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How does A&E in Wales and Scotland match up?

Every month, the A&E performance figures for the NHS in Wales come out.

The latest figures were released last week.

They showed that in September, across Wales, 84.5% of patients spent four hours or less in an A&E department. The target is 95%, and it hasn't been hit for years.

Recent figures show A&E targets are being met more regularly in Scotland

Of the four home nations, Wales sits in third spot.

Behind England, above Northern Ireland and trailing some way behind the front runner, Scotland.

In an effort to assess what Scotland might be doing differently, ITV Wales was granted unrestricted access into Monklands hospital just outside Glasgow.

Its latest A&E figures show that 96%% of 5,777 admissions resulted in a time of four hours or less spent in its emergency department.

In comparison, Wrexham Maelor, Ysbyty Glan Clwyd and Ysbyty Gwynedd in Betsi Cadwaladr University Health Board, each saw 5,235, 4,660 and 4,127 attendances respectively in September and none managed to achieve above 74%.

So how has Monklands managed to hit the 95% target, and is it fair to compare in the first place?

Andrea Fyfe Director of Hospital Services at Monklands Hospital said the challenges they face are the same as across the UK.

I don't think they're any different.

We're not any different to any hospital in the UK, I would suggest. We are constantly reviewing our workforce. For the patients, that's one system and that's what we absolutely have to remember.

– Andrea Fyfe Director of Hospital Services at Monklands Hospital

The focus at this hospital has been on patient flow and an entire hospital taking ownership of the challenge - with focus on patients leaving the hospital as well as coming in.

In November 2014, Monklands was ensuring around 86% of patients spent less than four hours in A&E.

At this point, there was intervention to turn performance around.

But increasing patient flow is nothing new and will be a focus for every hospital in Wales, too.

Execution of key processes has been seen as key at Monklands. There is work to assess and triage patients early, when they arrive at hospital, to best decide their care plan.

By doing this early, Monklands has been able to move patients through quickly and safely. In turn, work has been done to ensure the social care system can also accommodate patients leaving hospital.

Nigel Lee, Betsi Cadwaladr's Director of Secondary Care argued there are variables between Betsi Cadwaladr and Scotland that 'make it hard to compare'.

You would also need to compare the makeup of clinical teams, demographics of the population, the availability of alternative urgent care services and how well they are used in order to come to conclusions.

To try and make a direct comparison to another part of the country based on a couple of similarities...would be of little use to us without much more detail.

– Nigel Lee, Betsi Cadwaladr's Director of Secondary Care

So what detail is available between both countries?

The most recent figures for Scotland show 95% of patients were treated, transferred or discharged within four hours.

It has achieved this in the face of challenges shared by Wales.

There is increased demand. An ageing population with more complex medical needs adds strain.

Around 18% of Wales, approximately 500,000 people are over 65. Of a population of five million in Scotland, 18% are also aged over 65.

Staff at Monklands hospital also say that while they see younger patients too, complex issues linked to poverty, such as drug problems, can make a young patient just as likely to spend the same amount of time in an A&E as an older person.

Budgets are squeezed. NHS systems and advanced medical care are expensive to deliver.

Credit: PA Images

When it comes to money, Wales has less to spend under the devolution settlement and per head spends £1,974.03 compared to £2,342 in Scotland.

£7bn
is spent on the NHS in Wales - around half of its budget
£12bn
is spent on the NHS in Scotland - around 41% of its budget

Another challenge is the recruitment and retention of staff across disciplines.

The Welsh government has its 'train work live' scheme designed at attracting more people to work in the Welsh NHS.

Pennie Taylor, a health journalist working in Scotland, and she said A&E performance has been seen as a political priority.

Credit: PA Images

It has concentrated minds on that particular area.

A lot more money has gone into emergency care in Scotland.

It's a political priority in Scotland and I think that helps.

They [Scottish Government] monitor these figures very closely and if anyone looks as if they're an outlier, they send it, what I call, a hit squad, and help sort it out.

– Pennie Taylor, Scottish health journalist

The Scottish health secretary, Shona Robison, told ITV Wales they are "committed to improving unscheduled care".

The appointment of dedicated national and local teams to focus on improving patient flow, ensuring that once people arrive into A&E, they can be admitted or transferred in a timely way.

Boards continue to work on this as a priority, and while we can expect to see some variation, especially as we come into winter, our additional £5 million of funding announced last week for winter resilience will support this.

– Shona Robison, Scottish health secretary
Scotland's First Minister Nicola Sturgeon meeting hospital staff in Clydebank Credit: PA Images

When asked about Wales's performance compared to Scotland's when it comes to A&E, the Welsh Government said it is learning from the success of Scotland.

Working hard to deliver improvements in A&E performance here in Wales. We are also ensuring the whole health service works together, including social services, for the benefit of our patients with over £100m being invested this year in initiatives to deliver more care, closer to home, where possible.”

– Welsh Government spokesperson