Dear Ed, 

I am writing regarding recent media coverage on emergency department statistics for Wales. This suggested that official statistics have been under-reported since 2011, when a category known as “clinical exceptions” was introduced. The coverage centred around claims by the Royal College of Emergency Medicine that patients in this category were not reported in the official statistics, which would be contrary to the official guidance. 

 I take seriously any suggestion that official statistics produced by the Welsh Government might not meet the standards of trustworthiness, quality and value set out in the Code of Practice for Statistics. In light of the media reporting, statisticians in the Welsh Government have taken steps to investigate the concerns raised. This week, assurance was sought from and provided by Local Health Boards which confirmed that they are adhering to the guidelines on the reporting of clinical exceptions. We also received assurances that these patients are included in the data that is used to produce the official statistics. The evidence we have received from health boards is consistent with our prior understanding of the data collection underpinning these statistics. 

 The latest monthly statistics on NHS activity and performance, which includes emergency department performance, were published this morning. I have taken the decision to include the following Chief Statistician’s statement in the statistical release in order to publicly set out the steps we have taken to provide assurance on the quality and coverage of the statistics. 

Recent media coverage has suggested that official statistics on emergency department waiting times for Wales have been under-reported since 2011, when a category called “clinical exceptions” was introduced. Clinical exceptions (or breach exemptions) refer to when emergency department clinicians have deemed that patients require an additional, extended period of observation or treatment. Nationally agreed guidance states that clinical exceptions should be included in the data reported by health boards to Digital Health and Care Wales, with an agreed process for how waiting times for these patients are calculated and considered in performance monitoring. 

Official statistics must demonstrate trustworthiness, quality and value. They are produced independently and free from political influence. Following the concerns raised, Local Health Boards have provided assurance this week that the data they submit to Digital Health and Care Wales is in line with the guidance on reporting clinical exceptions.  

Welsh Government statisticians do not exclude clinical exceptions from the data we receive from DHCW. Patients subject to clinical exceptions are therefore included in the emergency department attendances in this report and previous reports.  

In line with the Code of Practice for Statistics we will continue to monitor this data to ensure quality and transparency for users of these statistics. 

 I hope that the steps I have taken provide you with reassurance that these statistics continue to meet the standards set out in the Code of Practice for Statistics. I welcome OSR’s consideration of this matter and would be happy to discuss further. 

 Yours sincerely, 

Stephanie Howarth

Prif Ystadegydd, Llywodraeth Cymru 

Chief Statistician, Welsh Government 


Related links:

Ed Humpherson to Stephanie Howarth: Emergency Department Statistics for Wales