A great deal of media commentary is based on the analysis of figures forEngland. The assumption is that everything is the same in other four countries that make up theUnited Kingdom. However, I felt it was time to test this assumption.
This analysis looks at the relatively simple issue of the rate of change in emergency admissions between the four countries. Taking a five year time span, the number of emergency admissions in each country has been indexed against 2002 (using the first year as a value of 100). The graph makes it abundantly clear that the four countries have each been experiencing something unique.
In summary,ScotlandandNorthern Irelandshow little increase withWalesandEnglandshowing more significant growth.Waleshas a slower rate of growth to begin with and then in the last couple of years it accelerates to a 10 per cent increase over the five years.Englandmeanwhile starts off with a much faster growth rate, achieving 20 per cent growth in four years and then flattens off.
But why are they so different? If you factor in population growth, for instance, it appears to be a relatively insignificant element. The growth across the four countries varies, withN. Irelandhaving the largest growth across the five years of 2.6 per cent (in total),England2.2 per cent,Wales1.5 per cent andScotlandonly 1.2 per cent.
Demographics may affect the overall rate of admissions but not the rate of change between countries (the rate of emergency admissions per head of population in 2006 varies fromNorthern Irelandwith 8.4 per cent,England8.6 per cent,Scotland9.2 per cent andWales11.1 per cent which raises some interesting questions of its own).
Another reason could be clinical pathways, but again there is no evidence to suggest that this should be different as the rate of spread is similar.
What we do know for sure is that policy has been different.Englandis the only country to have implemented the four hour target for A&E, and also the GP contract changes – both of which are known to have had some impact on emergency admissions, the debate has focussed on the scale of this impact. Walesmeanwhile also introduced the A&E target but somewhat later, and has not changed their GP contract. NeitherScotlandnorN. Irelandhas implemented either of these two changes.
Emergency admissions are a complex subject and this analysis is intended to highlight the danger of assuming that all countries have experienced the same trends.
Paul Robinson is had of market intelligence at CHKS