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Yesterday at PMQs the Prime Minister

Yesterday at PMQs the Prime Minister

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Published by Eoin Clarke

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Published by: Eoin Clarke on Jul 03, 2014
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07/03/2014

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Yesterday at PMQs the Prime Minister  
: 
When [Labour was in Government], the average waiting time [in A&E] was 77 minutes; under this Government, it is 30 minutes.
 This claim has been made a number of times by Ministers in the House of Commons. But other reports indicate that that
, with the 4-hour target having been missed
in England’s
major departments 
. So where does the PM’s claim come from, and is it correct? Here I’ll suggest that it relies on a simplistic reading of the data, and that the measure he refers to is
not the most natural
indicator of the “average waiting time” in A&E.
 
Means and Medians
 
The PM is referring to the mean “duration to initial assessment” in A&E –
 i.e. the time between when a patient arrives and when they are first assessed*. (This indicator is not available in the routinely published data, but can be viewed in 
 which were given in response to a parliamentary question). Here is a chart of the mean and median time to initial assessment from 2008 to 2012: Two things should jump out from this data: first, the large difference between
 waiting time; and second, the dramatic fall at the beginning of 2011-12. Whenever there is a large difference between the median and the mean, this usually indicates that the mean is being distorted by some outlying values
 –
 in this case, some very long waits for initial assessment. In their  
, the Health and Social Care Information Centre
warn that these extremes are “particularly sensitive to poor data quality and definitional issues”. This
suggests that the mean value here is not a good indicator of time to initial assessment in A&E; so we should rely on the median value to tell us what the typical time to initial assessment in A&E is. But the median has remained more or less unchanged at around 10 minutes to initial assessment, which does not show the trend that the PM refers to. What about the dramatic fall in the mean in April 2011? This corresponds with the time to initial
assessment in A&E being designated as a “care quality indicator” and becoming subject to mandatory
report
ing (along with several other similar measures). So it’s plausible that the fall in the mean in April
2011 reflects an improvement in data collection, quality and reporting, rather than any genuine change
in waiting times. It’s also worth noting that the 2
012/13 data has over three times as many data points
 –
 
“attendances with a valid duration to initial assessment” –
 than the 2008/09 data, and so is likely to be more reliable than this earlier data.

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