Introduction

1. NHS Scotland faced a difficult winter during 2022/23 and hospital waiting times statistics have featured regularly in public debate. Examples of this include media articles in the Herald and Scotsman which both reference weekly Accident and Emergency (A&E) statistics. The former First Minister also quoted these statistics to address the stabilising of A&E figures in her winter pressures briefing in January 2023. A&E waiting times were of high public interest prior to the COVID-19 pandemic and this interest has continued due to the ongoing demand facing hospital A&E units. A&E waiting times are also an important indicator used by NHS Performs to assess how hospitals and NHS Boards within NHS Scotland are performing.

2. Public Health Scotland (PHS) publishes a weekly update of emergency department activity and waiting times statistics. It also publishes monthly A&E statistics which have already been assessed as National Statistics. PHS asked the Office for Statistics Regulation (OSR) to assess its weekly statistics so that users could have the same accreditation assurance across both sets of statistics. In requesting this assessment, the team demonstrated its commitment to produce statistics that meet the standards required of National Statistics and the Code of Practice for Statistics.

3. The Scottish Government has set a target that 95% of people attending A&E should be seen, admitted, discharged or transferred within four hours of arrival. Overall A&E statistics are released once a month because data for some smaller sites are currently available only monthly. Weekly statistics contain all the emergency department data provided weekly by the NHS Boards and are released every Tuesday. Performance against the 95% target is formally monitored using the monthly A&E waiting times figures as those statistics include all relevant units and departments that constitute A&E services. However, the weekly emergency department statistics are often compared against that target by others too. In addition, due to the regularity of these statistics, the media often compare fluctuations across hospitals on a weekly basis.

4. The weekly statistics show the number of unplanned attendances at emergency departments in NHS Scotland. This includes the percentage of patients seen and subsequently admitted, as well as transfers or discharges within four hours, over eight hours and over 12 hours. Monthly A&E statistics cover these metrics and provide breakdowns on the demographics of patients and when they attend by NHS Board, hospital location and type of referral. PHS also publishes interactive charts allowing users to determine what happens to patients following A&E attendance at hospital level.

5. In January 2023, PHS launched a new platform to present both the monthly and weekly A&E activity data and statistics. The aim of this platform is to enhance accessibility to A&E information by putting it all in one place, and to increase users’ understanding of the differences between the monthly and weekly statistics, helping them to use the data appropriately.

6. In May 2023, the original publications for weekly and monthly statistics were discontinued, so now this platform is the primary method of accessing these statistics. The development of the new platform demonstrates the team’s creativity and desire to innovate to continually improve the statistics.

7. During the course of the assessment, we identified improvements that we highlighted to PHS. PHS adopted a proactive approach and implemented many of these as it developed the new platform. For example, PHS added a new section on the planned development of A&E statistics providing users with information on the continuing expansion of the range of statistics published. PHS also highlighted ongoing work to improve data quality and the development of user engagement plans.

8. We judge that these statistics require some further improvements to meet the standards of the Code and have identified three requirements that PHS needs to address for the statistics to become National Statistics. PHS has committed to implement these by September 2023.

*This report was edited on 16 August 2023, to amend a reference in paragraph 9 of the Value section, reflecting that Audit Scotland use monthly, not weekly, statistics to scrutinise NHS Boards’ performance.