England

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Pressure points in the NHS

a busy hospital

With annual increases in demand for care, the NHS in England is under a growing amount of pressure and has begun to noticeably struggle to meet targets.

As this pressure grows, so too does the importance of highlighting it and lobbying for the government to address this issue.

The BMA will be analysing monthly data releases published by NHS England to shed some light on the massive pressures being placed on an already over-burdened healthcare system.

 

Monthly data on A&E, waiting list and delayed transfers of care

Key indicators for November/December 2018:

  • There were 2.05m attendances at A&Es in December an increase of 43,000 from the previous December.
  • 545,000 emergency admissions were recorded, a 24,100 increase from December 2017.
  • Performance against the four-hour wait target at major A&Es deteriorated by 1.8 percentage points from November, reaching 79.3% last month. This is 2 percentage points higher than the previous December.
  • There were 59,800 trolley waits of four or more hours, which is 9,280 fewer than December 2017. The total number of trolley waits in 2018 was 578,100, 81,700 more than 2017 (a 12.8% increase). Including estimates for missing data, the waiting list for elective treatment was 4.34m in October. The 87.1% figure for patients seen within 18 weeks represents a small improvement (0.4 percentage points) from September.

 

Weekly data from the winter situational reports

Key indicators for week commencing 31 December:

  • Bed occupancy was 93.2%, lower than the 94.7% and 95% figures recorded in comparable weeks from the last two winters.
  • Arrivals by ambulance exceeded 100,000 for the first time since the figures were published at the start of the 2017/18 winter. Despite the increase in arrivals, the number of handover delays fell by 4,400 when compared with a similar week from last winter.
  • The average number of beds closed due to flu or norovirus was 398, less than half of what it was in either of the two preceding winters.

 

BMA analysis

The surprising story so far this winter is that so far NHS performance has seen a small but notable improvement when compared with the winter of 2017/18. Though demand continues to increase, trusts saw a greater proportion of patients within four hours than in December 2017, and there were over 9,000 fewer trolley waits.

It remains difficult at this point to identify the extent to which different factors have made this possible. On the one hand, trusts should be applauded for managing demand better than they did last winter, and it seems likely that better planning has played its part.

On the other, it’s difficult to ignore the fact that December 2018 was on average two degrees warmer than December 2017 (a pattern that looks set to repeat in January). A smaller spike in admissions is easier to manage – emergency admissions actually fell between November and December by 0.1%, the first time this has happened in the available data (2010 onwards). The average change prior to this year was a 3.5% increase.

It’s encouraging that the NHS is enduring a less severe winter than expected, and should this continue, trusts will be better placed during spring and summer to deal with the exceptionally long elective treatment waiting list.

However, with the best part of two months of winter still to endure, we are still far from out of the woods.

 

Data from previous months

  • September 2018

    • There were 2m attendances at A&Es in September, an increase of 78,100 from the previous September.
    • 510,600 emergency admissions were recorded, a 23,000 increase from September 2017..
    • Performance against the four-hour wait target at major A&Es deteriorated by 1% from August, reaching 83% last month. This is 1.6% lower than the previous September.
    • There were 44,300 trolley waits of four or more hours, which is 2,150 more than September 2017.
    • Including estimates for missing data, the waiting list for elective treatment grew to over 4.34m in August; in the past seven months, there has been a 9% increase in the number of patients waiting to start treatment. The 87.2% figure for patients seen within 18 weeks was 0.6% lower than July.
  • August 2018

    • There were 2m attendances at A&Es in July, an increase of 71,300 from the previous August. 
    • 517,500 emergency admissions were recorded, a 31,000 increase from August 2017.
    • Performance against the four-hour wait target at major A&Es improved by 0.4% from July, reaching 83.9% last month. This is 1.5% lower than the previous August.
    • There were 39,350 trolley waits of four or more hours, which is 2,000 more than August 2017.
    • Including estimates for missing data, the waiting list for elective treatment grew to over 4.31m in June, making it the third month in a row to set a new record. The 87.8% figure for patients seen within 18 weeks remains the same as the previous month. Having increased for seven consecutive months, the number of patients waiting over 52 weeks fell from 3,517 to 3,464. 
  • July 2018

    • There were 2.18m attendances at A&Es in July, an increase of 102,000 from the previous July.

    • 530,600 emergency admissions were recorded, a 31,000 increase from July 2017.

    • Performance against the four-hour wait target at major A&Es fell by 2.2% from June, reaching 83.5% last month. This is also 2% lower than the previous July.

    • There were 41,500 trolley waits of four or more hours, which is 4,300 more than July 2017.

    • Including estimates for missing data, the waiting list for elective treatment grew to over 4.3m in June, making it the second month in a row to set a new record. The 87.8% figure for patients seen within 18 weeks represents a small deterioration from May but remains higher than April (87.5%). The 3,517 patients waiting over 52 weeks is the highest figure since April 2012.

  • June 2018

    • There were 2.1m attendances at A&Es in June, an increase of 100,000 from the previous June.

    • 517,900 emergency admissions were recorded, a 25,000 increase from June 2017.

    • Performance against the four-hour wait target improved by 0.3% from May, reaching 90.7% last month. This matches the figure from the previous June.

    • There were 33,800 trolley waits of four or more hours, which is just over 700 fewer than June 2017, making it the second consecutive month to see a decrease from the previous year.

    • Including estimates for missing data, the waiting list for elective treatment grew to 4.3m in May. This is the highest figure on record, surpassing the previous high of 4.2m from August 2007. The 88.1% figure for patients seen within 18 weeks represents a small improvement from April, but the 3,101 patients waiting over 52 weeks is the highest figure since June 2012.

  • May 2018

    • There were 2,161,779 attendances at A&Es in May, an increase of 98,082 from the previous May.

    • 534,188 emergency admissions were recorded, a 5.2% increase from May 2017.

    • Performance against the four-hour wait target improved by almost 1.8% from April, reaching 90.4% last month. This is a slight (0.7%) improvement than May 2017.

    • There were 39,238 trolley waits of four or more hours, which represents a decrease of 8,764 from April, and a decrease of 1,057 from the previous May.

    • Not including estimates for missing data, the waiting list for elective treatment grew to 4.01 million. This is the highest figure since August 2007. The 87.5% figure for patients seen within 18 weeks is the worst since February 2009. The 2,822 patients waiting over 52 weeks is the highest figure for almost 6 years (July 2012).

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