We’ve been here before with A&E delays and excess mortality. Only the media operating in Scotland is reporting it.

How the numbers were calculated for this RCEM/Lib Dem study:

• The figures use a standard mortality ratio previously applied by the Royal College of Emergency Medicine (RCEM).
• It assumes roughly one additional death for every 72 patients who wait 8–12 hours before admission.
• The Lib Dems applied this to the number of patients waiting more than 12 hours (not official government statistics).

The RCEM ration 1:72 is supported by one 2022 peer-reviewed study based on A&E data from 2016 to 2018: https://pubmed.ncbi.nlm.nih.gov/35042695/

A latter to the BMJ cautions restraint:

While the data convincingly show an association between longer ED stays and higher mortality (reported around 28-day in the letter’s wording), this does not necessarily mean that long ED stays cause the increased deaths. Careful interpretation is needed before drawing causal conclusions or policy implications. the letter welcomes the evidence on ED delays and mortality but stresses that association does not equal causation. https://emj.bmj.com/content/39/11/876.full

So, the research is observational, so it shows association, not proven causation. ‘Residual confounding’ is possible . The study cannot fully separate “treatment time” from pure waiting, and data quality issues led to exclusions. Association does not automatically prove that the long ED stay itself causes the extra deaths.

Residual confounding is when a study still has leftover bias from other factors that affect both the thing you’re studying and the outcome, even after you’ve tried to account for them – e.g unmeasured illness severity, staffing, bed pressures.

Also, NHS England has repeatedly declined to accept the RCEM’s extrapolated excess-death totals as established fact. In response to earlier RCEM estimates (e.g., the 2022 figure of ~23,000), an NHS England spokesperson stated that “attributing deaths to one exact thing… is very unlikely to give a full or certain picture” and that official excess-death analysis is better left to the ONS. https://portsmouth.co.uk/read-this/nhs-ae-waiting-times-23000-excess-deaths-royal-college-of-emergency-medicine-4044241

However, too many long waits is a problem, of course it is but the Scotsman will not be telling you this kind of thing:

How can there be ‘an A&E crisis’ of deaths ‘associated’ with long waits only in Scotland when they are actually falling here and nearly FOUR times as common in NHS England?

This needs updating but 2025 data is not too far away.

From A&E activity: month ending 30 May 2025 published today:

There were 28,382 attendances at type 1 departments in NHS Scotland (compared to 27,560 the previous week, and 26,833 weekly average for 2024).Attendances of under 4 hours

19,160 (67.5%) of type 1 attendances were seen and resulted in a subsequent admission, transfer or discharge within 4 hours (compared to 18,367 (66.6%) the previous week, and 17,357 (64.7%) weekly average for 2024).Attendances of over 8 hours

2,852 (10%) patients spent more than 8 hours in a type 1 Department (compared to 3,108 (11.3%) the previous week, and 3,364 (12.5%) weekly average for 2024).Attendances of over 12 hours

1,104 (3.9%) patients spent more than 12 hours in a type 1 Department (compared to 1,204 (4.4%) the previous week, and 1,490 (5.6%) weekly average for 2024). https://www.publichealthscotland.scot/healthcare-system/urgent-and-unscheduled-care/accident-and-emergency/main-points/emergency-departments/

The above reveal increased attendance yet reduced numbers waiting, for each of the three waiting times measures – improved performance across the board.

In NHS England for the same period, also in Type 1, only 61.2% were treated within 4 hours. https://www.england.nhs.uk/statistics/statistical-work-areas/ae-waiting-times-and-activity/

This 6.3% difference, 10.3% better than 61.2%, means around 2 800 Scots were treated within 4 hours who would not have been had NHS England standards applied here and around 280 000 in England would have been been treated within 4 hours in England, had NHS Scotland standards applied there.

NHS England does not publish 8 hour data but 42 891 waited more than 12 hours, 40 times in crude terms, 4 times per head of population than the 1 104 in Scotland

How did Scotland’s media cover the above? They ignored it. STV used the one-week figures at the end of May to offer this – Scottish Government under fire over ‘swelling’ queues in A&E!