Another edition of Prime Minister’s Questions, another ding-dong over the NHS.

As ever, the statistics came thick and fast as both sides tried to set out diametrically opposite views on the state of the health service.

Asked about the prospect of a crisis in A&E departments this winter, David Cameron said:

FactFiction2“Last week was the 27th week in a row that we met our A&E targets.”

Ed Miliband replied:

factFiction4“The Prime Minister is simply wrong about the figures…the target has been missed for 15 consecutive weeks.”

The target they are talking about is for at least 95 per cent of patients to be dealt with (admitted, transferred or discharged) within four hours of arriving at A&E.

Labour introduced a target of 98 per cent, but former Conservative health secretary Andrew Lansley lowered it to 95 per cent shortly after the coalition came to power.

According to the latest weekly stats for all accident and emergency departments in England, the target has indeed been met for the last 27 weeks.

Labour are zeroing in the biggest A&E units, called “Type 1” and defined as “a consultant-led 24-hour service with full resuscitation facilities and designated accommodation for the reception of accident and emergency patients”.

If we just look at the results for Type 1 departments, these have dipped below the target for 15 weeks in a row. But the 95 per cent target is for all patients, not just for Type 1 departments.

So there’s a bit of misdirection from Labour here – but that’s not to say that everything in the A&E garden is rosy.

There are many ways to measure patients’ experiences in A&E, and many of these are getting worse.

NHS England points out that concentrating on the national average hide poor performance among individual NHS providers throughout the year.

The organisation recently noted: “In the last quarter of 2011/12, 47 out of 152 providers failed to meet the 95 per cent standard for patients being seen and discharged within 4 hours. For the last quarter of 2012/13 this figure had increased to 94 out of 148 providers, double the previous number.”

NHS England has set out an “urgent recovery programme” to try to get A&E waits back on track, which suggests that there is serious concern inside health service about recent trends in performance.

factFiction3“Today in our A&Es, the average waiting time is 50 minutes. When the shadow health secretary was sitting here as health secretary, the average waiting time was over 70 mins.”
David Cameron

It all depends on what you mean by “waiting times”. The Department of Health tells us that A&E patients faced a mean average wait of 77 minutes before being assessed in 2009/10, when Mr Burnham was in the hot seat, and that fell to 50 minutes for 2012/13.

Fair enough, but other measures don’t appear to have changed at all. Median average waiting time until treatment was 55 minutes then and the latest figures put it at 53 minutes now.

FactFiction2“We’ve taken 20,000 administrators out of the NHS…5,500 more doctors…1,000 more midwives…1,000 more health visitors.”
David Cameron

With the exception of health visitors (only 700 more), these figures are all broadly correct. We’re looking at the full time equivalent tables here and comparing the latest data from July 2013 with May 2010.

What Mr Cameron didn’t mention is that there are now about 6,000 fewer nurses. And midwives might feel that it’s a bit rich to boast about having 1,000 more, when the Prime Minister’s pre-election promise was to boost their ranks by 3,000 to cope with rising birth rates.

FactFiction2“We can look at the Labour record in Wales…they haven’t met a cancer target since 2008.”
David Cameron

True. The target here is for 95 per cent of patients newly diagnosed with cancer starting treatment within 62 days. It has not been met since 2009.

FactFiction2“Over 2,000 people have been made redundant…and re-hired.”
Ed Miliband

At least one frontbencher apparently shouted that this claim was “rubbish”, but it was revealed in a parliamentary answer by health minister Dr Dan Poulter in March this year.

The minister said 1,300 permanent and 900 fixed-term contract staff had been made redundant from the NHS since 1 May 2010 only to be re-employed by NHS organisations.

The verdict

Regular viewers of Prime Minister’s Questions will have spotted a pattern here. Both sides are experts at cherry-picking statistics from the vast selection available which appear to prove that the NHS is either on its knees or that everything is plain sailing.

The basic problem is that in an organisation as massive as the NHS there are so many ways of measuring performance that it’s difficult to get the big picture.

Independent NHS watchdogs like the King’s Fund provide a more balanced view. The think tank’s latest monitoring report confirms that pressure on accident and emergency departments is the single biggest worry for NHS providers.

But the King’s Fund notes that an extra £500m has been earmarked to support struggling A&E departments over the next two years, and concludes cautiously: “It remains to be seen whether this and other action being taken to address these pressures is enough to prevent the target being breached again next winter.”