By Professor John Robertson
Wes Streeting, Shadowy Health Secretary has just committed to the astonishing pledge that NHS England’s A&E departments, currently seeing less than 60% within 4 hours, will within one-year, be seeing 95%.
It’s such a wild contrast with everything else Labour is saying, making no promises, that he’s either lost the plot or has a sneaky New Labour plan in mind.
He’ll tell them to cheat.
They’ve done it before.
In October 2023:
NHS bosses are using misleading figures to hide dangerously poor performance by A&E units in England against the four-hour treatment target, emergency department doctors claim.
Some A&Es treat and admit, transfer or discharge as few as one in three patients within four hours, although the NHS constitution says they should deal with 95% of arrivals within that timeframe. How well or poorly A&Es are doing in meeting the 95% target is not in the public domain because the data that NHS England publishes is for NHS trusts overall, not individual hospitals.
That means official figures are an aggregate of performance at sometimes two A&Es run by the same trust or include data for any walk-in centres, minor injuries units or urgent treatment centres that a trust also operates. Forty-eight trusts have two A&Es and many also run at least one of the latter.
In June 2022:
NHS England also had the dubious practice of restarting the clock after patients are admitted whereas in Scotland counting continues from first arrival. See this:
And in June 2021:
The Royal College of Emergency Medicine, in its call for a ‘Summer to Recover‘ campaign, outlines a series of recommendations to ensure that Emergency Departments do not become the system failure service this winter.
The above, from 4 key requests, will strike a chord with TuS regulars. For more than a year now, I’ve been reporting on NHS Scotland’s superior A&E performance and noting that the gap is almost certainly even greater because NHS England fiddles its data.
Talking-up Scotland / Facts on NHS, Crime, ferries and everything else you can think of 
If that is a PLEDGE then no worries – Starmer will have told him to renege on it before the end of the day . If it is a prediction then Nostrodamus’ position is safe .
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There is another clever wheeze available to Mr Streeting it seems, one tried and tested by Labour in Wales. Perhaps he intends NHS England’s A&E waiting times performance reporting to adopt the practice the Labour government in Cardiff has been using to massage the A&E waits performance in Wales. Perhaps we’ll see NHS England under a Labour health secretary introduce the ‘breach exemption’?
From the BBC News website’s Wales section (16 October, 2023): ‘NHS Wales: Thousands of hours missing from A&E figures – doctors’.
In this we learn of the Royal College of Emergency Medicine’s (RCEM) claim that it could not measure “how bad” things were in NHS Wales ‘because thousands of patients subject to so-called “breach exemptions” were not included in the number of long waits in A&E.’(my emphasis)
The BBC article explains a ‘breach exemption’: ‘Doctors don’t normally want to keep patients in emergency departments any longer than necessary, but they are able to in certain circumstances. These are called “breach exemptions” – as they breach the four, eight and 12-hour waiting targets for A&E.
The article lists the exemptions and notes: ‘The patient is unlikely to know if they fall into this category and they might not notice the difference in the care they receive. But the RCEM said any time spent in A&E from that point on does not count towards the official monthly statistics on how long they wait. It said Wales was the only UK nation to do it this way.’
And on the statistical significance of this recording practice: ‘FOI responses to the RCEM show that in the first six months of this year, 38.7% of patients in Wales waited longer than four hours in A&E departments. When breach exemptions were included, as they were in other parts of the UK, the figure was 50%. That’s more than 45,000 long waits – or 12% – removed from the figures.’
‘From January 2012 to June this year, more than 670,000 patients were not included in published figures – 23% of the total.’
One can see the attraction of this tried and tested Labour practice in Wales for a prospective Labour health secretary in Westminster making seemingly unrealistic claims in an election campaign!
It’s worthwhile recapping: (i) the RCEM has called out the Labour government in Wales for the use of breach exemptions to massage the statistics; (ii) the RCEM has previously called out the Tory government in Westminster for its practice of measuring long waits in England’s A&E department from ‘decision to admit’ rather than from ‘time of arrival’ – the RCEM eventually forced a change; and (iii) the RCEM in its monthly reviews of waiting times performance across the UK has long demonstrated that NHS Scotland is by far the best performer.
And yet, the RCEM consistently fails to acknowledge such distinctions – viz. a better performance and with more honest reporting in Scotland. Moreover, it is the Scottish Government and NHS Scotland that is held up by Tory, Labour and Lib Dem politicians and by the mainstream media for the most intense and persistent, negative criticism. And now on political panel programmes and media interviews, even the mention of a comparative analysis favouring NHS Scotland is dismissed as of no relevance.
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