’A fundamentally dishonest way of reporting data’ – from House of Lords’ committee report on NHS England’s A&E waiting times.
On hearing the evidence, Lord Bichard, a cross-bench peer, responded: ‘What you have just said is pretty devastating because the great British public thinks it is one thing but it is far worse.’ A consequence of failing mainstream British journalism, notably the PUBLIC SERVICE broadcaster’s several health ‘experts’?
The latest assessment of the state of the NHS comes from the House of Lords (HoL) Public Services Committee. This is a diverse body: it has a Labour peer as Chair, three other Labour members, three Tory members, two Lib Dems and two cross-benchers. The focus of the committee’s report is emergency healthcare in England.
Source: Public Services Committee, House of Lords (19 January, 2023) Emergency healthcare: a national emergency (https://publications.parliament.uk/pa/ld5803/ldselect/pubserv/130/130.pdf )
For anyone relying on the BBC for information and ‘insight’ into the present state of the NHS this report may be revelatory!
LONG A&E WAITING TIMES
The following are extracts from the HoL report (with my emphasis):
Committee report Para 80: ….’The long waiting times highlighted in chapter 2, ‘A national emergency’, demonstrate that patients face serious delays in accessing emergency healthcare. We heard that the way waiting times are published on a monthly basis diminishes the scale of the problem.’ (Note: Scotland is the only nation that publishes waiting times data for its main A&E departments weekly!)
Para 81: ‘The data NHS England publishes monthly show the number of patients who wait 12 hours or more after a ‘decision to admit’, when a clinician decides a patient should be admitted to hospital, but not the number of patients who wait 12 hours or more after arriving at A&E. The data on 12 hour waits from arrival are gathered and shared with NHS England and Integrated Care Systems, but are not published alongside other monthly data, instead being published annually.’
And on the significance of this particular measurement methodology – Para 82: ‘The Royal College of Emergency Medicine report that in August 2022, over 133,000 patients waited more than 12 hours from arrival at A&E – a figure five times higher than the 28,000 reported by NHS England.
‘Dr Adrian Boyle, President of the Royal College of Emergency Medicine, argued that this manner of reporting waiting times was “a fundamentally dishonest way of reporting data. It is hiding and doing our patients a disservice by minimising a very serious problem”. Strong words!
(Note: NHS Scotland publishes A&E waiting times for its main A&E departments from time of arrival to transfer, discharge or admission – AND does so weekly!)
Figure 1 below, reproduced from the HoL report, plots the 12 hour waits as presently published monthly by NHS England. It only measure those attendances that lead to an admission and only the time from the decision to admit being take. Note the steeply rising trend from around August 2021.
Figure 9 below, from the same report, compares over time the difference between the two measures of 12 hour waits in England: (i) from decision to admit (DTA); and (ii) from time of arrival (TOA). Note the scale of discrepancy!
Elsewhere in the HoL report there is this re-statement: ‘To demonstrate, in August 2022, 133,286 people waited in A&E for over 12 hours. Of these, over 100,000 were not reflected in the data published monthly.’ – and therefore NOT reflected in UK news coverage by the BBC and corporate media!
And it’s not just the RCEM that finds aspects of NHS England’s reporting unsatisfactory!
Para 83: ‘In July 2022, the Office for Statistics Regulation wrote to NHS England arguing that there was a “clear need for more frequent figures” and requesting that the 12 hour from arrival data be published monthly. When questioned on this (in one of the Committee’s evidence sessions), Dr Vin Diwakar (Medical Director for Transformation and Secondary Care, NHS England) stated “the decision about what data to publish is not one NHS England can take alone.” Professor Julian Redhead (National Clinical Director for Urgent and Emergency Care, NHS England) indicated that there was discussion between NHS England and the Department of Health and Social Care on this topic, noting that it was “one measure out of a suite of measures” that was being considered.’ (Is it only in Scotland that the BBC follows up on critical comments from the official UK statistics regulator?)
A&E DEMAND AND MORE ON LONG WAITS
Expanding on the matter of long waits in A&E, during an oral evidence session held by the Committee, the RCEM’s Dr Boyle reported: ‘Hospital episode statistics about the number of people going to emergency departments do show an increase. However, the majority of that increase is in type 2 and type 3 emergency departments. These are urgent treatment centres, eye units, minor injuries units. The number of people going to type 1 emergency departments—what you and everyone recognise as the major emergency departments—has stayed pretty static for about the last two or three years. There are areas where it goes a little bit up, where you have population growth or where there has been a merger at the hospital. The problem is really not to do with increased demand.
‘Our big problem is with the length of stay within emergency departments and the inability to admit people into hospitals. The problems are largely all about the flow through emergency departments.’ (See more on the issue of delayed discharge below.)
Boyle goes on: ’There is a problem—particularly in England to a great extent and to a lesser extent in Wales—with the recording of very long stays in emergency departments.’ He then explains the issue with the use of DTA waits in England before adding: ‘I agree with Lord Bichard and pretty much everyone who thinks about this problem in any way that it is clear that it does not matter when that decision to admit is made. What really matters is how long the patient has been waiting in the emergency department. This has been routine for a number of years in Northern Ireland and Scotland, and it is a much more robust measure.’
Boyle went on: ‘The consequence of using a DTA metric—the decision to admit metric—is that it underestimates and conceals the true scale of the problem. We think it underestimates the scale of the number of people who are suffering long stays in emergency departments. In August 2022, 10% of all attendances to type 1 emergency departments spent longer than 12 hours from the time of arrival. The DTA metric was 2%, so it is underestimating it fivefold.’
In direct response to Boyle’s explanation, Committee member Lord Bichard, a cross-bench peer, states: ‘What you have just said is pretty devastating because the great British public thinks it is one thing but it is far worse.’
Perhaps BBC Scotland might like to share the following with its licence payers as part of its obligation to ‘inform’: it would help fill the context/perspective void that typifies its politicised news coverage in Scotland of the NHS. Based on the evidence received, the Lords’ Committee concludes – Para 84: ‘The current data published by NHS England on emergency department waiting times inaccurately portray the true waiting times experienced by patients attending A&E. NHS England should publish monthly the number and proportion of patients waiting 12 hours or more from arrival at accident and emergency departments.’ In other words, it should be following the transparency practiced in Scotland!
COMPARISONS WITH A&E IN SCOTLAND
The Lords’ report quotes the RCEM’s illustration of 12-hour waits in England from August 2022: specifically it reports the following:
- 10% of all attendances at Type 1 (the major) A&E departments waited over 12 hours from arrival – NHS England had reported a figure of just 2% i.e. a fivefold underestimation
- 133,286 people waited in A&E for over 12 hours in August 2022: the figure reported by NHS England was just 28,000 (from Para 82 of the Lords’ report).
What was the scale of 12-hour waits in the main A&E departments in Scotland during this illustrative benchmark month of August 2022?
- number of attendances = 130,882 (week ending 7 August to w/e 4 September 2022)
- number of over 12 hour waits to transfer, discharge or admission = 5,421
- % of attendances experiencing an over 12-hour wait = 4.1% (Recall, the RCEM gives a figure of 10% for the equivalent metric in England!)
And whilst we’re making comparisons, let’s look at the percentage of attendances at the major A&E departments that were transferred, discharged or admitted within the commonly applied four standard:
- NHS England = 58%
- NHS Scotland = between 64.9% and 67.7% (range across the weekly reporting periods)
And for completeness:
- NHS Wales = 55.9%.
Interestingly, on the other much discussed matter of delayed discharge from acute hospitals, the Lords Committee concludes that: ‘NHS England should resume publishing the Delayed Transfer of Care dataset’. More lack of transparency?
On this issue, the Committee states – Para 92: ‘As established in chapter 2, there are substantial numbers of people medically fit for discharge but who remain in hospital. Authoritative data on the reasons for this is collected, but it is not publicly available. In February 2020, for capacity reasons at the beginning of the COVID-19 pandemic, NHS England paused publication of the relevant dataset, the Delayed Transfer of Care dataset. NHS England states that they will “keep the paused collections under review to establish at which point further collections should be reinstated”.
The Committee report adds: ‘As with the other data points noted in this chapter, a lack of information hampers decision makers. Information that is available, but not to the public, impedes scrutiny, challenge and accountability.’ In Scotland delayed discharge data are published routinely.
How does the Westminster Government’s Department of Health and Social Care and successive Secretaries of State get away with this? Where are the equivalents of BBC Scotland journalists relentlessly pursuing a government over NHS waiting times when the good people of England are in need of them? Where are the ministerial scalp hunters in Westminster to rival our very own Dr Gulhane and Ms Baillie? Is there something afoot in Scotland that goes beyond concern about the NHS?