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 *

Metric	NHS England	NHS Scotland	NHS Wales
Number of attendances in month	1,439,432	127,193	68,225
– average attendances per day in the period	46,433	3,634	2,201
% of total GB attendances – based on daily averages in December	89%	7%	4%
% treated WITHIN 4 – hour wait from arrival to discharge, transfer or admission	49.6%	Between 56.0% and 63.3% (average 58.9%)	53.7%
number waiting OVER 8 hours from arrival to discharge, transfer or admission	not reported	20,199 (15.9% of attendances)	18,666 (27.4% of attendances)
number waiting OVER 12 hours from arrival to discharge, transfer or admission	not reported	8,984 (7.1% of attendances)	11,972 (17.5% of attendances)
emergency ADMISSIONS via ALL EDs	385,704	N/A	N/A
number waiting OVER 12 hours from DECISION TO ADMIT TO ADMISSION across ALL EDs	54,532 (14.1% of reported number of emergency admissions)	not reported	not 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/