17 October 2023
* This story was updated at 8pm on Tuesday 17 October to include RCEM’s response to a further statement issued by the Welsh Government.
The Royal College of Emergency Medicine has reiterated its concerns about the way A&E waiting time data in Wales is presented in offical statistics.
The confirmation comes after the Welsh Health Minister issued a statement rebutting RCEM’s concerns.
Data obtained via a Freedom of Information (FOI) request, and shared with BBC Wales, shows that the true length of A&E waiting times for more than 45,000 patients in Wales for the first six months of this year (2023) were not reflected in official monthly figures.
The discrepancy is caused by a policy introduced in 2011 which allows for the length of time patients whose waits in A&E will exceed the four-hour target to be excluded from the data if they are expected to complete their treatment within the Emergency Department.
These so-called ‘breach’ or ‘clinical’ exemptions mean that the length of waits faced by tens of thousands of people are not represented in the official published data. They are referred to by clinicians as ‘stop the clock’.
When you look over the longer term, from January 2012 to June this year, more than 670,000 patients were not included in published figures – 23% of the total.
The Welsh Government previously admitted breach exemptions ‘should be included’ in its official A&E performance reporting. But subsequently backtracked and issued two further statements, the last of which was from the minister herself.
Responding an RCEM Wales spokesperson said: “We stand by our concerns about the use of clinical exemptions in Wales and how they impact reported figures – especially in relation to ‘stop the clock’ situations (breach exemptions) where patients’ A&E wait times are suspended before their treatment is complete.
“What is clear is there is a discrepancy between the information provided to RCEM by Health Boards in Wales via our Freedom of Information Act request and the data published by Stats Wales in the official statistics.
“We would be happy to correct any inaccuracy but as yet we have received no alternative explanation as to the reasons for the differences in these figures. The figures show that a sizeable proportion of patients’ waiting times appear to be misrepresented in the data.
“We have been highlighting the issue of breach exemptions and our concerns around this for many years – via evidence submissions, statements, meetings and a letter to the Minister herself.
“Our only aim is to ensure transparency in reporting, and to ensure the true picture around A&E waiting times is publicly available.”
The Royal College of Emergency Medicine (RCEM) has forced the Welsh Government to admit it has been misrepresenting the extent of waiting times in the country’s A&E departments for years.
Data obtained via a Freedom of Information (FOI) request, and shared with BBC Wales, reveals A&E waiting times in Wales have been seriously under-reported with thousands of hours missing from official monthly figures.
In a significant win for RCEM’s members and for patients, when presented with the FOI results the Welsh Government was forced to admit it ‘should have included’ the ‘breach exemptions’ in its official A&E performance reporting.
The discrepancy is caused by a policy introduced in 2011 which allows for patients whose waits will exceed the four-hour target to be excluded from the data if they are expected to complete their treatment within A&E.
These so-called ‘breach’ or ‘clinical’ exemptions mean that the long waits faced by tens of thousands of people are not represented in the official published data.
Dr Suresh Pillai, RCEM’s Vice President for Wales, said: “We have long been campaigning for transparency in the reporting of the waiting time situation in Wales. It is one of the key elements of our #ResuscitateEmergencyCare campaign.
“And we have repeatedly asked for ‘breach exemptions’ to be included in the official statistics. To leave them out is misrepresenting the issue, and not providing the full picture.
“The data as it’s published does not give a true reflection of what is exactly happening on the shop floor. This year alone from January to June, about 45,000 patients’ waits were excluded – that is a huge number.
“If you don’t factor those patients in the already overcrowded emergency department, we cannot measure how bad things are.
“If you don’t get the true figures, then the perception would be ‘everything is fine’. When in reality it is not. This is crucial as we plan and prepare for what is looking like another extremely challenging winter ahead.
“We have been raising this issue with the Welsh Government for years, but it has fallen on deaf ears. We are very pleased the Welsh Government has finally admitted that these ‘exempted’ waits should be published.”
The FOI data also revealed that in the first six months of this year (January to June 2023):
When you look over the longer term, from January 2012 to June this year, more than 670,000 patients were not included in published figures – 23% of the total.
Dr Pillai said the issue had routinely been raised by RCEM during meetings with the health minister and officials and in evidence submissions made to the Welsh Government.
The Welsh Government has repeatedly claimed A&E waiting times in the country have ‘bettered English performance’ including as recently as last week, but once the missing data is taken into account, the performance in Wales is worse.
In its statement provided to BBC Wales the Welsh Government said: “Breach exemptions (or clinical exceptions), should be included in our published Emergency Department statistics.”
Continuing: “Guidance has been in place since 2011 to help staff avoid inappropriately admitting or discharging these patients, in an attempt to ‘hit the target’.
“We have asked Health Boards for assurances they are following the guidance, to ensure the data is absolutely transparent.
“Based on the data guidance and definitions, the collective view of the Office for National Statistics (ONS), and the responsible statisticians across the UK, is that Wales’ statistics for major emergency departments are comparable to the statistics for England and Scotland’s departments.”
RCEM contacted the ONS who confirmed it is currently looking into the differences between the way the home nations record A&E waiting time data, and that Wales is the only country which uses ‘breach’ exemptions.
The next monthly performance figures for Welsh Emergency Departments for September 2023 are due to be published this Thursday (19 October 2023).
