A&E waiting times
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What is the main topic discussed in this episode?
Thank you for downloading the More or Less podcast from the BBC, statistically proven to be the very best numbers programme around. This is the extended edition of the programme, first broadcast on BBC Radio 4. Hello and welcome to More or Less, the programme which resolves each year to cut down on unhealthy junk news and eat more tasty and nutritious statistics. This week, cancer, huge BBC mistakes about inequality, NHS waiting times and statistical whoppers that are true but deeply misleading.
Six hospitals declare major incidents amid the worst A&D waiting figure times for a decade.
This week, NHS England published figures that revealed it had missed its four-hour accident and emergency waiting time target. That's bad news in itself, but the numbers were particularly troublesome with performance dropping to its lowest level for a decade. Well, the news prompted many loyal listeners to write to more or less at bbc.co.uk to ask us questions, such as this one from Rachel.
Have you considered looking at the reporting of the latest NHS winter crisis? There are lots of percentages being bandied about without any contextualising numbers, so it all feels pretty meaningless to me.
Well, the government target used to be that 98% of people attending A&E should be seen in less than four hours. It's been relaxed to 95%. But nevertheless, the NHS is still missing the target. In the period October to December 2014, only 92.6% of people attending A&E were seen within four hours – So why? What's going on? Various reasons have been mooted for the drop in performance, and I put some of them to John Appleby, chief economist of the King's Fund, which is an independent health think tank. And my first question, suspicious fellow that I am, is exactly how is your weight at A&E measured?
When you go into an A&E department, as soon as somebody sees you, a clinician, a nurse, the clock starts and they'll note down the time and that goes on your record. The clock will stop when you leave the A&E department and you can exit the A&E department in various ways. You can go back out the front doors, you can just go back home. You could go back home but with a recommendation to see your GP or you could be admitted into hospital and about 20% or so of all people who go to A&E departments end up being admitted into a hospital bed in the hospital. And at that point, the clock stops. The target's being missed quite widely. Now, why is that? One explanation is that there's a lot of demand. There are a lot of people walking in the front doors or being carried in the front doors of A&E departments.
And A&E departments are having trouble coping with that number of people. And that will be part of the explanation. But interestingly enough, there are more attendances happening. at A&E departments in the summer than there are in the winter.
We don't have summer A&E crises, if I recall.
We tend not to, no, we tend not to. The patients who are using A&E in summer and winter, there's slightly different proportions of patients. So that would be another factor, is what type of patient is using A&E at different times of the year. In the summer, there is a tendency for them to be slightly less elderly people using them and proportionately more younger people.
What do the latest NHS A&E four‑hour waiting time figures show and why do they matter?
The problems tend to be less acute. In winter, you've got elderly people using A&E more. It's not like Arthur Bobbin's 10-year-old with a saucepan stuck on his head sort of view of A&E anymore. It could be an elderly woman with a broken hip, with dementia and diabetes and various other problems and so on. So more difficult cases.
So that's more representative of a winter case and that's harder to deal with.
And more likely to be admitted into hospital. So whereas across all patients it's about one in five will be admitted into hospital for further treatment as an emergency case. If you're over 65, it's 50%. It's an indication of more serious cases.
And I understand how that would explain why you have winter A&E problems and you don't particularly have summer A&E problems.
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Chapters
5 chapters
1
What is the main topic discussed in this episode?
0:00–3:27
2
What do the latest NHS A&E four‑hour waiting time figures show and why do they matter?
3:27–8:48
3
How is A&E waiting time measured and who counts as 'seen within four hours'?
8:48–14:00
4
Why do A&E departments struggle more in winter than summer and how does patient mix affect performance?
14:00–22:11
5
How do delayed hospital discharges and social care cuts contribute to A&E backlogs?
22:11–28:04