By stewartb
After a long-running campaign by the Royal College of Emergency Medicine (RCEM), NHS England has altered the way it reports monthly performance data on long waits by patients attending its major (Type 1) A&E departments.
In evidence to a House of Lords committee (on 19 January 2023), the prevailing practice of measuring 12-hour waits from the time of a ‘decision to admit’ (DTA) rather than from ‘time of arrival’ (TOA – as in Scotland) was described by Dr Adrian Boyle, President of the RCEM as “a fundamentally dishonest way of reporting data. It is hiding and doing our patients a disservice by minimising a very serious problem”.
NHS England has relented and published the first set of monthly data (for February 2023) on 12 hour waits measured from time of arrival at A&E to admission, transfer or discharge. This addresses an anomaly consistently highlighted here on TuS and just as consistently ignored by the corporate media and the BBC when reporting negatively on NHS Scotland.
Sources:
The ‘honest’ reporting
Here are the performance statistics for Type 1 A&E departments in NHS England for February 2023:
- Total attendances = 1,185,185
- Attendances waiting >12 hours from arrival = 125, 505
- 12 hour waits as % of attendances = 10.6%
Other performance data for NHS England’s Type 1 departments for February 2023 include:
- % attendances admitted, transferred or discharged within 4 hours = 56.8%
The latest performance data for Type 1 departments for March 2023 include:
- % attendances admitted, transferred or discharged within 4 hours = 56.8%
See ‘Supplementary ECDS Analysis February 2023 final (XLS, 220K)’ for the newly published 12 hour waits from arrival data.
An ‘honest’ comparison with NHS Scotland
- Total attendances at main A&E departments (equivalent to Type 1s) in February, 2023 = 94,911 (aggregating w/e 5 Feb to w/e 26 Feb)
- Number waiting > 12 hours from arrival to admission, transfer or discharge = 4,587 w/e 5 Feb to w/e 26 Feb)
- 12 hours waits as % of attendances = 4.8% – compared to 10.6% in England!
Over four weeks in March 2023, the number of 12 hour waits in Scotland amounted to 5.1% of attendances.
And on the 4 hour wait metric (range is across four weekly reports):
- % attendances admitted, transferred or discharged within 4 hours in February 2023 = between 64.3% and 68.5% – compared to 56.8% in England
- % attendances admitted, transferred or discharged within 4 hours in March 2023 = between 62.9% 68.9% – compared to 56.8% in England.
Source https://www.nhsperforms.scot/
End note
Today’s BBC Radio 4 news coverage of the latest A&E waiting time statistics for NHS England persists in reporting the four hour performance metric for ALL A&E departments, currently c. 71%. This is usual practice: as best as I can tell, the BBC NEVER reports on the always much poorer four hour performance metric for just the major (the Type 1) departments in England, currently c. 56%.
Isn’t this odd? It is in sharp contrast to the RCEM’s press statements issued most months to comment on the latest data for A&E performance in England: the RCEM ALWAYS focuses on the performance of Type 1 departments! BBC Scotland prefers reporting on Type 1 equivalents in Scotland.
How very different the polity we have in Scotland would be if (even just) the BBC – the much trumpeted ‘public service’ broadcaster after all – reported in a consistently even-handed, objective and balanced manner the better to inform its users!
Talking-up Scotland 
Thanks for this.
Since the unionist trope is ‘we’re all one country’ as in the 62% remain vote in Scotland is irrelevant because ‘we(sic) voted as one country (i.e. Britain/England)’ what the Scottish based media will now do is report the England, i.e. UK in their minds, data, since they are worse than Scotland’s and headline it “A&E WAITING TIMES SOAR!”
PS I contacted The Guardian re an article headlined the ‘deadly condition of Britain’s waters’, but which was entirely about England. I got a reply, by return, acknowledging the error and stating they had amended the heading and article to make clear it was about England. They sent a link, and, indeed, they had adjusted it!
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Well done!
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However, sadly, Open Democracy published a similar article by Feargal Sharkey, on ‘the state of Britain’s (sic) waters’. It was pretty much the same article which the Daily Ranger headlined. He, too, was talking about water in England. Being from Northern Ireland he ought to have known better.
Sadly, OD ought to have known, too. I posted a rebuttal on the site, but for some particular reason it appeared below an entirely different article elsewhere on the site! Gremlins?
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I have noticed The Guardian is using ‘England’ more often, and more accurately, in its headlines over the last week or two rather than its usual, and inaccurate,’UK’ especially when reporting on sewage contamination of England’s rivers. What else could they do once Sir David Attenborough stated all English rivers were polluted in his Wild Isles programme. I should imagine your letter, Alasdair, was the last straw.
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Could well be called SOP for all unionist communications.
Scream the lie with bright flashing lights if required, when challenged, quietly state the truth in the corner.
What then does the public remember the half page headlines or the small correction at the bottom of the inside column on page five a week later.
To stop most of the lies. Create a legal requirement for corrections to be given the same prominence and duration and reference as the lie.
P.S. obviously we all know there is a point reached with the screaming and flashy lights, where it becomes ‘don’t look there look here’. Unfortunately defining that point is difficult.
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On the subject of A&E waiting times I noticed that the BBC news at six on Thursday used the 71%;figures when reporting on the A&E 12-h waiting times. I did think they were a bit odd but were obviously used to make NHSS look bad. Worst of all though were the figures for NI at ca 45%.
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Since the Tory agenda is greater privatisation of the NHS, bad stories help to change public opinion (in a mendacious way) and, since the BBC has dropped most pretence at being a Tory propaganda station, you are probably right in your speculation.
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To follow up on the main blog post, what follows comes from the Royal College of Emergency Medicine’s (RCEM) comments (13 April) on the latest A&E performance figures published by NHS England for March 2023. It’s provided at length here because I suspect it will receive little or no media coverage: it may be only BBC Scotland that (selectively) covers RCEM statements.
The commentary is worth remembering next time the Scottish Tories – including Dr Gulhane – berate the Scottish Government and NHS Scotland. After all, Gulhane’s party is not only responsible for the NHS in England but in government it also has access to ALL the financial powers necessary to fix the resourcing problems IF it wished to do so!
Dr Adrian Boyle, President of the RCEM said this about the status of A&E in England (with my emphasis): “Emergency Care REMAINS IN CRISIS. NHS England’s Urgent and Emergency Care delivery plan is a welcome step towards the recovery of Emergency Care. As part of this, we welcome NHS England’s initiative on publishing 12-hour length of stay data measured from the time of arrival, but FURTHER ACTION CANNOT BE DELAYED.
“Emergency Department performance REMAINS POOR, ACUTE BED NUMBERS ARE LOW WHILE BED OCCUPANCY NUMBERS REMAIN DANGEROUSLY HIGH. Flow through our hospitals is EXCEPTIONALLY SLOW, leading to delays to admission and delays in Emergency Departments.
‘The CONTINUED LACK OF RESPONSIVE SOCIAL CARE means we are unable to discharge patients in a timely way – keeping patients in hospital longer than necessary.
‘We are hugely disappointed that THE GOVERNMENT HAS CHOSEN TO HALVE FUNDING PLEDGED FOR SOCIAL CARE, this is a significant misstep that THREATENS THE RECOVERY OF EMERGENCY CARE. Good social care underpins an effective health service and cuts will only have A FURTHER DETRIMENTAL IMPACT ON PATIENTS.’
(On social care, the Institute for Government published an article under this heading recently: ‘Funding changes signal an end to the government’s ambitious social care reform package – .. the government’s latest announcement is short-sighted, stores up problems, and leaves a key manifesto pledge unfulfilled.’)
The RCEM continues: “BED OCCUPANCY AT TRUSTS IS DANGEROUSLY HIGH. We must see an the expansion of the acute bed base, the NHS Urgent and Emergency Care delivery plan pledges ‘funding of £1 billion for additional capacity, including 5,000 new beds as part of the permanent bed base for next winter’ – SINCE THIS PLEDGE WAS MADE IN JANUARY THE ACUTE BED BASE HAS MARGINALLY DECREASED. NHS England and the Department of Health and Social Care must prioritise this to reduce delays to admission and overcrowding in Emergency Departments.
“Alongside this, we reiterate the urgent need for the publication of the fully-funded long term workforce plan that the government have pledged to deliver. This must contain workforce projections and figures and crucial measures to retain our existing workforce.
“HIGH BED OCCUPANCY, POOR PERFORMANCE, DELAYS TO ADMISSION, DELAYED DISCHARGES AND OVERCROWDING IN EMERGENCY DEPARTMENTS ARE DEEP ROOTED AND LONG-STANDING PROBLEMS. THEY ARE NOT NEW PROBLEMS CAUSED BY RECENT EVENTS AND DISRUPTION. These can only be tackled with medium- and long-term solutions that we lay out in our five priorities for UK Governments to #ResuscitateEmergencyCare – namely a renewed focus on beds, social care, and both workforce retention and long-term workforce planning.”
The RCEM statement also includes this performance summary for England: ‘In February 2023, 125,505 patients waited 12-hours or more from their time of arrival This accounts for 10.59% of Type 1 Emergency Department attendances. THIS IS 3.6 TIMES LARGER THAN THE NUMBER OF 12-HOUR WAITS MEASURED FROM DECISION TO ADMIT (34,976)’ – i.e. 3.6 times higher than what NHS England would normally have reported publicly!
‘The worst performing region was the North West. 13.7% of type 1 attendances waited 12 hours or more, 3.1 percentage points above the national average.
Source: https://rcem.ac.uk/publication-of-true-12-hour-length-of-stay-data-a-welcome-and-significant-step-for-emergency-medicine/
I commented earlier on the significance of the above for the credibility of Dr Gulhane and the Scottish Tories when berating the Scottish Government. However, since NHS Scotland often performs better than NHS England despite funding constraints on the Scottish Government that don’t exist for Westminster, there is, candidly, one other Scottish politician worth mentioning. It’s the one who in front of a national audience in a TV debate berated the then Scottish Government’s Cabinet Secretary for Health for the performance of NHS Scotland. I trust the individual in question has now at least ‘reflected’ on that performance!
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I usually enjoy cryptic puzzles but this one has me stumped.
Who is in the frame here?
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