‘A&E Compare’ – a service for BBC-reliant Tory and Labour loyalists in Scotland?

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By stewartb

With the publication (19 January) of the December 2022 A&E statistics for NHS Wales, it is now possible to compare and contrast the performance of NHS Emergency Departments (EDs) in England, Scotland and Wales during perhaps the most challenging month to date in the history of the NHS. (Comparable statistics for Northern Ireland are not currently available: these are only reported quarterly and Q4 2022 data have yet to be released.)

This blog post tabulates key metrics and compares them across the three NHS organisations. The statistics are focused largely on 24 hour, consultant-led full-service EDs, the ones most people would recognise as ‘A&E’. These facilities are known variously as ‘Type 1’ (in NHS England); ‘Main’ (in NHS Scotland) and ‘Major’ (in NHS Wales).

(For more on differences in terminology and their significance for comparative analysis see https://www.health-ni.gov.uk/sites/default/files/publications/health/hs-niwts-ecwt-guidance_3.pdf )

Why this focus? This is consistently the focus of analysis and commentary by the Royal College of Emergency Medicine (RCEM). It reflects the consistent editorial policy of BBC Scotland to report on the ‘Main’ departments in NHS Scotland. Oddly (perhaps!), the BBC makes different editorial choices when reporting on the performance of EDs in NHS England and NHS Wales: certainly for NHS England, the BBC typically refers to a statistic encompassing the performance of all EDs rather than just the Type 1s, i.e. it opts to report a figure that includes for example minor injury units (see more on this later).

Emergency Department performance December 2022 *

MetricNHS EnglandNHS ScotlandNHS Wales
Number of attendances in month1,439,432127,19368,225
– average attendances per day in the period46,4333,6342,201
% of total GB attendances – based on daily averages in December89%7%4%
    
% treated WITHIN 4 – hour wait from arrival to discharge, transfer or admission49.6%Between 56.0% and 63.3% (average 58.9%)53.7%
    
number waiting OVER 8 hours from arrival to discharge, transfer or admissionnot reported20,199 (15.9% of attendances)18,666 (27.4% of attendances)
    
number waiting OVER 12 hours from arrival to discharge, transfer or admissionnot reported8,984 (7.1% of attendances)11,972 (17.5% of attendances)
    
emergency ADMISSIONS via ALL EDs385,704N/AN/A
number waiting OVER 12 hours from DECISION TO ADMIT TO ADMISSION across ALL EDs54,532 (14.1% of reported number of emergency admissions)not reportednot reported

* Note: Data for England and Wales are reported for the calendar month of December (i.e. 31 days). For NHS Scotland, the data in the table come from weekly reports spanning the period from w/e 4 December to w/e 1 January 2023 (i.e. from 28 November to 1 January or 35 days).

Be alert – BBC News reporting’s about!

On 19 January, in the Wales section of the BBC News website under an article headed ‘Ambulance response times: Services in Wales see record lows’, we learn this:

‘Waiting times in A&E were also the worst on record with only 63.1% of people seen within the four hour target. The worst was at Morriston Hospital in Swansea, where only 43.7% were dealt with within that time in December.

‘Those waiting more than 12 hours or more were also at record levels – and numbers passed the 12,000 mark for the first time.’

Note that the Morriston Hospital has a ‘Major’ ED. The figure of 63.1% seen within the four hour target given by the BBC is for the performance of ALL EDs in Wales, including minor injury units. The national figure for ‘Major’ EDs is just 53.7% (as given in the above table). There is a significant distinction being ignored by the BBC: there is a big difference in the performance figures being ignored here!

In the Health section of the BBC News website on 9 January 2022, under the headline ‘We couldn’t get an ambulance for my husband then he died’, we learn this:

More than a third of patients in A&E waiting longer than four hours’.

So more than 33% of patients were waiting too long! The figures for December published by NHS England show that indeed 35% of patients waited over four hours but this is the statistic for ALL departments, including minor injury units. The official data on major EDs – Type 1s –  show that in December 50.4% of patients waited more than four hours before transfer, discharge or admission – so not more than a third, but more than a half!

The actual December performance statistics published by NHS England are as follows: just 49.3% of patients attending Type 1 EDs were treated within the four hour standard and 65% of patients across ALL EDs were treated within the same standard. These are significant differences! There is a significant distinction being ignored by the BBC: there is a big difference in the performance figures being ignored here!  Why did the BBC not report this straightforwardly? After all BBC Scotland manages to do this – every weekl!

On 2 January, the Scotland page of the BBC News website under the headline ‘A&E patients in Scotland enduring ‘inhumane’ conditions’ we learn this:

‘Scotland recorded its worst ever performance times at A&E in the week up to 18 December, with 55% of patients seen within the government target of four hours. This is down from 62.4% the previous week.’

Both these percentage figures are for the performance of Scotland’s MAIN EDs, the equivalent of England’s Type 1s. Unlike in England and Wales, the BBC in Scotland chooses (rightly IMHO) never to use the performance figure for ALL EDs.

The other high profile statistic used by the corporate media, the BBC and opposition politicians in Scotland is the number of patients waiting over 12 hours before transfer, discharge or admission. The number for some time has been too high – no-one is claiming otherwise, least of all the Scottish Government. However, the table above puts the Scotland figure in perspective.

The BBC and others report on over 12 hour waits in EDs in England but typically fail to mention the key distinction between how this metric is defined in England in contrast to how 12 hour waits are defined in NI, Scotland and Wales:

  • the NHS England statistic is ONLY the ‘trolley wait’ i.e. the time between the decision made to admit and the eventual admission – it is very different from the way 12 waits elsewhere.  The patients captured in the NHS England statistic will already have spent time (length not reported) from their arrival at the ED to the time when the decision to admit is made;
  • this facet of the NHS England measurement system has led the RCEM to state in its comment on the December data: “12-hour waits from decision to admit obfuscate the truth and are only the tip of the iceberg, we know the reality is far worse. We know that the scale of long-waiting times for Emergency Care is causing harm to patients and is associated with patient deaths.” Bear this in mind when comparing the statistics in the table above!

End note

The purpose of this ‘A&E Compare’ blog post is NOT to underplay the seriousness of the marked under-performance against waiting time standards in NHS Scotland. There is an urgent need to find ways to do better even though undoubtedly performing relatively much better than its peers.

One purpose is to shed further light on the hypocrisy of opposition politicians in Holyrood most notably the ministerial ‘scalp hunters’, the Tory Dr Gulhane and Labour’s Ms Baillie whose parties are in government and have responsibilities for the NHS in England and Wales respectively. Are their colleagues in Westminster and Cardiff simply opting to ignoring the ‘silver bullet’ solutions they (apparently) have, the ones they are relentlessly pressing on the Scottish Government?

The purpose is also to show up differences in BBC editorial practices across the UK – but then evidence of this is already well known to regular visitors to TuS!

And of course the purpose more generally is to provide relevant context and perspective on the performance of NHS Scotland and indirectly, the Scottish Government and its Cabinet Secretary for Health – to fill the void left by the corporate media and the BBC!

Sources

NHS England: https://www.england.nhs.uk/statistics/statistical-work-areas/ae-waiting-times-and-activity/ae-attendances-and-emergency-admissions-2022-23/

NHS Scotland: https://www.nhsperforms.scot/

NHS Wales: https://statswales.gov.wales/Catalogue/Health-and-Social-Care/NHS-Hospital-Waiting-Times/emergency-department

RCEM statement on NHS England: https://rcem.ac.uk/rcem-how-far-does-emergency-department-performance-need-to-fall-for-political-leaders-to-take-meaningful-action/

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12 thoughts on “‘A&E Compare’ – a service for BBC-reliant Tory and Labour loyalists in Scotland?

  1. Stewartb,
    A timely post because tonight CH4 News will be covering Scotland’s NHS. Last night, Thurs, they covered the NHS in Wales, Wed was NHSE and Tuesday was NHS NI.

    I noticed last night they reported the 63% figure for A&E in Wales and I knew immediately that they were using the figures for all A&E depots.

    I expect tonight on CH4 news they will use the Scottish A&E figures then compare them to Wales etc but not make clear or even mention the differences between the various NHS groups as to how they collect the data.

    It is not just the BBC that hides the true state of things CH4 is perfectly capable of doing it too.

    TUNE in to CH4 news tonight and take notes.

    Liked by 2 people

    1. Is there a way of disseminating this post, or the statistics it includes, more widely? It is very valuable and needs to be more widely understood, but TuS readers are as you say already aware of the misrepresentation that is prevalent.

      Liked by 1 person

        1. Yes, John, I do appreciate all your efforts and acknowledge the difficulties. Maybe sending selective blogs, such as the one with comparative health figures today, in a different format to selected media would be worthwhile? It would be an advance if even ‘The National’ were to publish it.

          Liked by 2 people

    2. Yes, despite its much self trumpeted radical approach Ch5 News has always adopted an anti Scottish devolution and independence line. When questioning any SG member an aggressively hostile, sneering and blustering approach is always used with a ‘have you stopped beating your wife yet?’ style of questioning. Creepy Ciaran always reports negatively. Indeed, the risible Jon Snow once introduced a piece with, ‘Ciaran will now tell us about the fire situation in Scotland.’ Ch4 News has no Scottish presenters or reporters, but there are English, Irish, Welsh, ones and others from ethnic backgrounds and, indeed, with disabilities. This diversity, is welcome, but for the obvious omission.

      Liked by 1 person

  2. When less than half of patients are seen within 4 hours at Englands A&E it’s no wonder they don’t publish the figures for those waiting more than 8 hours and those waiting more than 12 hours clearly the figures are so bad they are hiding them

    Liked by 3 people

  3. I’m sure you don’t mean to praise BBC Scotland for publishing the correct ED-only results for 4 hour performance. 😨

    The BBC does not publish the correct weekly figures for Scotland by choice. It does that because they are the only weekly figures that are published. And you have to dig a bit to find out that they are ED-only, so they don’t bother to mention that – it might draw attention to the fact that the data for England is not comparable.

    Comparisons are not helped by the fact that NHS England only provides monthly data.

    Has anyone spotted a BBC reference to the RCEM data, which shows NHS England in its true light?

    Liked by 2 people

  4. The Scottish Gov has put in funding to unblock beds. Funding places for people to go. Non urgent operations have been suspended for Feb. To free up more Doctors for emergencies. Jan and Feb are the worst months for illnesses by comparison. Something is being done to spread the load.

    The usual Tory is calling for payment for GP – hospital appointments. The Tories underfunding the NHS. From 2015 to 2020. Spending monies on projects of no value. HS2, Hickley Point etc and escalation war in Europe, The Brexit disaster losing £Billion and not cutting migration. Migration caused by Westminster infernal and eternal wars. To try to distract from Westminster bad, poor decisions. An absolute shambles of governance. . .

    Liked by 1 person

  5. Professor Robertson another outstanding piece of work you really are the best at this , you uncover the sneaky methods used by NHS managers and Westminster officials aided by BBC and other media to hide what are scandalous performances and degradation of services in Englands NHS healthcare , they must be boiling it takes a lot of joint effort for then to concoct their conniving lies and misleading statistical reports.
    Well done , thank you , I’m heartened that we have someone like you with the brainpower and determination to give us this information i just with WGD scotgoespop etc etc would add your information to their so that all blogs cover everything , is there no plan for sharing and collaboration on the horizon.

    Liked by 1 person

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