Lies, Dammed Lies, and NHS ED Statistics

NHS Emergency Department admission statistics were thrown about like confetti yesterday with headline figures portraying a worrying decline in NHS performance targets.  But hang on a minute and look behind the headlines.  The Emergency Department Syndromic Surveillance System Bulletin (EDSSS) allows micromanagers at all levels to monitor performance (actually, monitor things being measured) and, thus promote the image of their awareness and concern for the real-time state of our national icon, the NHS.  EDSSS is also helpful for people like us who are interested in what is really going on rather than what we are fed by the media agenda.  In the final week of 2019 the daily number of total attendances recorded across the EDSSS network was about 20,000.  Apparently, only 79.8% of those 20,000 were either admitted, transferred or discharged within the 4-hour target.  Nevertheless, glass half full, there would have been about 15,960 patients every day who were treated within the guideline.  In comparison, for the same week in 2018, daily admissions were only about 15,000.  I am not sure what proportion of the 4-hour target was achieved but let us be generous and assume it was the full 95%.  Otherwise assuming manpower, support resources and infrastructure were roughly the same during the comparison, it would seem that 14,250 patients were treated within the guideline.  In the weekly snapshot this shows that the NHS ED actually admitted, transferred or discharged (at least) 1710 more patients within the 4-hour guideline per day in 2019, than it achieved in 2018.  Far from showing an NHS in crisis, this represents a very creditable improvement in efficiency.  So, what is causing the NHS the biggest problem is not the staff resources and infrastructure but the number of customers using the service.  Rather than bang on about insignificant decimal points in notional target percentages, the media would do better to expose the inexorable increase in demand resulting from our chaotic and hopelessly benevolent immigration policy.