Part of the problem is that there’s a great deal of heat, but not a lot of light. Last week, Cameron again drew attention to the difference in waiting times for diagnostic tests, where 30% of people in Wales wait for more than 6 weeks, compared to only 1.5% in England. In purely numerical terms, that’s a shocking gap between two neighbouring countries, but there’s much more to this than averages can reveal.
From the perspective of each and every individual patient, whether they’re part of the 30% in Wales or the 1.5% in England is irrelevant; the figure for them as individuals is 100%. And given the small size of Wales compared to England, even on those figures there are almost as many individuals waiting longer than 6 weeks in England as there are in Wales. If it were really the best interests of patients driving Cameron’s concern, he could halve the total number of people waiting more than 6 weeks in EnglandandWales by eliminating the 1.5% in England, where he does actually have direct responsibility.
There’s another thing about averages as well; whilst they tell the headline story, they hide the detail. These are averages for all specialities across all locations; there will be a lot of variation in there. Are there no specialities in particular locations in England where the lists are longer than for the same speciality in some locations in Wales? I don’t know; but I do know that overall averages will never tell us that.
And how about urgency? A 6 week target for all tests of all types is nice and easy to shout about, but as a patient, there are some tests that I would want to have immediately, and others that I wouldn’t mind waiting a while for if priority was being given to those in greatest need. Again, an overall average will never tell us anything about that; yet from a patient perspective, it’s outcomes which matter more than anything. If Wales could achieve a much lower average (and thus undermine Cameron’s argument) by concentrating on doing the least urgent cases first (if, for instance, they were easier to do), would anyone really think that was the right thing to do? Fixing the numbers isn't the same as fixing the problems.
Let me stress this: I don’t know the answer to the questions I raise above about the detail underlying the averages. But I doubt that Cameron does either. Worse, I’m not sure that he really cares; he’s only after making a political point which has more to do with winning English constituencies in the upcoming election than it does with care for the wellbeing of Welsh patients.
But the underlying problem here isn’t the politics of health, nor the way that politicians use statistics (although it would help if some of them were a little more numerate). It is that, in Wales as in England, there is a target-meeting approach to managing the health care system, and as long as that continues, the Welsh Government is inviting this sort of criticism.
Whilst we’d all like to be able to have whatever tests we need ‘on demand’, what really matters to patients is whether we get the tests (and treatment) we need at a time which makes a difference to the outcome for us. In some cases, that may well be very much less than 6 weeks; in other cases, it could be longer. Do we want our doctors to be deciding what to do on the basis of meeting a simplistic target to keep the politicians happy, or on the basis of meeting the clinical needs of patients?