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By stewartb

So it’s true – the ONS has confirmed that NHS Scotland has the best performing A&E services in Britain in terms of waiting times. What’s more, it has been a top performer for over a decade. This may come as a shock to many voters in Scotland given it runs counter to BBC Scotland’s framing and to the ‘outraged’ media performances by a Labour Party dame and a Tory in scrubs with a ‘cool’ hairdo.

Source: ONS (28 February 2024) Accident and Emergency wait times across the UK: 2024 – A summary of the cross-UK comparability of Accident and Emergency wait time statistics from January 2013 to September 2023. (https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/articles/accidentandemergencywaittimesacrosstheuk/2024-02-28 )

On comparability

The ONS article is produced in partnership with NHS England, Public Health Scotland, Welsh Government, Department of Health Northern Ireland and the Department of Health and Social Care. It is ‘part of a cross-government approach to improve the coherence of Accident and Emergency (A&E) wait time data and improve understanding of the trends of this data over time.’

The ONS briefing explains: ‘Based on our analysis, we have collectively determined that A&E wait time policies in England, Scotland, and Wales are broadly comparable.’ (my emphasis)

‘… our analysis determined that healthcare policy definitions and data collections of Type 1 Departments (England), Emergency Departments (Scotland) and Major Emergency Departments (Wales) are similar, allowing for broad comparisons of A&E wait time data from these departments to be made. Other types of A&E department cannot be included within cross-country comparisons, as their definitions within respective healthcare policy differs too greatly.’

Standards

The ONS confirms that all UK countries have a “four-hour standard” that at least 95% of attendances are admitted, transferred, or discharged within four hours of their arrival at any type of A&E department. However, this was changed for NHS England in December 2022, when it implemented an ‘intermediate minimum standard’ where at least 76% of A&E attendances should be seen within four hours: this was in response to increased pressures on A&E services. England will continue using the original (95%) four-hour standard from March 2024.

ONS findings – waiting times

The following graphs are reproduced from the ONS publication. Candidly, they are self-explanatory in revealing the longstanding and substantially better performance of NHS Scotland compared to its peers. However, one particular feature stands out: although prior to early 2015 the performance of the NHS in England and Scotland on this metric was similar, the NHS in Wales has consistently been the poorest performer from at least 2013 up to around mid-2022 when its performance became broadly similar to that of NHS England and still inferior to Scotland’s.

Both graphs reveal that across the UK, NHS A&E services have been struggling as exemplified by progressively poorer performances against the four-hour A&E standard which pre-dates the pandemic. So this is a UK-wide problem that has coincided at least in part with a prolonged period of austerity.

Now which government with responsibility for a nation’s NHS has ALL necessary agency to determine how much to invest in its health and social care services as well as in all its other public services’ responsibilities? Unlike the spokespersons for opposition parties in Holyrood, we know it’s alway and only the one in Westminster. And of those governments with the limited powers of devolution that have been faced with Westminster-imposed austerity, which party of government and which NHS has the better performing A&E? Despite what BBC Scotland and its goto Labour dame may try to imply, it’s the SNP-led government and NHS Scotland: in over at least a decade it NEVER has been Labour-led Wales!

ONS findings – number of attendances

The ONS acknowledges that one factor to consider when interpreting A&E wait times is the changing number of A&E attendances over time. It considers that on this metric direct comparison can be made across all four nations (Figure 3).

The graph reveals that per capita, NI has the highest rate of A&E attendances and this figure has increased steadily over the period 2013 to 2019. In Scotland and Wales, the rate has remained fairly stable since 2013 except over the period of the pandemic. The most notable feature of the graph is the marked decrease in the rate of attendances in England in the years prior to the pandemic and continuing to drop in 2022-23: a trend of a decreasing rate of attendances per 1,000 population each month in England’s Type 1 emergency departments coupled with an increasing percentage of over four hours waits! 

Performance on long waits

Much attention is paid by the Royal College of Emergency Medicine (RCEM) to overly long waits in A&E. Unfortunately the ONS has not undertaken a comparative analysis of this metric so far. However, the RCEM addresses the matter: the graph below on 12-hour waits reproduced from its website is revealing. Once again, the best performing A&E service in terms of minimising long waits is, by a substantial margin, NHS Scotland – and based on the RCEM plot, it has performed best on this metric since at least January 2018.

Source: https://rcem.ac.uk/data-statistics/

End note

The performance of A&E services matter to people, and to voters! A&E waiting times statistics have been elevated to an iconic status in Scotland: they have been politicised to a degree not seen anywhere else in the UK. This has been facilitated most notably by BBC Scotland over a number of years. Given the verified performance data set out above, it is clear that ‘politicisation’ as a tactic deemed favourable to opponents of the SNP in government is only possible so long as the general public remains less than well informed of the comparative analyses provided by the ONS and the RCEM. Just more misrepresenting and misinforming Scotland for political ends!

No-one – including in the Scottish Government and Scotland’s health boards – would seek to claim that the length of time patients are having to spend in emergency departments is acceptable.

However, the impact on public (and voter) opinion in Scotland is very likely to be different – at the very least have ‘negatives’ somewhat moderated – if BBC Scotland and others in the mainstream media here did two quite reasonable things: (i) offer their audiences context and perspective through amplifying the kinds of UK-wide comparisons published by the ONS and the RCEM; and (ii) challenge leading Labour and Tory politicians in Scotland on the track record of their own parties in government when it comes to the NHS. The hypocrisy of leading Labour politicians in Scotland is especially egregious given the evident difficulties the Labour government in Cardiff has been experiencing over an extended period of time in carrying out its responsibilities for improving the performance of NHS Wales.

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