What impact ‘perspective’? – the case of NHS performance.

By stewartb

A longstanding theme in TuS is that when debating the performance of public services and of the associated responsible government, context and perspective are valuable inputs to decision making by voters. It is also a recurring theme that despite having public service broadcasting with an obligation to inform operating alongside commercial news media, Scotland is ill-served. Candidly, it is commonplace to experience BBC Scotland as a void when it comes to the provision of context or perspective.

The case of NHS Scotland

The NHS performance metric of greatest concern to the Royal College of Emergency Medicine (RCEM) – a go-to source of comment for BBC Scotland – is the number of patients in major/Type 1 Emergency Departments  (EDs) across the UK waiting 12 hours or more from arrival to discharge, transfer of admission. Although contested, the RCEM argues for a direct link between such long waits and excess (avoidable) deaths.

The RCEM’s website compiles time series data on waiting times in major/Type 1 EDs (see its ‘NHS Performance Tracker’). It published the graph below which plots number of 12 hour waits as a percentage of total ED attendances across the period January 2018 to January 2023.

The graph reveals the extent of 12 hour waits experienced by patients of NHS Scotland to be substantially – arguably dramatically – lower than in any other part of the UK!

Who thinks that voters would gain this view of NHS Scotland’s performance from the BBC, the mainstream corporate media or the ‘outraged’ comments of opposition politicians in Holyrood?

(Note: the RCEM is presently in dispute with NHS Wales: it argues that due to the exclusion from performance data of so-called ‘breach exemptions’, long waits in Wales are under-reported.)

Comparing four hour waits

The graph from the RCEM below compares performance against the four hour waiting time standard across the UK, from January 2011 to February 2023. (Note the Y-axis is labelled incorrectly; it should read ‘< 4 hours’ as evidenced by the caption below the graph.)

The performance figure for NHS Scotland (the pale green line) is the highest (the best) over the past decade albeit its overall downward trend is not so dissimilar to that elsewhere. (Note the blue line, denoting the performance of the NHS in Labour-run Wales – a remark made not to have a pop at the Welsh Government but to reflect on persistent negativity of Labour leaders in Holyrood over Scotland’s NHS and government.)

The graph reveals the extent of 12 hour waits experienced by patients of NHS Scotland to be substantially – arguably dramatically – lower than in any other part of the UK!

Who thinks that voters would gain this view of NHS Scotland’s performance from the BBC, the mainstream corporate media or the ‘outraged’ comments of opposition politicians in Holyrood?

(Note: the RCEM is presently in dispute with NHS Wales: it argues that due to the exclusion from performance data of so-called ‘breach exemptions’, long waits in Wales are under-reported.)

The RCEM and excess deaths

As mentioned earlier, the RCEM argues that long waits in A&E lead to avoidable deaths. It provides estimates of the potential scale in a table, reproduced below.

(As best as can be ascertained, the data are from around 2021/22. The ‘SMR methodology’ refers to ‘Standardised Mortality Ratio’. The number of long waits divided by 76 equates to the likely number of excess deaths based on the research upon which the RCEM relies. For more on the basis of this calculation see https://rcem.ac.uk/data-statistics/. For more on the issues raised by the RCEM’s claim see https://fullfact.org/health/accident-emergency-delays-excess-deaths/ .)

Using the RCEM’s claims, the totals in the table are revealing of the situation pertaining in NHS Scotland given the relative scale of the four nations of the UK.

Who thinks that voters in Scotland would gain this view of NHS Scotland’s performance from …!