By stewartb
Let’s begin by taking back control of the ‘framing’ from BBC Scotland: ‘A&E performance by NHS Scotland is indeed by far the best in UK’.
The Scotland section of the BBC News website on 4 October ran one of its regular features on the state of A&E services within NHS Scotland. The article was constructed around the remarks of the Vice President for Scotland of the Royal College of Emergency Medicine (RCEM). It followed a common pattern – negative, in parts alarmist, reported uncritically and without context or perspective.
And being a BBC Scotland article, it omitted that ‘A&E performance in Scotland is by far the best in the UK’. No one – including the Scottish Government – would quibble if the RCEM and BBC Scotland added the qualifier to this positive ‘fact’ with ‘but still needs to do much better’!
The RCEM is in this context using the profile of a BBC Scotland news article to influence public (and therefore voters’) opinion against the Scottish Government. Whilst its approach in failing to acknowledge what its own analysis clearly reveals (see below) may be problematic, the RCEM has no inherent duty to inform more fully, properly the public at large. The role of BBC Scotland as a public service broadcaster SHOULD be markedly different – and once again it fails miserably to meet its obligations.
Scope
This blog post:
- justifies the claim that ‘A&E performance in Scotland is by far the best in the UK’ using evidence from none other than RCEM analyses
- it goes on to compare specifically how A&E in two UK nations – both with governments with broadly similar devolved powers – performs: (i) in Scotland where the British Labour Party repeatedly denigrates the performance of NHS Scotland and the Scottish Government; and (ii) in Wales where the British Labour Party has been in power as long as Welsh devolution has existed
- it offers comment on how the language of RCEM communications in a Scottish and a Welsh context differs
- finally, it examines why the NHS – and other public services – are in such a poor state. In this it draws NOT on the statements of the SNP Scottish Government but on those of the British Labour Party government in Wales.
What the RCEM reports for 2023 On September 27, 2024 the RCEM published its Annual Report and Accounts for the year 2023. This contains a useful graphic (reproduced below) which summarises key performance statistics for NHS A&E departments in the four nations of the UK during the year:
There are a number of observations to make when comparing the 2023 information for Scotland with the other parts of the UK:
On percentage of patients in the year seen within the waiting time target of 95% discharged, admitted or transferred within 4 hours: Scotland = 66.10%; NI = 56.70%; Wales = 59.90%; England = 58.10%.
However, in a press release published on the RCEM’s website on 26 September, 2024 we read this prompted by newly released data from NHS England: ‘.. as important as the four-hour standard is, we know where the true danger lies; in the excessively long stays of 12 hours or more.’ (my emphasis.) The RCEM explains: ‘Over one in 10 people who turned up to our EDs (Emergency Departments in England) last year waited 12 hours or more to be seen, admitted, transferred or discharged’ i.e. over 10% of A&E patients in England experienced ‘true danger’.
So what does the above chart from the RCEM’s Annual Report for 2023 reveal about 12 hour stays across the nations of the UK?
On percentage of patients experiencing a 12 hour stay in A&E: Scotland = 56,268 out of 1,310,874 attendances i.e. 4.29%; NI = 109,084 out of 647,185 attendances i.e. 16.85%; Wales = 109,557 out of 775,571 attendances i.e. 14.12%; England = 1,520,578 out of 16,142,484 attendances i.e. 9.42%.
So in the RCEM’s terms, ‘true danger’ was experienced everywhere but surely the percentage point differences between NHS Scotland and the rest are remarkable, noteworthy – even newsworthy?
Just a good year in Scotland?
Perhaps the better performance of NHS Scotland’s A&E departments over the period referred to in the 2023 RCEM Annual Report is anomalous. Perhaps NHS Scotland just had a good year. Again the RCEM itself delivers the answer. The RCEM’s graph reproduced below plots time series data for 12 hour waits between January 2018 and January 2023. (The green arrow pointing to ‘Scotland’, the blue to ‘Wales’ have been added for emphasis.) The differences are self-evident but nowhere else acknowledged by the RCEM in its press communications – as far as I can tell.
In the graphs taken from the RCEM’s website which follow, those with time series data for NHS Scotland and NHS Wales have been selected. The graphs have plots of percentage of patients treated within the four hour target. (The vertical red lines are set at around April 2020 to indicate the occurrence and impact of the Covid pandemic: the horizontal blue lines are set at 70% in order to emphasise how the performance of NHS Scotland on this metric has been relatively better for some considerable time.)
Recent performance figures
Bringing matters up to date, the table below summarises the most recent RCEM analyses of A&E waiting times performance for NHS Scotland and NHS Wales.
| A&E patients: | NHS Wales (August 2024) | NHS Scotland (August 2024) |
| % treated within 4 hour target in ‘Type 1/major’ departments | 57.1% | 65.8% |
| % spending 8 hours or more in A&E | 23.6% | 11.3% |
| % spending 12 hours or more in A&E | 14.5% | 4.65% |
The differences in A&E performance between NHS Scotland and NHS Wales are stark – why not newsworthy?
Contrasts in communicating
In a press statement on the August 2024 figures for Wales, the RCEM wrote: ‘The Welsh Government must come up with a plan to address the extreme demands being experienced by the country’s Emergency Departments – with some already issuing warnings to the public about being overwhelmed.
‘That’s the call from the Royal College of Emergency Medicine following a message from Cardiff and Vale University Health Board yesterday (Wednesday 18 September) asking the public to “only attend in an emergency” due to a “huge spike in attendances” at University Hospital of Wales.’
It goes on: ‘On Monday, First Minister Eluned Morgan called for NHS bosses to be “held accountable” and has vowed to bring down appointment waiting lists, but RCEM has stressed that the government must also urgently tackle soaring Emergency Department waiting times.’
‘Dr Rob Perry, RCEM Vice President Wales said: “We welcome the First Minister’s commitment to improving the NHS in Wales. However, as well as waits for elective care there must be a strategy to address the dreadful long waits experienced on a daily basis in Emergency Departments. Just this week we have seen at least two Health Boards issuing warnings about being overwhelmed.
“August’s performance figures speak for themselves and it seems the situation has worsened since then. As an Emergency Physician the scenes we see are unacceptable, it is simply not fair for people to endure these long waits.”
Source https://rcem.ac.uk/long-emergency-department-waits-causing-real-harm-in-wales/
For comparison, in a press statement on the August 2024 A&E waiting times in NHS Scotland, the RCEM’s Vice President for Scotland, Dr John-Paul Loughrey is quoted: “Once again Scottish people seeking emergency care this winter are facing extreme waits and, for many, the indignity of so called ‘corridor care’. These are not just inconvenient, they are dangerous and potentially life threatening.”
Source https://rcem.ac.uk/scottish-government-urged-to-heed-ae-alarm-bells/
Candidly, and not for the first time, the RCEM Vice Presidents in Wales and Scotland choose to adopt (let’s say) different language in their statements. You may find it noteworthy that the general pattern is that more alarmist language tends to be used by the individual referring to the much better performing A&E service and its responsible government. Moreover, for whatever reason (!), the RCEM Vice President associated with the better performing A&E service is the one that is able regularly to have his mode of expression amplified by BBC Scotland – of course minus context, minus perspective!
Why is the NHS in such a state?
Let’s obviate the risk of the usual Unionist responses – ‘always blaming someone else’ or ‘more grievance politics’ – and turn to the British Labour Party in government in Wales for explanation and insight. What follows are extracts from the British Labour Party government’s statement on the Welsh Draft Budget 2024-25 published in December 2023.
Source: https://www.gov.wales/sites/default/files/publications/2023-12/2024-2025-draft-budget-narrative.pdf
‘The NHS in Wales is facing increasing demand for its services at a time when the costs of care, including staffing and treatment, are rising. These pressures are common to health services across the UK.’
‘In October, the Minister for Finance and Local Government announced changes to the Welsh Government’s 2023-24 spending plans to help manage a significant projected overspend in some areas. This was largely as a result of the significant pressures on public service budgets, such as in the NHS, caused by rising demand, persistently high inflation, ongoing Covid-19 pressures and unfunded public sector pay rises.’
‘‘The financial challenge for the NHS, common to all areas of the UK, relates to a number of significant factors:
Inflationary pressures across all areas, which are outside of health board control – for example, pay and non-pay inflation, including the costs of medicines and increasing costs of packages of care; increasing demand; More expensive and complex treatment.’
And the British Labour Party government in Wales offers insight into ‘strategic context’: ’Most of our funding continues to come directly from the UK Government as a block grant, even following the devolution of some tax-varying powers. This means Wales is directly exposed to UK Government fiscal policy and the political decisions driving it as we move closer to a General Election.’
It adds: ’Over the last 13 years, we have experienced some very challenging fiscal and economic times, which have resulted in a real terms reduction in our budgets from 2010 onwards.’
And ‘This decade of fiscal constraint, which includes austerity, the impacts of the UK leaving the EU, the subsequent global pandemic, increasing impacts of climate change and cost-of-living crisis and associated inflationary pressures linked to the war in Ukraine, has left public services incredibly vulnerable to further shocks, despite everything we have done to protect them from the worst impacts. Our budget continues to be impacted by the withdrawal of EU funding from Wales.’
Now in any one’s book that’s a lengthy and diverse set of reasons to explain the poor state of public services – including the NHS – in Wales under, let’s remember, a longstanding British Labour Party government. You may recall that recently the British Labour Party’s leader in Scotland expressed a radically different explanation for the state of public services and finances here: incredible as it may seem, NONE of the factors impacting the British Labour Party in government in Wales have impacted negatively on Scotland. Here it’s all down to something Mr Sarwar refers to as ‘incompetence’.
Talking-up Scotland 'Albatraz' 
I think it is fair to say that TUS and others have clearly shown that the BBC (especially in Scotland) has repeatedly failed to meet its obligation to fully inform the viewing public on matters that are of significant importance and interest to a much wider audience. As such given the SNP/Scottish Government’s apparent reluctance to take them to task over this I just wonder if BBC Scotland is open to a LEGAL challenge.
If as an institution it is legally bound to inform the general public under its terms of reference then would it not then be possible to force them to offer some context when making comparisons (or not as it seems) across the UK on matters such as Health, Crime, Public services etc? Surely IF it is their legal duty to FULLY inform viewers and if not then OFCOM (laughing aside) should be given wider powers to make this possible.
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I have trawled the BBC website to aid my own understanding. One little gem I found was that (apologies, I cannot reference it) the BBC adheres to strict guidelines for accuracy “in its online content”. No mention of on-air or on-view content. A cynic might be persuaded that strict guidelines do not apply in these cases.
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I went back to my notes and I found the reference.
First, find “! Why you can trust BBC News” – there are 5 pages of it. Next, a headline “Learn how the BBC is working to strengthen trust and transparency in online news.”
Why focus on online news? What about television and radio. A bit of trust in their output would not go amiss, would it?
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The BBC have a unit called- BBC Verify- that exists to verify news , which is done by apparently them “checking and verifying information and video content before it appears on our platforms” (which then , if that were the case, make the following section- corrections and clarifications-a redundant part of their service, surely ?).
But they still also have a dedicated section on their website called ‘corrections and clarifications page’ where supposed ‘mistakes’ are listed via the various parts of the BBC (where BBC GMS & Reporting Scotland often have listed ‘mistakes noted and then needing to be corrected and clarified in this particular not so well known part of the BBC’s website).
Strangely all of the supposed ‘mistakes’ made by BBC in Scotland are those that have a negative impact upon the Scottish government and also the SNP as a party, (sourced from God knows where or just made up by either the BBC themselves or by one of their too frequent many various sources they reach out from outside the BBC itself) as the misinformation is never that which presents either the Scottish government or the SNP in a positive light. (God forbid).
BTW the BBC’s Verify Unit note that “BBC’s news teams are using ever more sophisticated tools, techniques and technology to check and verify video as well as images and information. ” and so this then apparently “ensures” that “their (BBC) journalism meets the rigorous Editorial Standards the BBC is proud to uphold” (well that’s news to me !).
Anyhoo if you want to see how the BBC in Scotland are not complying with these standards , in fact seem to be completely ignoring these “rigorous editorial standards”, that BBC Verify say that “the BBC is proud to uphold” then have a wee gander on their BBC website at how BBC verify came into force and what they (supposedly) do under the headline on their website entitled “Explaining the ‘how’ – the launch of BBC Verify”.
Honestly as far as the BBC in Scotland is concerned that article about BBC Verify , is like it is from a parallel universe, Ha Ha.
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i seem to recall a piece of information that surfaced during the covid pandemic when nicola sturgeon was giving her day to day updates online and im sure it said something along the lines that englands nhs were fiddling the books with regards records kept about A&A waiting times , i think it said that they were excluding many A&E patients from the figures because they had been seen at orher medical establishments before arriving at A&E so i would treat the figures 58.10% seen within 4 hours and 9.42% seen after waiting longer than 12 hours with a degree of scepticism i think it likely that englands figures are worse than this because its unlikely theyve corrected their fiddling of stats
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STV News is increasingly vying with BBCScorchedland to find the best Gloom and Doom misleading stories about Scotland , particularly the Scottish NHS .Yesterday they highlighted ”the worst NHS A&E waiting times since John McKay had hair ” but , like the MSM , failed to put this in context with the rest of this ”united’ Kingdom .
With any story highlighting the Scottish NHS they attempted to doorstep the Health Minister , which seldom happens when discussing the English NHS . In conclusion they threw in a prediction that this Winter A&E departments would be under even more pressure . ”No shit , Sherlock !”
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Certainly England’s A&E depts will under enormous pressure this coming winter, as the article says, RUK NHS is very very unwell indeed, end of life even because the Labcons are going to sell it off lock stock and barrel and as has been pointed out, it will be the US style/system, which is basically no health service unless you have the money at hand to pay for it, or a house to sell!
Only with Independence can Scotland really protect and save their NHS from the same terrible fate.
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“STV News is increasingly vying with BBCScorchedland to find the best Gloom and Doom misleading stories about Scotland”
True that .
Which is why I now never watch either , so called, ‘news’ programme.
As to the (Scottish) “Winter NHS departments” being under even “more pressure” well I would say , that for Scotland, the BIGGEST pressure on our Scottish NHS is the media and also the opposition parties constantly undermining the Scottish NHS as a service , overly criticising it and failing to include any comparisons with other countries NHS services within the UK to Scotland’s NHS.
Indeed if I worked in the Scottish NHS I would be P’d off at the barrage of negativity I and my colleagues always received by both the media and opposition parties both from WITHIN and also OUTSIDE of Scotland.
Which as negativity is driven, it seems, purely for politically partisan reasons as opposed to genuine concern, that as supposed concern , actually wanted to see any improvements or benefits both FOR the NHS and also emanating FROM the NHS as a public service in Scotland.
(That is seeing benefits and improvements for both the staff who work in the Scottish NHS and also for the patients who use it as a service in Scotland).
One wonders if Scotland were independent what our NHS would be like without a UK government’s bad decisions and interference and also without the constant onslaught of negative comments on supposdley how poor the Scottish NHS performed as a public service in Scotland .
(Thus diminishing the public’s confidence and trust in the Scottish NHS as a service in Scotland and also diminishing the morale of staff in the Scottish NHS too).
Of course the Scottish NHS critics (usual suspects) do not want anyone in Scotland to even consider for one moment how different (as in how much it would be even more better than now) our NHS could be and I think would be if we , Scotland, were finally independent as a country.
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” Indeed if I worked in the Scottish NHS I would be P’d off at the barrage of negativity I and my colleagues always received by both the media and opposition parties both from WITHIN and also OUTSIDE of Scotland. “
I’m sure many are indeed pissed off, but there will also be many who buy into this this crap and we’ve had yrs of this nonsense.
Golfnut.
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” Here it’s all down to something Mr Sarwar refers to as ‘incompetence’. ” is on rinse/repeat as much as Sandesh Gulhane’s unwitting double negative “Critical services are teetering on the brink of collapse yet Neil Gray cannot admit how badly the SNP have mismanaged the health service.”
It has long been thus from BBC Scotland, anything reported remotely connected to the SNP must be framed in the negative and both main opposition parties are given opportunity to comment – It has been thus at BBC Scotland under both James Cook and his predecessor Sarah Smith’s management as ‘BBC balance’, but when Institutions are drawn into what are political criticisms, it stinks.
However much political ‘management’ of the NHS is amplified in Scotland, what do party politics contribute other than bad press ? – Were Labour in control at Holyrood, the only difference under Jackie Baillie would I imagine be Pacific Quay changing reference to ex-SNP-Minister as the political assault continues – At board and hospital level, however good relative stats really are, the ‘problem’ is as ever funding from an ever shrinking public purse due to myopia over economics in London.
I keep coming back to the example of the post-war Attlee government – Despite the UK being almost bankrupt from WW2 and rationing still on the go, they set up the NHS etc. recognising the people were the country’s greatest asset – Yet here we are almost 8 decades later with foodbanks, increasing poverty, and an NHS we ‘can’t afford’ ?
Knowing the cost of everything and the value of nothing is the British disease which is slowly killing us….
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“Knowing the cost of everything and the value of nothing is the British disease which is slowly killing us….
Nail on head Bob, though I would hazard that the ‘ human cost ‘ in poverty, illness and death is a price they are prepared to pay. Not for them of course. What on earth are their supporters thinking when politicians make conscious and deliberate decisions to do harm, what kind of moral void do they live in where the most vulnerable are targeted, when does it become unacceptable?
Golfnut.
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There was always that type, but Thatcher’s introduction of Reaganomics to the UK allowed it to grow unchecked until most of society now asks ” where’s the money going to come from ?” – Government revenues and expenditures are nothing like a ‘household budget’, yet Thatcher sold that lie to the public, and politicians have repeated it ever since….
That’s why I keep bringing up the Attlee era… What did they know of economics back then which our politicians would have us believe do not exist today… ?
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