In the Herald today, there is a desperate and flawed attempt to undermine the SNP Government and NHS Scotland under the heading: The truth about the Scotland-England A&E comparisons
Yet time and again, the Scottish Government has sought to deflect at least some of the heat by noting that – however bad things are – at least they are not as bad as England. But are such comparisons fair?
Her first criticism is that the services are not comparable:
Scotland has 91 A&E services in total, including minor injury units, but the weekly statistics published by Public Health Scotland cover only the 30 larger A&Es – emergency departments (EDs) – which typically provide a 24-hour consultant-led service.: PHS)
These vary widely, however, from Scotland’s busiest ED at Edinburgh Royal Infirmary (roughly 2,300 attendances per week) to remote EDs such as Western Isles hospital or Balfour hospital on Orkney, which each see around 100 patients a week.
When the Scottish Government compares waiting times at these 30 EDs, it does so against England’s 170 Type 1 “major” A&Es, which have full resuscitation and hospital services in addition to being 24-hour consultant-led departments.
Furthermore, if total monthly attendances were divided equally between each of these departments in England versus Scotland, patient turnover would also be twice as high: around 7000-8000 per Type 1 A&E in England against 3000-3,500 per ED in Scotland.
She’s right, their attendances are not comparable but, to state the obvious, neither will their staffing be. The bigger EDs will have more staff to deal with the greater attendance levels. Taking into account the patient/staff ratio, not offered by McArdle, averages remain valid. I mean, duuh.
Second, she writes:
While Scotland’s weekly A&E statistics cover EDs only, the monthly report issued by Public Health Scotland covers “all A&E sites”, including small community hospital casualties and minor injury units.
Actually, I didn’t know that, good point, but when you do the sums it matters little such is the remaining gap in performance.
In NHS Scotland A&E departments for August, the monthly figure was 69.7% in 4 hours
The August, 4 week-ending average, based on 7th 67.9, 14th 65.1%, 21st 65%, 28th 66.1%, is 66%.
NHS England Type 1 for the same month was 58%, still far worse. Remember that, at first, small-looking 8% difference, is 14% better than 58% and means hundreds of patients were treated faster in Scotland and thousands waited longer in England.
Finally, she suggests “there is even more sleight of hand at play” on when the clock starts:
What’s more, the “clock” starts at a different point in Scotland than it does in England. In Scotland, performance against the four-hour target is measured from the time patients arrive in A&E (even if they have been waiting hours in an ambulance outside).
In England, the clock starts on arrival in A&E or 15 minutes after the ambulance pulls up outside, even if the patient handover is delayed – an increasingly common occurrence UK-wide.
Leaving aside the fact there have been no reports of people “waiting hours in an ambulance outside“, in Scotland, deflating her case, McArdle offers no sources for these claims while those actually published tell a different story.
NHS England also has the dubious practice of restarting the clock after patients are admitted whereas in Scotland counting continues from first arrival.