UK countries and with historic trends.’ However, the more remarkable feature is this: ‘We (i.e. the Trust) were asked by the BBC to review how waiting times in Wales compare with other UK countries and with historic trends.’ (my emphasis)
Regular visitors to TuS will appreciate the ‘groundbreaking’ nature of this, of the BBC actually commissioning a comparative study! Many will know that BBC Scotland for years has failed to acknowledge the relevance of giving UK context or perspective when repeatedly condemning the Scottish Government for NHS Scotland’s performance.
It seems timely to highlight the findings of the Nuffield Trust study as the Labour Party in Scotland once again pushes its SNP-bad refrain with regards to the NHS. This from Jackie Baillie, from 15 July, seems to be way over the top:
‘DISTRACTED SNP ENDANGERING LIVES AS WORST EVER A&E WEEKLY STATISTICS RECORDED’ adding ‘… Humza Yousaf has completely failed to make any meaningful attempt to address the underlying problems or control this crisis.” and“… lives are being risked due to the incompetence of Humza Yousaf.” and“This distracted SNP government is putting lives at risk and threatening the very existence of our NHS.”
Is this what ‘jumping the shark’ in Scottish politics looks like?
For the avoidance of any doubt, the motivation for this post this is really NOT to have a pop at the Welsh Labour Government: it is to expose the crass politicisation of the challenges facing NHS Scotland by opposition politicians in Scotland – and especially by the leadership of the Labour Party in Scotland. And in the process, it is to expose the editorial position – with its failure to provide context or perspective – adopted by BBC Scotland to the detriment of its mission to educate and inform listeners/viewers and to the advantage of opposition politicians in Scotland.
First on context and attribution of responsibility: ’The Welsh government has exercised its powers to determine a distinct structure for the health service’ adding ‘All parts of the UK have struggled with waiting times over the past decade – missing their targets as financial constraints were followed by workforce shortages and Covid-19’
1) A&E Waiting Times compared across four parts of the UK, since 2012:
’Patients in Wales have been more likely than their Scottish or English counterparts to wait four hours in every single month since 2012 .… People waiting longer in A&E is often a sign that a health care system is struggling to free up enough bed space and staff inside the hospital to admit people.’
2) Median waiting times for referral to treatment in (Tory) England and (Labour) Wales, since September 2011:
’… patients in Wales have consistently waited longer. The gap had been slightly closing before Covid-19, but median waits spiked further in Wales during the pandemic and did not recover as much.’
3) Waiting times for referral to treatment for trauma and orthopaedics in England and Wales, 2020-2022:
‘The same pattern of longer waits in Wales (than in England)is visible. The gap is just as pronounced at the 36-week mark, which is perhaps surprising given that Wales, unlike England, has an explicit target that no patient should wait for 36 weeks.’
4) Distance away from cancer waiting time targets in England and Wales: the report shows the proportion of patients starting treatment within 62 days relative to the relevant targets in the two countries:
‘Since 2019 the Welsh NHS now counts all patients who wait from the point of cancer being suspected, whether by a GP, in A&E or during some other treatment. It has reduced its target from 95% to 75% to reflect this wider category. It has continued to miss this target by about the same as England misses its target: there is little sign here of Covid-19 being a greater problem west of the border.’
5) Treatable mortality rate, 2001 -2020: this is the rate at which people in each country die from causes which can be mainly avoided by timely and effective health care:
‘While it has made progress since devolution, Wales currently has a higher rate of treatable mortality than England or Northern Ireland, and around the same as Scotland. Improvements have stalled in all four countries in recent years, but this slowdown seemed to happen earlier in Wales and there has been little progress for the last decade.’
6) Age standardised mortality rates:
‘A person in Wales is more likely to die each year than a person of the same age in England.’
7) Funding 2004-5 to 2018-9: per capita spend on the NHS in 2019-20 was highest in NI followed by Scotland, then Wales and then England:
‘Wales gets far more funding per person than England – around 15% more, or £1,325 per person more in 2019/20. …. However, Wales actually spent (only) around 5% more than England in the year immediately before Covid-19. This smaller difference (in NHS spend) is because the Welsh government has prioritised health care slightly less aggressively and spends more on other services – including social care, where spending is 30% higher than in England.’
8) Staffing levels: consultants and nurses per 100,000 population:
‘Looking at the numbers of staff, Scotland has by far the highest number of doctors and nurses, as shown in the figure below. Compared to England, Wales has fewer consultant doctors relative to its population size, but more nurses.’
9) Staffing levels (2): general practitioners per 100,000 population, 1997-2021:
‘The number of GPs in Wales is broadly the same as a decade ago relative to the size of the population. Meanwhile, this ratio rose sharply in Northern Ireland but fell in England. The total number of GPs per person in Wales (63 per 100,000) is considerably lower than in Scotland (77) but higher than in England (57). These differences are equivalent to Wales having 170 more GPs than if they had English staffing levels, but 470 fewer than Scotland.’
10) Hospital beds, 2020-21:
‘the Welsh health service had around 270 general hospital beds, not including maternity, mental illness or learning disabilities, for each 100,000 people. This compares to 170 in England.’ (But see later.)
11) Length of time people stay in hospital, 2010-11 to 2020-21: as long as good care is being provided, a shorter length of stay will usually reflect greater efficiency:
‘The average length of stay in Wales is much higher than in England, at seven days against 4.3 in 2020/21. This is a very large difference: … The difference actually grew in the three years before Covid-19 as England improved.
‘It might be that some proportion of this difference reflects patients being more unwell, or needing different kinds of treatments, but there are some serious questions to ask here. Northern Ireland and Scotland, which also have higher need and a more rural population than England, have somewhat higher length of stay but to a much lesser extent than Wales.’
‘It is also possible that longer length of stay may have some benefits, reducing the chance that people are sent home too early only to have to be admitted all over again. Data from one clinical audit on breathing difficulties did find that this happened less in Wales.’
Nuffield Trust’s conclusions – possible reasons why patients in Wales generally wait longer for care than English counterparts
- the Trust argues that although the Welsh NHS receives more money than the English NHS per patient, this may not be enough more to account for an older population with a higher mortality rate
- It suggests that whilst total public spending in Wales – around 15% higher than in England – is more in line with estimates of higher NHS need, the ‘Welsh government has simply chosen not to focus its budget on health to the same extent as governments in London, who over the past decade have increased English NHS funding while cutting other budgets. These are not easy choices to make.’
- the Trust suggests that: ‘the NHS in Wales is less efficient or less focused on delivering timely care. While it may be influenced by the kinds of procedures people need, length of stay data appears to suggest that Wales is taking much longer to get patients treated and safely discharged. This may explain why it struggles to admit patients as quickly despite having many more beds.’
- it adds: ‘The OECD, in a review six years ago, warned that Welsh health boards lacked the capacity to drive improvement and innovation, and that central government needed to do more to support them and hold them to account.’
Labour’s political posturing in Scotland
In the Nuffield Trust’s extensive analysis of the state of the NHS in Wales – an NHS which is the responsibility of a Labour government in Cardiff – you will NOT find any of the following charges being levelled against the Welsh Labour government.
- that the Welsh Labour government is ‘distracted’?
- that the Welsh Labour government is responsible for ‘endangering lives’ due to the A&E performance figures for NHS Wales
- that the Welsh Labour government’s health secretary has ‘completely failed to make any meaningful attempt to address the underlying problems or control this crisis’
- that ‘… lives are being risked due to the incompetence of the Welsh Labour government’s health secretary’ – nor this
- that ‘This distracted Welsh Labour government is … threatening the very existence of our NHS.’
Despite the evidence from the comparative study, there is no mention of any of this: other reasons are advanced for the relatively poor performance of NHS Wales! Notwithstanding the poor performance of NHS Wales – relative both to NHS England (under a Tory government) and NHS Scotland (under an SNP government) – it is the Labour Party in Scotland that makes such lurid accusations against the present Scottish Government and its health secretary. And Labour finds a BBC and other corporate media outlets in Scotland only too willing to amplify its ridiculous, hypocritical claims without perspective or challenge – and specifically without reference to what’s occurring within the NHS in Wales under a Labour government.
Based on the results of the Nuffield Trust’s and other evidence, the logic is clear: attacks by Labour on the Scottish Government over NHS performance here in Scotland must warrant greater condemnation of the track record of a Labour government in Cardiff.
Why doesn’t BBC Scotland commission a comprehensive, independent expert assessment into the performance of NHS Scotland relative to the NHS elsewhere in the UK? And while it’s at it, let the BBC commission a similar UK-wide comparative study into education. I have no fears as to how Scotland would fare in such studies despite the Scottish Government – like the Welsh Government – having severely limited control over crucial economic policy levers unlike the government for England.
However, I do wonder if even an authoritative evidence base would end the disrespectful, casual and unsubstantiated claims of Scotland’s ‘failures’ – the almost daily gaslighting of Scotland – coming from Unionist politicians and their media allies!