Thousands of patients 'deliberately hidden' from Scottish Government's A&E stats

Thousands of patients are being “deliberately hidden” from accident-and-emergency (A&E) figures, a whistleblower has warned, amid claims the Scottish Government is trying to “cover-up the true scale of the humanitarian crisis in our NHS”.

A whistleblower from Glasgow’s Queen Elizabeth University Hospital (QEUH) says as many as 2,000 patients a month are being missed off the facility’s A&E waiting time statistics, due to how the Government collects data.

NHS Scotland is experiencing record high A&E waiting times, with just under 65 per cent of patients being seen within four hours – despite Government targets of 95 per cent – and with thousands of patients waiting more than 12 hours for treatment.

At NHS Greater Glasgow and Clyde (NHSGGC), the health board which runs QEUH, just over 6,000 patients are seen in A&E each week, with 71.3 per cent of those patients seen within four hours.

As many as 2,000 patients a month are going unrecorded in A&E waiting times at Queen Elizabeth University Hospital, a whistleblower has said. Picture Jeff J Mitchell/Getty Images

However, the health board does not include patients who present at its Acute Assessment Unit (AAU) at QEUH in its A&E figures, despite the two fulfilling basically the same function.

Patients are generally referred to the AAU for emergency assessment after first seeing their GP with their concerns, whereas A&E patients self-present. Like A&E, the AAU sees a wide range of patients with potentially life-threatening ailments, such as heart attacks, pneumonia, Covid, strokes and falls.

The whistleblower, a consultant physician at QEUH, said: “If you turn up at A&E, you will immediately be put on the target for four hours. Whereas in our medical assessment units, none of our patients go on the clock at all – but that is not the case across Scotland.

“If you look at the Western General Infirmary in Edinburgh, which has a medical assessment unit and no A&E department whatsoever, they are all on the clock immediately. So there's no logic to this at all.

“If you have pneumonia and you're sitting at home in the community, if you take yourself to QEUH’s A&E, then that's fine, you get put on the clock. Whereas if you find a GP, the GP probably won't see you anyway, and they'll send you straight to hospital and you'll come in via one of the other two doors and you will not go on the clock.”

The consultant says QEUH’s AAU sees around 500 patients a week, and estimates “around 90 per cent of those patients aren’t getting seen and treated within four hours”.

“I’ve seen 13 patients sleeping in the waiting room in a row of trolleys,” said the whistleblower. “And that’s not a medical area – that’s just a waiting room. It has been extraordinarily bad. There are people sleeping on trolleys regularly.”

Scottish Labour’s health spokesperson Jackie Baillie said: “This is a shocking example of SNP cover-up and secrecy. It is clear for all to see that this SNP Government is failing to comply with its own guidelines and is focused only on massaging the figures.

“This isn’t just an attempt to mislead, it can also mean patients being treated as a lower priority and waiting hours on trolleys. Once more, the SNP put saving their own reputation before the health and wellbeing of the people of Scotland.

“The true scale of the humanitarian crisis in our NHS is being deliberately hidden. Staff are demoralised and patients are living in fear – we can’t go on like this. It’s high time that this spin-obsessed, do-nothing health secretary got his jotters.”

The whistleblower said there was “unwritten pressure” to get people moved from A&E and into beds at QEUH, while patients in AAU are left waiting on trolleys.

“We're not being transparent and honest about this,” said the consultant. “We need to be able to see how big the problem is and make sure that we give priority to patients who are sick, rather than giving priority to one group of patients who come into the A&E door rather than coming into another door in the hospital.”

According to Public Health Scotland’s (PHS) guidance, NHS boards are required to submit data on all attendances for emergency care, whether this is delivered in an A&E department, an emergency department, a minor injuries Unit, or the trolleyed area of an assessment unit.

There is no suggestion NHSGGC has not complied with this guidance. However, it is alleged the data sent to the Scottish Government is not then being presented in a way that allows taxpayers to see the true picture of emergency care in a region.

Critics say this creates a misleading picture of emergency care across Scotland – with the true picture being dramatically worse.

The revelations come just days after it was reported other statistical discrepancies exist within the Government’s A&E data. NHS Tayside consistently tops Scotland’s mainland health boards for A&E performance, thanks largely to its implementation of a "continuous flow" policy – which sees patients requiring admission moved out of A&E as soon as they are ready, regardless of whether there are any beds available on wards.

At the board’s Ninewells Hospital in Dundee, patients who would have spent hours waiting on a trolley in A&E can instead spend hours waiting on a trolley elsewhere in the hospital, where the four-hour waiting time target does not apply.

A Scottish Government spokesperson said: “The Scottish Government expects all boards to comply with the guidelines for recording waits against the four-hour A&E target, which covers attendances at all types of A&E sites, including in trolleyed areas of assessment units. We will contact all boards to seek assurance that this is being adhered to.

“A&E departments continue to experience significant pressure and, in common with healthcare systems in the UK and globally, the pandemic is still impacting services. Scotland is the only part of the UK to publish weekly A&E statistics.

“Recovery will not happen overnight and we are working closely with those boards experiencing the greatest pressures as we enter what will be an extremely challenging winter period.”

A spokesman for NHS Greater Glasgow and Clyde said: “At all times NHS Greater Glasgow and Clyde reporting procedures comply with national guidelines and agreements. To suggest otherwise would be inaccurate and misleading.

“Data for attendances to A&E/emergency department and assessment units are submitted on the same submission file to Public Health Scotland.”

- The Scotsman has added further to this story following publication to make clear we are not alleging NHSGCC broke guidelines. The story sets out key statistical discrepancies that exist within the Scottish Government’s A&E data.