Several ways have been revealed recently in which official NHS statistics have been manipulated.

The target: achieving a wait for patients in accident and emergency of no more than four hours.

Why claims of achieving this target are misleading:

1. The ambulance bringing the patient to the hospital is kept waiting outside. The hospital simply declines to accept the patient. This means that the starting time of the four hour wait is delayed and the hospital can claim it is meeting the target.

2. The hospital refuses to accept any emergency patients for a while. The patient has to be transported to a different hospital. This enables the first hospital rightly to claim that patients who get into the hospital are not kept waiting for more than four hours.

Why are the hospitals so keen to meet the target? Because the hospitals receive less money from the government if they fail to meet it.

Who or what suffers? Of course the patient suffers from being kept waiting for emergency treatment for more than four hours. In the second case, the patient may be carried to a hospital that is much further away, delaying treatment. Also people suffer who need an ambulance but cannot get one because ambulances are being kept waiting outside hospitals or taking journeys to hospitals far away. But this suffering is not a direct result of the target. It is a result of inadequate emergency provision in NHS hospitals. What suffers directly as a result of the target and the cheating on the target is the truth and public awareness of the truth. That, of course, suits the government well. The truth that is kept secret from the voters is the extent to which the massive increase in spending on medical services in Britain has been wasted. We simply do not know the extent because NHS statistics are lies.

The evidence: The information for these assertions comes from the article by Laura Donnelly in the Sunday Telegraph in which she quotes from letters sent between NHS senior executives obtained under the Freedom of Information Act. It also comes from comments she obtained from Katherine Murphy of the Patients' Association and Sam Oestricher, ambulance representative of the unison Unison.

Here is a part of the article:

In one of the letters, disclosed under the Freedom of Information Act, Sir Graham Meldrum, chairman of the ambulance trust, said patients were "being put at risk on a daily basis", with 7,600 delays last October - a position which has since deteriorated further.

Sir Graham Meldrum wrote: "The risks of delayed handover cannot be overstated.

"The constant and prolonged delays present risks to two patient groups: 1. the patient waiting in the corridor, with less than ideal clinical care, and forced to endure cramped/busy corridor environments, 2. the patients who dial 999 in an emergency and receive a delayed ambulance response, while ambulances are rendered unavailable whilst queuing at hospital departments."

The letter, sent last November, followed warnings from the ambulance service's head of operations that repeated closures of casualty units to 999 arrivals were putting patients in danger.

Over a six month period, hospitals in the West Midlands closed their A&E units to all ambulances on 472 occasions, forcing 999 crews to take seriously-ill patients on lengthy journeys in the search for hospital care, the documents say.

More than three quarters of the requests for such "diverts", in the six months ending April 2008, came from Heart of England Foundation trust, in Birmingham, the correspondence says.

Last September Rob Ashford, the ambulance trust director of operations, wrote to all hospital chief executives in the area, saying he could no longer "condone" the practice because of the "inherent dangers" it posed to patients.

Ambulance staff believe "diverts" are regularly used by hospital managers to ensure they do not miss Government targets to treat patients within four hours, by shifting pressures to other hospitals.

Mr Ashford proposed a total ban on the practice, in widespread use across the country, which allows hospitals to close their doors to all 999 patients when pressures can no longer be managed.

The local hospitals did not agree to the ban, although some restrictions on its use were agreed.

The full article as it appears online is here. But the printed article had extra sections.

Notably: "Sam Oestricher, ambulance representative for the trade union Unison, said ambulances were being treated "as mobile waiting rooms".

And again, "Katherine Murphy, from the Patients' Association said 'We are hearing increasing numbers of storied of seriously-ill patients lying in pain in ambulances, worried out of their mind. The A&E target is the one that comes with financial penalties attached, and it is the one hospitals care about.'"

And again, "Since family doctors stopped providing routine out-of-hours care five years ago, the number of emergency admissions to hospitals has risen by 30 per cent, while the number of beds has fallen by more than 20,000. More than 100,000 ambulance journeys were delayed at casualty units by more more than 30 minutes in the month of March alone - an increase of 18 per cent in 12 months."

One further quote from the printed article:

Most ambulance trusts measure delays by "turnaround time" - the time between the ambulance's arrival at A&E and its availability for the next call. It includes any time cleaning or restocking the vehicle, which should take no more than a few minutes.

Research by one ambulance trust found three quarters of delays occurred before the patient was handed over to staff, and that 84 per cent of those cases were connected to bed shortages.

It is a pity that the source for this information is not named. That would add further force to the evidence. However, if we trust the source and take it to be representative, then the vast majority of times when an ambulance has an overlong stay when delivering a patient to a hospital, it is because the hospital is overrun with patients and does not want to spoil its apparent (but not real) success in meeting the waiting time target.

Here are further details of the extent of ambulance delays.

Posted by James Bartholomew • Indexed in NHS

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