“We are ensuring the flow of patients through emergency care is faster than ever, we are discharging people at a record rate out of hospitals to ease the constraints they are facing.”
During Prime Minister’s Questions on 18 January, Rishi Sunak made a number of claims about how the government was working to improve ambulance waiting times, including that it was “ensuring the flow of patients through emergency care is faster than ever” and “discharging people at a record rate out of hospitals”.
This exchange was also later shared by the Conservative party Twitter account.
Over the past two weeks we’ve repeatedly asked the government what Mr Sunak was referring to in these comments, but we have not been given any data which supports the claims.
We asked Number 10 about the claims on 18 January, 19 January, 24 January and 27 January, but have not received any response.
We also asked the Department of Health and Social Care (DHSC) if it could provide any data to support these claims. In a reply on 18 January it pointed us toward weekly-published situation reports by NHS England showing daily statistics for urgent and emergency care over the winter period, but did not explain which specific figures supported Mr Sunak’s claim.
We’ve not been able to identify anything in this dataset, which largely consists of data on how many beds are occupied by patients with different diseases, which substantiates the PM’s claim. The DHSC did not respond to further requests for clarification on 19 January and 27 January.
Data published alongside NHS England’s weekly situation reports does show that more patients have been discharged so far this winter than last, but we haven’t been able to find comparable data beyond that. In the two weeks prior to Mr Sunak’s claim, more patients were discharged from hospital in England than in the equivalent period last winter. But the numbers for that two-week period don’t appear to be a record.
Other data published by the NHS does show that in England the volume of A&E attendances in December was the highest on record.
Health experts have told us this may be what Mr Sunak was referring to when he talked about “A&E patient flow”. However, they also said that A&E waiting times are the highest since current records began, while the proportion of patients declared medically fit who are discharged each day is lower than it was last winter.
These figures all refer to the situation in the NHS in England, for which the UK Government is responsible, as do the rest of the figures in this article.
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A&E attendances are the highest on record, but so are four-hour waits
Number 10 hasn’t said what measure Mr Sunak was referring to when he claimed “the flow of patients through emergency care is faster than ever”, and as outlined above the data we were directed to by the DHSC did not appear to include anything to back up the claim. So we asked the Nuffield Trust, the Health Foundation and the King’s Fund about Mr Sunak’s comments.
The Nuffield Trust suggested Mr Sunak may have been referring to data showing the total volume of patients attending A&E in England in December 2022 was the highest on record, at over 2.28 million.
At the same time, emergency admissions to hospital in December were lower than they were pre-pandemic, meaning that more people attending A&E were leaving to destinations other than hospital admission.
It’s possible Mr Sunak may have been relying on these figures when he claimed patient flow was “faster than ever”, but Number 10 has not responded to our attempts to confirm this.
All three health charities we spoke to cited data showing that the proportion of patients waiting longer than four hours from arrival to be admitted, transferred or discharged, and the number waiting longer than 12 hours from the decision to admit to being admitted (metrics often referred to when talking about A&E waiting times) are in fact the highest since current records began in 2010.
In December 2022, 50.4% of patients attending major (type 1) A&E departments waited longer than four hours to be admitted, transferred or discharged from arrival. December was the first month since the four-hour waiting time target was relaxed in 2010 that more than half of type 1 A&E attendees waited longer than the target time.
The number of patients waiting longer than 12 hours between the decision to admit and being admitted was also the highest on record, at 54,532.
The Nuffield Trust told us: “We do think ‘ensuring the flow of patients through emergency care is faster than ever’ makes it sound as though people are being seen, treated and leaving A&E faster than before, which is not the case.”
Mr Sunak also claimed that “we are discharging people at a record rate out of hospitals”. Again, the government has not confirmed the source for this claim.
When we put this claim to the Nuffield Trust, it pointed us towards NHS data on the number of patients who no longer meet the criteria to reside in hospital and the number who are actually discharged each day.If Mr Sunak was referring to the number of patients discharged, then NHS England figures do show that the total number of discharges across the 2022/23 winter season (over 640,000) so far is higher than the number across the same period of the 2021/22 winter season (over 470,000).
However, in considering Mr Sunak’s claim about recent figures being a “record”, it’s also worth noting that we weren’t able to find comparable data that goes back beyond November 2021, and the Health Foundation told us “we can’t directly compare delayed discharges with before the pandemic”.
Looking at data from a narrower time period doesn’t provide any evidence to support the claim. NHS England figures show that between 2 January and 15 January (the last full fortnight before Mr Sunak made his comments), a total of 127,186 patients were discharged from hospital.That is a higher number than in the equivalent period last year—113,465 patients were discharged between 3 January and 16 January 2022. But it doesn’t appear to be a record even within the very limited two-year period for which we found comparable data. For example, between 14 November and 27 November 2022 some 136,836 patients were discharged.
The Nuffield Trust also noted that the number of patients ready to be discharged who remained in hospital reached a high of 14,710 on 7 January, though this number has since fallen to 13,124 as of 22 January. Overall the average daily total number of patients ready to be discharged but remaining in hospital is higher so far this winter than last winter, by around 3,000. Again, comparable figures don’t go back beyond November 2021.
So while Mr Sunak may have been correct to say the number of patients being discharged is up, if that is what he meant, so too is the number who could be discharged but aren’t.
The Nuffield Trust says the average daily proportion of patients who no longer met the criteria to stay in hospital but were not discharged has been slightly higher, at 61%, for this winter so far, than for the same period last winter (57%).
Ministers must back up the claims they make
Anyone making serious claims in public debate should be prepared to back up their claims with evidence, and that should clearly apply to the Prime Minister making a high-profile claim about a key issue such as this. So it’s disappointing that neither Number 10 nor the DHSC have offered any figures to back up Mr Sunak’s specific claim, or even explained exactly what he meant.
As outlined above we’ve contacted Number 10 four times about this claim, and the DHSC three times, and received only one response from the DHSC which pointed us to data which does not appear to support Mr Sunak’s claim. We’ll update this piece if either responds further following publication.
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Image courtesy of Chris McAndrew