NHS Wales: Thousands of hours missing from A&E figures

by | Oct 16, 2023 | Health

Getty ImagesBy Jenny ReesBBC Wales health correspondent The true picture of A&E waiting times in Wales has been seriously under-reported for a decade, the BBC can reveal.The Royal College of Emergency Medicine (RCEM) has established thousands of hours are missed from monthly figures.Senior A&E doctors have been raising the issue for months. The Welsh government said it would ask health boards for assurances they were following the guidance “to ensure the data is absolutely transparent”.The RCEM said it could not measure “how bad” things were because thousands of patients subject to so-called “breach exemptions” were not included in the overall A&E waiting times.The Welsh government initially disputed the RCEM’s claim, but after seeing detailed figures – which were obtained through freedom of information (FOI) requests to health boards – it changed its position.Wales’ health minister has repeatedly claimed A&E waiting times in Wales have “bettered English performance”.But once the missing data is taken into account, it suggests the performance in Wales is worse.What is a ‘breach exemption?’Doctors don’t normally want to keep patients in emergency departments any longer than necessary, but they are able to in certain circumstances.These are called “breach exemptions” – as they breach the four, eight and 12-hour waiting targets for A&E.Exemptions may follow when:Patients who are clinically unstable need more input from the emergency teamTest results are needed before they can be admitted or dischargedPatients need plaster-casts on broken bonesInput is needed by occupational therapy or physiotherapyThe patient is unlikely to know if they fall into this category and they might not notice the difference in the care they receive.But the RCEM said they do not therefore count towards the official monthly statistics on how long they wait. It said Wales was the only UK nation to do it this way.Doctors warn it could mask underlying issues and not give the full picture of the pressure A&Es are under.Is Wales worse than England for NHS waiting lists?Cancer treatment targets still not being metWelsh A&E departments have busiest month on recordWhat is the Royal College’s argument?”We are not getting a true reflection of what is exactly happening on the shop floor,” said Dr Suresh Pillai, vice president of RCEM for Wales.”This year alone from January to June, they have excluded about 45,000 patients and that’s a huge number.”If you don’t factor those patients in the already overcrowded emergency department, we cannot measure how bad things are.”If you don’t get the true figures, then the perception would be ‘everything is fine’. In fact, it is not.”Dr Pillai said the issue had been routinely been raised during meetings with the health minister and officials.FOI responses to the RCEM show that in the first six months of this year, 38.7% of patients in Wales waited longer than four hours in A&E departments.When breach exemptions were included, as they were in other parts of the UK, the figure was 50%.That’s more than 45,000 patients – or 12% – removed from the figures.From January 2012 to June this year, more than 670,000 patients were not included in published figures – 23% of the total.The chart above shows that when the exempted patient waits are included, the position in Wales is consistently worse than previously published.”I’m really concerned about the winter and that is purely because the figure that is published is misleading,” said Dr Pillai.”We always try to make plans for the winter but if we have already excluded 12% of patients in the first six months are we really factoring that to our winter plans?”The RCEM has been campaigning for transparent data to drive up the quality and safety of care, as long waits in A&E are directly related to worse patient outcomes.How does Wales compare with England?Waits for planned care in Wales have compared poorly with England, but published data has so far given the impression Wales is doing far better at reducing A&E waits compared to England.The health minister has previously said waiting times at major emergency departme …

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