Scotland’s A&E departments impressive performance on the 4-hour target contrasts dramatically with the other UK areas as they worsen dangerously and are apparently out of control


The Nuffield Trust have released an update, on 28th January, on the percentage of patients waiting more than four hours in A&E. The graph above looks frankly frightening with regard to the situation in Tory England, Labour Wales and DUP Northern Ireland. It’s clear that NHS Scotland has managed to stay very near the demanding 5% maximum target requiring more than 4 hours other than in the winters of 2012/13 and 2014/15.

During the period 2012 to mid-2015, NHS England’s A&E departments performed slightly better than those in Scotland. That might be expected given the greater severity of Scottish winters. However, since then, NHS England’s A&E departments have performed less-well and this winter have begun to soar away from the Scottish performance by more than 10%. This is, of course, the period of unconstrained Tory government in the UK. These figures only go so far as end December 2017 and given the apparent trend may have worsened in January 2018. There’s no sign of these even on 31st January 2018. NHS Scotland’s figures for January have returned to 86% being treated within the 4 hours.

I haven’t said much about Wales or Northern Ireland. The graph says it all.

Footnote: Does the Nuffield Trust have a political agenda? Why did they tweet this? If you look under the tweet, several respondents suggest we won’t see this graph on BBC Scotland news!


13 thoughts on “Scotland’s A&E departments impressive performance on the 4-hour target contrasts dramatically with the other UK areas as they worsen dangerously and are apparently out of control

  1. Bugger (the Panda) January 31, 2018 / 3:20 pm

    I also think there are dodges and wheezes used by the ENHS to change patients status in their system and reset the clock.

    I really do want to sound triumphalist, because the Scots (all of us) are not the universal Masters.

    It is just we have a Gov focussed on what we in Scotland need.

    No wonder small Countries lead the World’s richest and happiest in the World.

    We do not have the baggage of the 19th Century European national coagulations of power and influence.

    Liked by 2 people

  2. John January 31, 2018 / 3:27 pm

    Great news but don’t wait for it to be reported without distortions thrown in , have reblogged to NSAS .

    Liked by 1 person

  3. Bugger (the Panda) January 31, 2018 / 4:05 pm

    From Twitter 5 mins ago


    Replying to @BuggerLePanda @tailohthedug @wordpressdotcom

    Especially when different criteria used In Scotland the target is not waiting time per se but time being triaged, tested, diagnosed & discharged/admitted/transferred to specialist unit


  4. Brian January 31, 2018 / 7:04 pm

    Repscot’s focus was on the number of operations postponed in January “to date”. They couldn’t bear to wait until Feb for the stats so submitted FOI requests for the data.
    The Nuffield update, surprisingly, didn’t get a mention.
    And tonight they are doing their best to turn the Fire & Rescue “proposed deal” into a bad news story, because, allegedly, the Fire Service didn’t talk to the Union first. 20% over 4 or even 5 years sounds great to me in this day and age, and so does the opportunity to take on new skills and responsibilities. Very progressive.


  5. Ann Forbes January 31, 2018 / 8:10 pm

    In case anyone missed this –

    January 11, 2018 / 11:31 am
    It is also worth noting that NHS Scotland and NHS England use different definitions of waiting times. In Scotland the clock starts ticking as soon as the patient arrives at A&E and it keeps ticking until the patient leaves A&E. In England the clock is reset each time the patient is seen by someone. What does this mean? If a patient has to wait over four hours for a bed in Scotland, that’s four hours after first arriving at A&E. If a patient has to wait over four hours for a bed in England, that’s four hours after seeing a doctor who ordered the admission, but the patient might already have waited six hours to be seen by that doctor. In other words, Scotland’s time limit is far more stringent than England’s, yet Scotland’s A&Es are still outperforming England’s.


    January 11, 2018 / 1:10 pm
    Didn’t know that. Very interesting. Got a source I could use?


    January 11, 2018 / 1:55 pm
    How’s this for a source?

    See Dr. Philippa Whitford MP’s statement at 2:09 pm, third paragraph.

    Liked by 1 person

    January 11, 2018 / 2:07 pm
    Here’s the official definition for England; The waiting time is defined on page 11.

    And here’s a definition for Scotland:

    Liked by 1 person

    January 11, 2018 / 4:17 pm
    Thanks. Much appreciated


    January 11, 2018 / 12:36 pm
    Consider the following scenario: two people go to A&E, one in Scotland and one in England. The English patient waits three hours before being seen by a junior doctor, who decides that the patient needs to be seen by a consultant. The patient waits another three hours for the consultant, who decides the patient must be admitted to a ward. After a further three hour wait the patient is taken to a ward and admitted. The patient was admitted to the ward nine hours after arriving in A&E but is recorded as having met the four hour waiting time target.

    The Scottish patient waits an hour and a half to be seen by a junior doctor, another hour and a half to be seen by a consultant, and is admitted to a ward after waiting a further hour and a half. The Scottish patient is admitted to a ward four and a half hours after arriving in A&E, and is recorded as having missed the four hour waiting time target.

    And yet, even with these different recording methodologies, Scotland’s NHS is outperforming England’s.

    Liked by 1 person

    January 11, 2018 / 5:30 pm
    Sorry HB but I think it’s the same. In NHS England:

    ‘The clock starts from the time that the patient arrives in A&E and stops when the
    patient leaves the [A&E] department on admission [to a ward], transfer from the hospital or discharge.’

    If someone in A&E gets them into ward, then there’s no need to start the clock again because it’s only the time in the A&E department that has a target.


    January 12, 2018 / 9:35 am
    Read the definition in the NHS England document I posted:
    “The waiting time for an emergency admission via A&E is measured from the time
    when the decision is made to admit, or when treatment in A&E is completed
    (whichever is later) to the time when the patient is admitted.
    i) Time of decision to admit is defined as the time when a clinician decides and
    records a decision to admit the patient or the time when treatment that must be
    carried out in A&E before admission is complete – whichever is the later.”

    It’s very clear that times are calculated from the last clinician’s consultation, i.e. all time waiting to see a clinician is counted separately. Decisions to admit are made by clinicians, not receptionists, so the waiting time is always calculated from when a clinician has already seen the patient. It may be different for a discharge from A&E.

    Now read the NHS Scotland definition I posted:
    “95% of all A&E patients should be admitted, discharged or transferred within four hours of arrival at an A&E department across NHS Scotland”

    …within four hours of arrival


    January 11, 2018 / 1:11 pm
    Thanks very much for this HB!



  6. Ludo Thierry January 31, 2018 / 9:37 pm

    Hi John – in case the other John doesn’t see your query I believe I can answer your question. The NSAS = The Nicola Sturgeon Appreciation Society.

    Re. the criteria for recording Waiting Times we’ll hopefully get some clear info if the National Statistics Office Chief is ‘permitted’ to respond to Carwyn Jones’ recent letter requesting chapter and verse on this issue. (I’m not holding my breath – I’m sure the Westminster Minister will find some way to prevent an unambiguous response being issued should it show a problem in the English NHS Waiting Time measurement methods).

    Liked by 1 person

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