Senior doctors have said that the accurate representation of A&E waiting times in Wales has been significantly under-reported for the past ten years.
The Royal College of Emergency Medicine (RCEM) asserts that it has identified the omission of thousands of hours from the monthly data. This issue has been raised by senior A&E doctors over the course of several months.
However, the Welsh government refutes these claims and has expressed doubts about the data’s interpretation.
According to the RCEM, it is challenging to gauge the extent of the problem because the monthly A&E waiting time figures do not include thousands of patients who are categorized under “breach exemptions.” Despite the Welsh health minister’s repeated claims that A&E waiting times in Wales surpass those in England, accounting for the omitted data suggests that the performance in Wales is actually poorer.
In most cases, doctors aim to minimize the time patients spend in emergency departments. However, certain circumstances allow for extended stays, known as “breach exemptions.” These exemptions come into play when patients breach the designated four, eight, and twelve-hour waiting targets for A&E. They may be applied in situations such as:
- Patients in an unstable clinical condition requiring additional care from the emergency team.
- Waiting for test results before admission or discharge.
- Patients needing plaster casts for fractured bones.
- Requiring input from occupational therapy or physiotherapy.
Patients themselves may not be aware of their categorization under these exemptions, and they may not notice any difference in the care they receive. However, the Royal College of Emergency Medicine (RCEM) points out that such patients are not included in the official monthly statistics that track their waiting times. This approach is unique to Wales among the UK nations. Doctors have raised concerns that it may obscure underlying issues and fail to provide a comprehensive picture of the challenges faced by A&E departments.
“We are not getting a true reflection of what is exactly happening on the shop floor,” said Dr Suresh Pillai, vice president of RCEM for Wales.
“This year alone from January to June, they have excluded about 45,000 patients and that’s 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’. In fact, it is not.”
Dr Pillai said the issue had routinely been raised during meetings with the health minister and officials.
The Welsh government remains steadfast in its assertion that it has not underreported the statistics.
Welsh Secretary David TC Davies said it was “embarrassing and scandalous” that thousands of A&E waits in Wales had not been counted for a decade.
“Time and time again, the Labour-run Welsh government has badly let down our NHS in Wales. Getting a grip of this very serious situation must be Labour’s priority, rather than wasting time on creating more Members of the Senedd and other needless projects,” he said.
“Solving this latest scandal is a priority for the people of Wales – and I call on Labour to, at long last, listen to them.”
Plaid Cymru’s health spokesman Mabon ap Gwynfor called it a “fiasco”.
“This is not just about patients waiting longer than necessary – which is bad enough – but about the consequences of under reporting in terms of workforce planning and health board budgeting,” he said.
“Welsh government is quick to point the finger of blame at health boards, yet we understand the data is collected according to government guidance. What’s more, senior A&E doctors have been raising the concern for months – only to be dismissed by government.”
