Dear Ms Martin,
Thank you for your letter of 7 March regarding statements made by the Prime Minister in a BBC programme that aired on 8 January. In this programme, the Prime Minister made reference to the relative performance of the NHS in the different countries of the UK. He said:
“…you mention A&E waiting times; in Wales and Scotland for example, they’re operating at worse levels than they are in England.”
You asked us to investigate the accuracy of these claims and the appropriateness of the measure chosen for comparison.
The monthly official statistics for November 2022 (the latest publicly available at the time of the interview) presented a mixed picture of Accident and Emergency (A&E) performance, as shown in this table.
For waits under four hours, NHS Scotland had better performance for major A&E departments (known in England as Type 1 emergency departments) whereas NHS England was performing marginally better when all types of emergency unit were included . On both measures, emergency units in all three administrations are falling short of the official targets for waiting times.
Parallels between A&E performance across the UK must be drawn with an appreciation of the limitations in comparability between countries. While the Prime Minister used the most readily available measure, which is published regularly across all three countries, it is possible to make other comparisons. The publication you mention by NHS Digital  (as was) says that the nearest like for like comparison between administrations can be found in waiting times for Type 1 and major emergency departments, rather than all types of emergency units, to account for the different models of service provision across the four nations. Even so, policy differences in emergency health provision mean that these units will not be treating exactly the same type of patients, so when making these numerically more robust comparisons, users should still be aware that they are not exact. We have made officials responsible for briefing the Prime Minister aware of this case, to ensure that they are aware of the trade-offs between coverage and comparability involved.
I have written previously to Dr Sandesh Gulhane MSP about A&E waiting time statistics , and I noted the importance of being able to accurately compare performance between UK administrations. In April, NHS England published a supplementary file of data on 12-hour waiting times for Type 1 departments , as well as the usual data on 4-hour waiting times, to facilitate comparisons across a broader range of measures. I welcome this development.
Sir Robert Chote
Percentage of attendances that met the 4-hour target for A&E waiting times by GB administration, November 2022
Country Type 1 / Major emergency units All types of emergency unit England 54.5% 68.9% Scotland 64.1% 67.5% Wales 57.8% 67.3%
- A&E Attendances & Emergency Admission monthly statistics, NHS and independent sector organisations in England, November 2022 (XLS), NHS England, 8 December 2022
- See under ‘Percentage of attendances within 4 hours’.
- Accident & Emergency Activity and Waiting Times Statistics (XLXS), Public Health Scotland, 4 January 2023
- Use cell B4 in sheet ‘board_comparison’ to select either all A&Es or Emergency Departments only. See percentages meeting the 4-hour target on row 24.
- Performance against 4 hour waiting times target by hospital, StatsWales (Welsh Government)
- Under ‘Date’ in the top left of the table, select ‘Next Selections’, then ‘November 2022’. This table shows the percentage of attendances meeting the 4-hour target across all types of emergency unit.
- It is not possible to see the performance of major emergency departments from this table without adding up individual rows. By using the ‘Export’ function and filtering columns B and C of the spreadsheet, it is possible to see total attendances at major emergency departments in column E (which sums to 63,913), and those which met the 4-hour target in column F (36,966).
 In England, this means Types 1, 2 and 3 A&E departments. Type 1 departments provide a consultant-led 24-hour service with full resuscitation facilities and designated accommodation for A&E patients Type 2 departments are consultant-led A&E services for a single specialty, such as emergency ophthalmology or dental clinics. Type 3 departments (or Urgent Treatment Centres) are led by a doctor or nurse and treat minor injuries and illnesses without an appointment.
 Hospital Accident and Emergency Activity, 2021-22; Home Nations Comparative Analysis (Spreadsheet), NHS Digital, 15 September 2022
 Letter to Dr Sandesh Gulhane MSP on waiting time statistics, UK Statistics Authority, 16 December 2022
 Emergency Care Data Set (ECDS) Data, February 2023 Statistical Commentary, NHS England, April 2023