NHS bosses are using misleading figures to hide dangerously poor performance by A&E units in England against the four-hour treatment target, emergency department doctors claim.
Some A&Es treat and admit, transfer or discharge as few as one in three patients within four hours, although the NHS constitution says they should deal with 95% of arrivals within that timeframe.
How well or poorly A&Es are doing in meeting the 95% target is not in the public domain because the data that NHS England publishes is for NHS trusts overall, not individual hospitals.
That means official figures are an aggregate of performance at sometimes two A&Es run by the same trust or include data for any walk-in centres, minor injuries units or urgent treatment centres that a trust also operates. Forty-eight trusts have two A&Es and many also run at least one of the latter.
The Royal College of Emergency Medicine (RCEM), which represents A&E doctors, wants that system scrapped. It is urging NHS England to start publishing data that shows the true performance of every individual emergency department against the 95% standard.
“The current data is misleading,” Dr Adrian Boyle, the college’s president, told the Guardian. “It’s a good example of a lack of transparency and also of performance incentives. Being open about the long delays in some A&Es would shine a light in some dark places.”
Walk-in centre-type settings have much better performance against the four-hour target. That is because, although they also provide urgent and emergency care, most patients who use them have minor ailments and are quicker to treat, whereas those attending hospital-based A&Es are more seriously unwell and take longer to treat and discharge or find a bed for.
Boyle said the current system was flawed because it meant hospital leaders may be tempted to focus on improving four-hour performance in places such as walk-in centres, as high marks there may help to mask what were often low scores in hospital A&E units.
“The problem with the current data is that it encourages hospital managers to chase down the quick wins – to focus on low-acuity patients, such as people with a sprained ankle or cut finger, while neglecting the patients who are waiting on trolleys [in A&E] for admission to hospital,” he said.
NHS England collects but does not publish site-level data. But its practice of combining performance figures from A&Es and other settings “provides a figleaf and a smokescreen that hides poor performance and real harm that’s being done to patients through them having long stays in A&E,” Boyle added.
Earlier this month the Health Service Journal acquired and published site-level data for every individual A&E in England. It showed that between April and June this year Pilgrim hospital in Boston, Lincolnshire, managed to deal with only 33% of patients within four hours, the lowest proportion in the country. However, the performance of the United Lincolnshire Hospitals trust that runs it was much higher, at 45.3%.
Similarly, North West Anglia trust’s overall 56.3% performance disguised the fact that the A&E at its Peterborough city hospital site scored just 38.1%.
Publishing figures for each individual hospital would improve patient safety, Boyle said. “We know that there’s an increased risk of mortality once someone has spent more than six hours in A&E waiting for a bed. Our efforts must be to prioritise the sickest, the oldest and the most vulnerable patients, to reduce the risk of them dying. Our system as it is currently designed is making sick people more sick.”
Boyle said Steve Barclay, the health secretary, fully supported the RCEM’s call for greater transparency around A&E data. The Department of Health and Social Care did not respond when asked about the minister’s view.
NHS England said it would continue publishing aggregated data for trusts. A spokesperson said: “Data is published at the level of accountability – in this case trusts, which use site data to identify and tackle variation.
“As part of a national support package and measures in the urgent and emergency care recovery plan, the NHS offers on the ground tailored support at both site and trust level through tiered interventions and sharing good practice, which reduces variation both within and across systems.”
