THE FIX IS IN

The Scottish Government is manipulating the data to hide the true scale of Scotland's A&E waiting times crisis

A whistleblower has revealed how official statistics are hiding thousands of patients from accident and emergency (A&E) figures, and now the Scottish Government has been referred to the UK statistics watchdog.

‘On the clock’

Scotland’s devolved administration has a ‘four hour target’, where 95 per cent of attendances at Scotland’s emergency departments (EDs) should be seen within four hours. It is already well documented that the Scottish Government has failed to meet this rule since the 12th July 2020, currently only 65.1 per cent meet this 4 hour rule.

Data from public health Scotland

The idea is simple, patients presenting at any of Scotland’s EDs go ‘on the clock’, and we are able to know the speed at which patients are being seen.

But the problem is, there are grounds to suspect that the Holyrood government is manipulating the data with an inconsistent approach to how this data is being collected.

Who goes ‘on the clock’?

The Scotsman recently published an article quoting a whistleblower, revealing details about how thousands of patients are hiding from the statistics. According to the reporting the whistleblower is a consultant physician at Queen Elizabeth University Hospital (QEUH). This person - who is clearly in a position of knowledge - explains how patients are being deliberately kept ‘off the clock’ concerning the 4 hour rule

“If you turn up at A&E, you will immediately be put on the target for four hours. Whereas in our medical assessment units, none of our patients go on the clock at all – but that is not the case across Scotland”

What that means in plain English is that the rules on A&E data collection for Glasgow’s QEUH don’t count patients against the 4hr rule if they present at its Acute Assessment Unit (AAU), but do at the A&E.

And for the avoidance of doubt, the AAU is - like the A&E - an ED.

The AAU is effectively fulfilling the same function as A&E. The only difference is at A&E patients are self-presenting, whereas at AAU patients present for emergency assessment following first seeing a GP. Beyond that, it’s fulfilling the same role.

But by failing to count any patients presenting at the AAU in QEUH in Glasgow, it becomes possible to exclude as many as 2,000 people a month from the (already bad) A&E waiting time statistics.

Inconsistent data collection

Some may say that this is merely one hospital in one city, but they would be wrong. For example, if you look at the Western General Infirmary in Edinburgh you discover something equally interesting.

The Western General in Edinburgh counts patients presenting at its facility toward the A&E 4 hour rule. In short, their patients - as you would expect - go ‘on the clock’. But the interesting thing is, it has no A&E department.

You read that correctly, the Western General Infirmary in Edinburgh does not have an A&E department, but does count patients toward the 4 hour rule. So how does that work?

Well, it may not have an A&E department, but it does have a medical assessment unit. So over in Edinburgh patients presenting at EDs which are not specifically an A&E are counted by the Scottish Government for its data.

This all raises an interesting question, doesn’t it?

Why do patients at QEUH in Glasgow NOT go on the clock of presenting at AAU (which is an ED) but in Edinburg patients are on the 4hr rule clock even when not presenting at an A&E specifically?

Clearly there is a complete absence of consistency. It doesn’t require a uniquely cynical mind to consider that the data is being manipulated. There is absolutely no medical rationale for this lack of consistency. There is equally no logic regarding robust a process for gathering and measuring information. If anything, it smacks of politics of the worst sort.

An NHS in crisis

Beyond the obvious that this indicates (again) exposes an SNP government allergic to transparency and accountability, it also demonstrates the erosion of A&E services in Scotland is worse than you realise.

Official figures show about 6,000 nursing and midwifery posts are unfilled in Scotland’s NHS. Additionally, according to Dr Kennedy, chairman of the industry body BMA Scotland, 15% of hospital consultant posts across Scotland vacant (the SNP government refuses to accept this 15% statistic, instead claiming 7%)

Even the nurses are threatening to go on strike amid woeful pay, terms and working conditions from the Scottish Government. Indeed the threat of our nurses taking action has exposed the reality that over the past five financial years, 10,867,979 of overtime hours have been undertaken by NHS staff. Put simply, Scotland’s NHS is only functional thanks to staff working copious amounts of overtime. If the nations nurses ever decided to only ‘work to rule’, the whole precipice may collapse.

Nicola Sturgeon’s administration initially only offered our nurses 5% pay increase for 2022-23, despite inflation likely to top 11 per cent, and a skyrocketing cost of living. But given how bad things are, and how devastating a nursing strike would be for her politically there are signs she is blinking. The Scottish Government, despite insisting there was “no more money” available, has began returning to negotiations with the nurses with its tail between its legs.

And it’s worth remembering all of this is transpiring even before the usual winter squeeze hits the hospitals. Personally speaking, I’m alarmed, not least when I learn that over in Glasgow’s QEUH “around 90 per cent” of patients presenting at the AAU are not being seen within four hours (QEUH’s AAU sees around 500 patients a week)

Frankly given all of this, I am far from reassured by Health Secretary Humza Yousaf sheepish admissions that A&E waiting times “are not acceptable”. Someone should inform Mr Yousaf that the only thing which isn’t acceptable is the manipulation of data and reliance on dodgy statistics to massage an already grim SNP governing record on health.

Looking ahead

How can we have a debate about how to improve Scotland’s NHS if our own devolved administration is manipulating data?

It becomes impossible to ascertain the true scale of the problems if the fix is in and we lack reliable data. The nation’s experts, academics, journalists, politicians and voters are all rendered unable to understand what the problems even are if operating on dodgy data.

This whole episode reveals a Scottish Government once again entirely allergic to basic tenets of accountability, transparency and openness in governance. Worse still, it’s reducing our capacity to repair a health service we all pay for in our taxes on the expectation it will be there ready when we need it. Our hospitals are understaffed, overworked and failure to meet patients needs has been deliberately cloaked in secrecy.

Something worth keeping our eyes pealed for will be the investigation being conducted by the UK statistics watchdog, which the First Minister’s government now finds itself.

Looking ahead, the only way to solve this healthcare crisis is to fix the fixers - time for a new government in Holyrood. Time for a new First Minister.