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
McArdle writes:
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.
See this:
Talking-up Scotland / Scottish media fact checking is like shooting fish in a barrel 
Did she do the sums?
If I leave out NHS Orkney, NHS Shetland and NHS Western Isles from the data for the week ending 9 October 2022, the 4-hour performance result changes from 64.2% to 63.8%.
Hardly surprising!
If I leave out the boards with less than 1,000 attendances, the result is 63.3%.
If I include only the Greater Glasgow & Clyde, Lanarkshire, and Lothian Health Boards, the result is 60.6%.
If they wanted to be really picky, they could delve down to individual hospital data.
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To be honest, there is so much wilful misinterpretation over A&E figures and ambulance waiting times it is beyond ludicrous.
If you look at any emergency scenario from call handlers to arrival at A&E, there is a thread of assessment throughout – Call handlers are not simply an answering service, paramedics and ambulance drivers are not simply drivers, whether a patient is in an ambulance or a car or arriving on foot at A&E they will be triaged asap.
The stats are not the full picture by a very long shot, and I’m sure all in NHS Scotland are pig sick of it all.
Only in Wales (lately) and Scotland is it used as political football by the opposition, in Scotland’s case maliciously amplified across it’s media. It doesn’t happen in Wales.
It’s all diversion to the real problem of the NHS being chronically and deliberately underfunded by HMG, particularly under the current (for how long?) Chancellor.
Only a complete moron would expect production line management techniques to work where it is not a repetitive process, unfortunately they get elected.
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I happy to note that Helen McArdle has at least made an attempt at justifying or supplying some context for her “comparison” argument and that does indeed make a welcome change from her usual articles.
The headline in the Herald reads “The SNP says Scotland’s A&E’s outperform England – but is that really true?” Yes, I agree that they do say that.
Probably with good reason right enough.
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But, she is demonstrating her hypocrisy. She and the other media have, for years, ‘mined’ data to unearth one’s, which, presented without context, show Scotland in a poor light. When sites such as this one started subjecting media claims to more rigorous analysis, we could see how mendacious the media and unionist politicians were being. And, now that the SG is doing this regularly, we are getting performative indignation from Ms McArdle, who then goes on to try to show that such comparisons are not valid. If these are not valid then almost all of what she and her colleagues have done for years is even less valid. This is hypocrisy and demonstrates her mendacious propagandising.
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It’s a ploy used often by the media, when the percentages look good for Scotland start using raw numbers as England’s will always look bigger. Throw in a bit of confusion about measurements, bingo you prove Scotland is worse, well for your compliant readers anyway.
Why does England have a higher proportion of people attending A&E. Using the lower figures that’s 90,000/month in Scotland and 1.190,000 in England, more than ten times Scotland’s (about 290,000 more than Scotland’s equivalent). Is it something to do with being unable to make a doctors appointment.
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How many newspaper articles in England compare their dire A&E stats with Scottish ones , Helen ?
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The table comparison shown above states that in England the clock is started when the patient arrives in A&E. It’s my understanding from my involvement in A&E systems a number of years ago that in Scotland the clock starts when the patient is admitted i.e. before triage and the involvement of a consultant. On the other hand my understanding of the process in England is that the clock starts when the consultant becomes involved i.e. after admission and triage. Has this been changed recently?
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