In the news – A&E in England: are we really that bad?

Summary: As A&E performance in England and the rest of the UK continues a seemingly endless race to the bottom, we consider just how bad (or good) we are.

When considering transformational change, the NHS is often quoted against international institutions such as the Mayo Clinic and Canterbury in New Zealand for example. These comparisons are often unfair for many reasons. For example, some individual organisations and smaller systems can be very selective on who they treat and don’t treat.

So, is this a true and fair comparison? We take a quick look.

Beyond the UK

#If we review A&E performance in Canterbury in New Zealand, the NZ Herald highlights the impact of the 6hr wait (50% longer than we get in England) target which was set at 95%. In May 2017, just 13 out of the 20 district boards were meeting the target (65%). They also give an estimated ‘overall’ performance of around 94%.

If we go back 12 months then the performance in England was 90% (not forgetting that in England there was 2hrs less to get patients through the department). So you could argue they aren’t that dissimilar. However, England is on a downward trajectory. If we go back a few years, to July 2015, it was 95%. So when we were hitting the target we were potentially world leading.

Interestingly, a study undertaken in New Zealand to look at the impact of the new target showed a 57% drop in ED deaths and 28% less crowding between 2006 and 2012 (the target was introduced in 2009). This equated to 700 fewer deaths in 2012.

These are amazing statistics and it’s amazing to think what may have occurred in England over the last decade following the introduction of the 4hr target and how many this may have saved.

Protective effects of the NHS

Simon Stevens’ speech at the Confed in June 2016 encourages us to think positively about the performance of the NHS than perhaps some do at the moment:

“…There is no other major industrialised country in the world that over the course of the last year can claim to have treated 9 out of 10 of its patients within 4 hours in an A&E department, or provided 9 out of 10 of its citizens with access to needed planned surgery within 18 weeks. If you look at the ground-breaking study published in the Lancet a few weeks ago……the fact is that we have an NHS which has protected our citizens from the effects of austerity, when it comes to cancer mortality, for example. Across the OECD, during this period of austerity, there have been 260,000 excess deaths from cancer – but not a single one of them in this country, thanks to the protective effects of the NHS.”

Perhaps the performance within the NHS isn’t quite as bad as it is sometimes made out. Maybe when the NHS was funded a little better and the pressures were a little less, we were actually extremely good.

There is always the need for improvement but maybe we shouldn’t constantly be seeking other people’s ideas about how we can be better, they should be seeking ours?

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