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.

Winter pressures report 2018/19

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 April/May 2019:

A&E (May - excluding 14 trusts piloting new targets)

  • Only 86.6% of people were admitted, transferred or discharged from A&E within 4 hours, down from 90.3% last May.
  • The fall in 4 hour wait performance was even bigger in major A&Es, down to 79.1% from 84.7%. Both these figures make May 2019 the worst May on record.
  • Trolley waits of over 4 hours were up 57% on last May to 61,500. (All trusts)
  • Trolley waits of over 12 hours almost tripled to 415, compared with last May. (All trusts)

Cancer (April)

  • 89.9% of cancer patients seen by a specialist within 2 weeks of urgent GP referral. Falling below 90% for the first time on record. The 93% target has now been missed in 10 of the last 12 months. Almost half of all providers (46%) missed the target.
  • 79.4% of cancer patients were treated within 2 months of an urgent GP referral, making April the 40th consecutive month that the government target, to treat 85% within 2 months, has been missed. 63% of providers missed the target.

RTT Waiting List (April)

  • The waiting list for treatment grew to its highest level since records began, reaching 4.41 million people in April 2019. Compared to last April, there are an additional 215,000 people waiting for treatment, a rise of 5.1%.
  • The average wait for treatment grew over 7 weeks in April 2019.
  • Only 86.5% of patients were treated within 18 weeks, falling well below the 92% target. This is the worst performance since January 2009.

BMA analysis

It is now clear that the NHS is under intense pressure all year round. Despite the milder winter, the pressures on the NHS are as high as ever. The waiting list is now the longest it’s been; this year continues to be the worst on record for cancer patients, with each month the worst on record; and A&Es remain at winter-level pressures.

NHS cancer targets were badly missed again in April 2019. 20,000 patients faced a wait of over 2 weeks to see a cancer specialist, over 3,000 more than in any other month on record.

A&Es continued to face pressures more commonly associated with the peak of winter, with more than 2 in every 10 people visiting major A&Es having to wait over 4 hours to be transferred, discharged or admitted. The most striking example of the intense pressure on A&Es over May was the almost tripling of trolley waits of over 12 hours. That such long trolley waits remain in our A&Es deep into spring is a shocking consequence of the year-round pressures put on the NHS.

With 4.41 million people now waiting for treatment, the pressure looks unlikely to ease. Making this worse is the fact that 13.5% of people are waiting over 18 weeks for treatment.

The government must act to ensure the NHS is sufficiently funded and staffed to meet the healthcare needs of the population. We made 9 recommendations for action in our report on winter 2018/19.

Read our full report on winter 2018/19. The report reveals how this winter was, in many respects, the worst ever for the NHS, and exposes the lack political attention to this crisis. Whether it was because of Brexit, warmer weather, or a lack of media interest, there was a crisis in the NHS this winter, and it was largely ignored.

Read a BMA blog from a consultant working in A&E, on what these figures mean for them.

 

Data from previous months

  • March/ April 2019

    A&E

    • Only 85.1% of people were admitted, transferred or discharged from A&E within 4 hours, down from 88.6% last year.
    • The worsening of performance against the 4 hour wait target was even greater in major A&Es, down to 77.2% from 82.3%. These figures make April 2019 the worst April on record.
    • 304,000 patients waited over 4 hours in major A&Es. This is up 38% on last April.
    • Trolley waits of over 4 hours up 39% on last April to 67,000. Trolley waits of over 12 hours rose by 24% to 442, compared with last April. The worst April on record.
    • Demand continues to grow with a 6.6% increase in total A&E attendances compared to last April, rising to 2,100,000. There was a similar rise in emergency admissions to 535,000.

    Waiting list and cancellations

    • The waiting list for treatment continued to rise in March 2019, reaching 4.34 million people. Compared to last March, there are now an additional 241,500 people waiting for treatment, a rise of 5.7%. The waiting list has only been higher than this once on record.
    • Almost 22,000 elective operations were cancelled between January and March 2019. While this is down on last year, it represents the 5th worst quarter since records began in 1994.
    • 347 urgent operations were cancelled in March 2019.

    Cancer waits

    • 91.8% of cancer patients seen by a specialist within 2 weeks of urgent GP referral in March 2019. Falling back under the 93% target. This target has now been missed in 10 of the last 12 months. It was only missed once in the previous year.
    • 79.7% of cancer patients were treated within 2 months of an urgent GP referral, making March 2019 the 39th consecutive month that the government target, to treat 85% within 2 months, has been missed.
    • Both these figures make this the worst March since records began in 2009.
    • These figures confirm that winter 2019 (Jan-Mar) was the worst winter on record for cancer waits, with 43,000 having to wait over 2 weeks to see a specialist and almost 9,000 waiting over 2 months for their first treatment.
  • February / March 2019

    • There were 2.17m attendances at A&Es in March, an increase of 116,500 from the previous March.
    • 555,500 emergency admissions were recorded, a worrying 6% increase from March 2018.
    • Performance against the four-hour wait target at major A&Es was 79.5% last month, a slight improvement on February's historic low.
    • There were 59,500 trolley waits of four or more hours, making it the second worst March on record.
    • Including estimates for missing data, the waiting list for elective treatment rose to 4.31m in February.
    • There were 127,300 delayed days recorded in February, a 6% fall from last month.
  • 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.
  • 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.
  • Further resources