Omitted evidence?

Editor—I was surprised that Alvarez-Rosete et al in their article did not discuss what is thought to be the best piece of evidence that the NHS in England has improved: performance of accident and emergency departments.¹ Then I double checked my sources.

What is clear is that English accident and emergency departments are dramatically better than they were five years ago, when more than one in four people waited more than four hours for admission or treatment. Over the past six months fewer than two in 100 have waited more than four hours in England. The situation in Scotland, which boasted about being the best in the United Kingdom in 2001,² has certainly got worse and is probably much worse than England. The current Scottish figures are hard to compare and may not be reliable as the sampling technique (a three day sample, once a year) may be both unrepresentative and gameable.³ English departments have to submit statistics on all-patient performance weekly.

I could find no site reporting useful statistics about Wales, but according to anecdotal evidence, accident and emergency performance is as poor as English performance in 2000 in some of the larger hospitals. It seems that the experience of reform in this part of health care in England is a success.

Debate is ongoing in these pages about the evidence for and against reform, and it would be ironic indeed if the evidence for elements of reform were undermined by the lack of information about what happens if you don't do it.