hours in A&E in the first week of November.
Professor John Robertson OBA
They know, their many researchers, that a one-week change wouldn’t be reported by a good reporter, but still they do it. Are BBC reporters just thick or, worse, are they dishonest?
Here’s one of our star players, stewart ‘The Lawman’ b, I’m hoping to keep in the January window, with those tricky facts:
Nearly THREE times as many emergency patients per capita wait 12 hours or more in NHS England than in NHS Scotland
By stewartb
Campaign against austerity needed to push Westminster to support the NHS in England, NI and Wales even to match the A&E waiting times performance in Scotland – for the sake of all patients across the UK.
The RCEM is an active campaigner in the cause of NHS staff and patients involved with NHS emergency services across the UK. It responds frequently to the release of official waiting times performance statistics by issuing press statements. The RCEM is especially ‘diligent’ and especially hard-hitting politically when responding to the situation in Scotland. Moreover, it seems to be accorded an especially high media profile in Scotland, for example with BBC Scotland. All this despite NHS Scotland performing better than its peers.
Through its close attention to official data releases, the RCEM knows quite well that the NHS in England, NI, Scotland and Wales perform differently when It comes to waiting time metrics for emergency departments – and have for some time. The existence of substantial differences is a ‘fact’ even though the RCEM – legitimately – regards A&E waits across the UK as unacceptable and sometimes dangerous.
Performance differences across English regions
A new report on ‘corridor care’ in NHS England’s A&E departments, funded and researched by the RCEM, has just been published by Westminster’s All-Party Parliamentary Group on Emergency Care (See https://rcem.ac.uk/wp-content/uploads/2025/11/APPG-report-final-2.pdf ).
It reports this, in a chapter entitled ‘Inequalities’: ‘There is also a lot of regional variation across England in terms of how long patients wait on average when they get to the hospital. In the South East of England, an average of 62.9% of patients were seen within four hours in 2024, whereas in the North West of England, only 55.5% of patients were seen within four hours on average.
‘The North West of England also had the highest percentage of 12- hour waits last year, with 15.5% waiting at least this long, whereas in the South East of England, this figure was 9.4%. Long waits like those seen most acutely in the North West will inevitably mean significantly more patients being made to wait in corridors.’
Regarding the 95% target for meeting the four hour standard, the report confirms: ’NHS England has since lowered this target to 78%, but such an unambitious goal risks creating perverse incentives. Trusts may prioritise patients who can be discharged quickly in order to meet the target, while the sickest patients needing admission end up waiting even longer.’ (my emphasis) This change to 78% has NOT been adopted in Scotland.
2024 comparisons
According to Public Health Scotland (PHS), during 2024 the weekly average for patients in major (Type 1) emergency departments in NHS Scotland being treated within the four hour standard was 64.7%. This makes Scotland’s national average better than the average in best performing part of England, the South East (62.9%).
During 2024, for 12 hour waits the weekly average across Scotland in 2024 was just 5.5%. This is substantially better than the best performing English region, the South East, at 9.4%.
Other findings from ‘corridor care’ in England report
- the UK ‘has one of the lowest bed-to-population ratios in the OECD, falling from 4.1 per 1,000 people in the year 2000 to 2.4 in 2022’ – another legacy of Tory austerity?
- in NHS England, in 2025 to date 13% of the total hospital bed base was occupied by patients medically fit for discharge but still remained.
On the matter of delayed discharge, the RCEM argues: ‘For the most part, elective care and unscheduled care share the same bed base, meaning high demand in Urgent and Emergency Care often displaces elective procedures, leading to cancellations and delays.’
For a perspective on the latter from Scotland, see the PHS data on the number of planned operations that were cancelled the day before or on the day of treatment. PHS groups cancellation reasons into those cancelled by the hospital for clinical reasons, cancelled by the patient, cancelled by the hospital due to capacity or non-clinical reasons, cancelled for other reasons and cancelled for unknown reason.
Of all 25,322 planned operations during September 2025 in NHS Scotland, 819 (3.2%) were cancelled for clinical reasons, 728 (2.9%) were cancelled by the patient, 521 (2.1%) were cancelled by the hospital due to capacity or non-clinical reasons, and 73 (0.3%) were cancelled for other reasons.
On British Labour Party government action in England, the same RCEM produced report notes: ‘The 2024/25 Capital Incentive Scheme allocated £150m to trusts meeting four-hour and 12-hour performance targets, but the impact was limited and short-lived. While some trusts saw improvements in March 2025, performance often declined immediately afterward, suggesting resources were mobilised temporarily to secure funding rather than to embed sustainable change. … Overall, the scheme reinforced inequalities and incentivised short-term gaming.’
Latest evidence of national differences
From the RCEM’s press statements on newly released A&E waiting times data:
1) 4 November – on NHS Scotland – ‘‘Where is the tangible plan for winter?’: RCEM asks Scottish government as Emergency Departments record worst-ever September performance’.
The RCEM statement reports the following emergency department (ED) performance statistics for September 2025:
- one in nineteen patients spent 12 hours in an ED – i.e. 5.3%
- one in eight spent 8 hours in an ED – i.e. 12.5%
- 63.7% of patients were seen within four hours.
2) As far as I can discern, the RCEM did not issue a press statement on the equivalent NHS England performance statistics for September. Here is what the official data release reported:
- attendances at EDs (Type 1 and 2) spending 12 hours or more was 9.8% – the near equivalent (Type 1 only) NHS Scotland figure is just 5.3%.
- the four hour standard at Type 1 departments in England was met for 61.1% of attendances – the direct equivalent NHS Scotland figure is 63.7%.
NHS England does not report monthly an eight hour metric.
3) In its latest press release (October 24) on September’s performance by NHS Wales – ‘All the signs are pointing towards an incredibly tough winter ahead: RCEM Wales’ – the RCEM reports:
- 25% of patients spent more than eight hours in major EDs- recall, the equivalent figure for NHS Scotland is 12.5%
- more than one in seven patients waited 12 hours or longer i.e. 14.3% – the equivalent figure for NHS Scotland is 5.3%
The RCEM (oddly) doesn’t specify the actual performance against the four hour standard in Wales. StatsWales tells us it was met by just 51.7% of attendances. Remember, the equivalent NHS Scotland figure is 63.7%.
4) On October 23, the RCEM issued a statement with this headline ‘‘It’s cruel and undignified’: Hundreds of ED patients waiting more than two days for a bed in Northern Ireland’. Not sure why but the RCEM gives a rather partial report of the most recent data release from NI’s Department of Health. The official source (Emergency Care Waiting Time Statistics :July – September 2025) on October 23 reveals:
- during the quarter ending 30 September 2025 (July, August and September), 44.7% of patients spent less than 4 hours at an ED
- just 33.8% of attendances at Type 1 EDs in September 2025 spent less than 4 hours in the department – the equivalent NHS Scotland figure is 63.7%
- in September 2025, 16.1% of attendances spent over 12 hours in an ED – the equivalent figure for NHS Scotland is 5.3%.
Looking at performances in the round, there seems little doubt that unsatisfactory waiting times in Scotland are proving stubbornly hard to improve in a substantial way. And concerns about how the service will cope across the UK this winter are undoubtedly justified. However, there is also no doubt that (albeit unsatisfactory) performance in NHS Scotland is substantially better than that in England, NI and Wales – and has long been so. And there is no doubt that the unsatisfactory waiting times performance in A&E in England, NI and Wales is also proving stubbornly hard to improve!
End note
The RCEM website publishes ’tracking’ information (see charts below) that clearly shows the longstanding and substantially better performance of NHS Scotland relative to its peers. So the RCEM knows this!
What might account for its unwillingness to acknowledge national differences, whilst now pointing out and drawing insights from regional differences within England?
Talking-up Scotland 'Albatraz' 