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The Royal College of Emergency Medicine issued a press statement (July 2) entitled: ‘RCEM Response to NHS England’s Urgent and Emergency Care Plan 2025’. This is part of the much heralded reforms to improve NHS services in England from the British Labour Party government in Westminster. I have little doubt that the same party in the run up to the 2026 Holyrood election, with the help of its mainstream media allies, will be telling us to vote Labour in order to get similar super-duper ‘change’ implemented for NHS Scotland.

So what does the RCEM say about Labour’s plan for A&E in England’s NHS?

‘RCEM is very disappointed by the lack of meaningful commitment to reduce 12 hour stays. Setting a target threshold of no more than 10% of people staying more than 12 hours represents a failure to meaningfully grip this problem. The proportion of 12 hours stays in 2024 was about 10% and several times worse than before the pandemic.’ (my emphasis)

On July 1, the RCEM published this statement on NHS Scotland: ‘The evidence to address delayed discharges continues to mount’. It included these data from Public Health Scotland (PHS) for the month of May 2025:

• 125,779 people visited a major A&E Department (Type 1) in Scotland
• 4,863 patients ‘waited’ 12 hours or more – ‘the equivalent to one in every 26 patients’.

Not sure why the RCEM didn’t do the calculation: in May 2025, just 3.9% of attendances spent 12 hours or more in a Type 1 A&E department  in Scotland.

Now 3.9% of attendances spending 12 hours or more in A&E is a whole lot better than 10%, the target threshold specified in the Westminster government’s Urgent and Emergency Care Plan for NHS England. Perhaps NHS Scotland’s emergency departments had an exceptionally easy May? Presumably, we will need to find a more robust comparison if Mr Sarwar, Dame Jackie, the Daily Record, The Herald et al and the RCEM itself are to be convinced of the significance of the difference?

The graph below shows the percentage of attendances spending 12 hours or more in major emergency departments in England, Scotland and Wales. The earliest data are for February 2023 only because that corresponds to the range provided by the NHS England source (see below).

The red line highlights ‘the target threshold of no more than 10%’, the level of ambition in Labour’s Urgent and Emergency Care Plan 2025 for NHS England complained of by the RCEM. Across the period since February 2023 (and indeed before) NHS Scotland has NEVER come anywhere close to having 10% of patients spend 12 hours or more in an emergency department before admission, transfer or discharge.

And yet STILL the RCEM and the mainstream media steadfastly refuse to acknowledge NHS Scotland’s substantially – significantly – longstanding better performance! Easy prediction – the vast majority of the Scottish electorate will learn nothing of these FACTS from the mainstream media that supposedly serves Scotland, and not from the public broadcaster with its explicit mission to inform.

(The time series data on which the graph is constructed come from:

• For NHS England (Type 1 and Type 2 departments): Supplementary ECDS Analysis Time Series February 2023 Onwards (XLS, 48KB) found at https://www.england.nhs.uk/statistics/statistical-work-areas/ae-waiting-times-and-activity/
  • this provides direct access to time series data
• For NHS Scotland: https://publichealthscotland.scot/healthcare-system/urgent-and-unscheduled-care/accident-and-emergency/interactive-charts/how-long-people-spend-in-ae/
  • attendance and numbers spending 12 hours or more in Type 1 departments can be down loaded and imported to a spreadsheet in order to calculate the percentage experiencing these long timescales
• For NHS Wales: https://statswales.gov.wales/Catalogue/Health-and-Social-Care/NHS-Hospital-Waiting-Times/emergency-department/performanceagainst12hourwaitingtimestarget-by-hospital
  • it’s a laborious task to visit each monthly spreadsheet published by StatsWales in turn in order to extract data relevant to plotting percentage of attendances at major emergency departments experiencing 12 hour or longer stays.)

End note

Whilst no-one would wish to be in A&E for 12 hours or more, the RCEM’s use of the term ‘wait’ in the context of the 12 hour metric for NHS Scotland is misleading: the PHS metric for NHS Scotland is NOT ONLY for so called ‘trolley waits’ i.e. actually waiting AFTER a decision to admit has been taken. The PHS metric is calculated for all attendances experiencing 12 hour or longer stays – which could be made up of lengthy diagnostic and/or treatment procedures and/or ‘trolley waits’,  and is based on time spent since arrival.

In a recent press statement – ‘Slight improvements hard to celebrate when thousands of people are enduring extreme A&E waits’ – the RCEM comments on the waiting times performance of NHS England’s major emergency departments during May 2025. It reports:

• 1,453,036 attendances
• 135,219 patients spent 12 hours or more in the emergency department (oddly it doesn’t provide a percentage: 9.3% of attendances), and of these:
• 42,891 people waited (strictly) 12 hours or more after the decision to admit them to hospital was made (2.9% of attendances) – this is the commonly referred to ‘trolley wait’.

And finally, the RCEM’s website has an ‘NHS Performance Tracker’ – https://rcem.ac.uk/data-statistics/. Inspecting its various graphs, we find the following:

•  Type 1 ED attendances, per 1000 population of each UK nation – from January 2015 to January 2023 (the latest data plotted), Scotland has the lowest or equal lowest attendance metric – surely that must be a good indicator of the effectiveness of an integrated Scottish health care system!
• Four Hour Performance across the UK – on this standard waiting time metric, from July 2015 to February 2023 (the latest data plotted), apart from one month, NHS Scotland has the best performance by a substantial margin – another best in class performance!
• 12 hour waits as a percentage of Type 1 attendances, measured from the patient’s time of arrival – from January 2018 to February 2023 (the latest data plotted), the RCEM graph confirms that NHS Scotland has long had the best performance of any of the UK’s national health services. NHS Wales has long been performing more poorly than (even) NHS England – one more best performance by NHS Scotland!

I can find no explicit acknowledgement of these favourable indicators of NHS Scotland’s performance from the RCEM or mainstream media or opposition politicians in Holyrood.  NHS Scotland may be far from perfect but let’s acknowledge the successful efforts of its staff to deliver such results and a supportive Scottish Government!