the four countries there was little evidence, where there was comparable data, of any significant differences in outcomes. The authors also complained about the increasingly limited set of comparable data on the four health systems of the UK. In 20142015 more than 7,500 NHS patients were treated in private hospitals in order to meet waiting times targets. Dr Peter Bennie, of the British Medical Association, attacked the decision to release weekly reports on the Accident and Emergency 4 hour wait target in June 2015. In June 2015 92.2% of patients were admitted or discharged within 4 hours against a target of 95%. He said "The publication of these weekly statistics completely misses the point and diverts attention from the real issues in our health service." The Academy of Medical Royal Colleges and Faculties in Scotland produced a report entitled "Learning from serious failings in care" in July 2015. The investigation was launched after concerns about high death rates and staffing problems at Monklands Hospital, a clostridium difficile outbreak at the Vale of Leven Hospital and concerns about patient safety and care at Aberdeen Royal Infirmary. The report found the problems had been predominantly caused by the failure of clinical staff and NHS management to work together. They found leadership and accountability were often lacking but bullying was endemic. Their 20 recommendations for improvements in the NHS included a set of minimum safe staffing levels for consultants, doctors, nurses and other staff in hospital settings. They criticised a target driven culture, saying: "Quality care must become the primary influence on patient experience... and the primary indicator of performance." In January 2017 the British Medical Association said that the health service in Scotland was "stretched pretty much to breaking point" and needed an increase in funding of at least 4% "just to stand still". The service missed seven out of eight performance targets in 20162017. There was a 99% increase in the number of people waiting more than 12 weeks for an outpatient appointment. Drug-related deaths were the highest in the European Union. NHS Scotland's local health boards also have high vacancy levels in their mental health departments. In 2020, it was revealed that over 1 in 8 senior mental health roles were unfilled, which has directly led to increased waiting times for mental health patients. In November 2022 a survey by Ipsos and the Health Foundation found just 28% of the