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.

Read: BMA warns that latest NHS England performance figures show a health service that is on its knees

 

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

Key indicators for January/February 2019:

  • There were 1.95m attendances at A&Es in February, an increase of 133,800 from the previous February.
  • 505,700 emergency admissions were recorded, a 28,900 increase from February 2018.
  • Performance against the four-hour wait target at major A&Es deteriorated by 0.4 percentage points from January, reaching 75.7% last month. This is 1.2 percentage points less than the previous February which represents another historic low.
  • There were 70,800 trolley waits of four or more hours, which is 2,100 more than February 2018.
  • Including estimates for missing data, the waiting list for elective treatment was 4.26m in January. The median wait of 7.8 weeks to begin treatment was the highest figure recorded since May 2008.
  • There were 135,700 delayed days recorded in January, a 6,300 increase from December.

 

BMA analysis

Despite a period of weather that wouldn’t have seemed out of place in July (per the Met Office, “The provisional UK mean temperature [in February] was 6.0 °C, which is 2.4 °C above the 1981-2010 long-term average”), last month proved to be another intensely difficult period for trusts in England.

A new record low for performance against the four-hour wait target coupled with 70,000 trolley waits suggest that demand once again exceeded capacity. Similarly, the median wait to begin treatment grew once again, presumably as focus continues to remain on emergency care rather than elective.

Curiously the bed occupancy recorded during the winter situational reports (5th Dec – 3rd March) was almost an entire percentage point lower than the previous winter: 93.5% was the mean average, compared with 94.4% in 2017/18 (that figure remains a concerning one, as it still comfortably exceeds any recommended safe occupancy level). The bottleneck at A&E (which leads to worse four-hour wait performance and trolley waits) is often attributed to bed shortages, so the fact that performance deteriorated even as occupancy fell suggests an endemic, system-wide problem of stretched resources.

Last year March proved even more difficult than February – another chaotic month at A&Es will mean not just overworked staff and long waits for patients in the short term but will also once again mean a stressful summer as trusts try to tackle a waiting list that remains as long as it has ever been.

 

Data from previous months

  • December 2018 / January 2019

    • There were 2.1m attendances at A&Es in January an increase of 111,500 from the previous January.
    • 563,800 emergency admissions were recorded, a 37,700 increase from January 2018. 
    • Performance against the four-hour wait target at major A&Es deteriorated by 3.2 percentage points from December, reaching 76.1% last month. This is 1.1 percentage points lower than the previous January (and an historic low).
    • There were 83,500 trolley waits of four or more hours, which is 2,290 more than January 2018.
    • Including estimates for missing data, the waiting list for elective treatment was 4.28m in December. The median wait of 7.6 weeks to begin treatment was the highest figure recorded since May 2008. 
    • There were 129,400 delayed days recorded in December, the lowest figure since June 2014.
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