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 August/September 2019:

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

  • 85.4% of people were admitted, transferred or discharged from A&E within four hours, down from 88.9% last year.
  • The fall in four-hour wait performance was even bigger in major A&Es, down to 77.0% from 83.0%. Both figures are the lowest recorded in the month of August by some distance. 
  • Demand has continued to increase at an accelerated rate; there were 2.14 million attendances at A&E, and 529,900 emergency admissions, increases of 6.9% and 3.8% (All trusts).
  • Trolley waits of over four hours were up by 45.6% on last September to 64,900. This is the largest increase between consecutive Septembers since 2013/14 (All trusts).

Delayed Transfers of Care (August)

  • There were 148,900 delayed days, the highest figure since March 2018.

Cancer (August)

  • 78.5% of cancer patients were treated within two months of an urgent GP referral, making August the 44th consecutive month that the Government target - to treat 85% within two months - has been missed.
  • 89.4% of cancer patients seen by a specialist within two weeks of urgent GP referral. The 93% target has now been missed in 15 of the last 17 months. For the second consecutive month, more patients than ever before (21,191) waited over two weeks to be seen by a specialist. 

RTT waiting list (August)

  • The waiting list for treatment grew to its highest level since records began, reaching 4.56 million people (includes estimates for missing data). Compared to last August, there are an additional 35,400 people waiting for treatment, a rise of 0.8%.
  • The average wait for treatment was eight weeks, while only 85% of patients were treated within 18 weeks, falling well below the 92% target. This is the worst performance since 2008.
 

BMA analysis

To describe the last three months in the NHS as 'the worst summer on record' would almost certainly fail to convey the extent to which the system has been under strain recently. In a period that the health service traditionally relies on to recover from increasingly severe seasonal pressures - to reduce bed occupancy, improve performance against key indicators and to give staff a break - trusts were instead forced to endure levels of demand and pressure they might have experienced during the height of winter only two years ago.

The 77% performance against the four-hour wait target at major A&Es is the sixth lowest figure ever recorded, and that includes all winter months. In the three summer months (July, August, September), trolley waits increased from the previous year by 35%, 40% and 46% respectively.

One explanation is that demand has increased fairly substantially this year. Attendances are up by 4.7% through the first nine months of 2019 compared with the same period in 2018, while emergency admissions in the same window have increased by 4.6%. However, this rate of increase is not unprecedented (those figures were 4.1% and 5.6% between the first nine months of 2017 and 2018).

Equally concerning is the sustained increase in the waiting list to begin treatment. In the last four years, the list has grown in 33 of 48 months. The data set was created in 2007 when the list stood at 4.2 million, the median wait was over 14 weeks, and there were over half a million people waiting a year or more for treatment. However, within a year and a half, that had been reduced to between 2.3 and 2.4 million, and the median wait was cut in half. It’s not impossible that we could return to a similar situation, and urgent action should be taken before the waiting list once again spirals out of control.

On the horizon awaiting the NHS looms the spectre of another winter crisis – in addition, a number of factors could be lying in wait to exacerbate what promises to be another 'worst winter on record'. The pensions situation continues to prevent doctors from picking up extra shifts; Brexit planning could well interfere with the ability of trusts to legislate for the imminent increase in demand. Importantly, the NHS has also had no opportunity to bounce back from last winter, simply lurching from one crisis to another. Urgent action is needed if the health service is to cope, with additional funding allocated to health and social care, more beds opened and more staff in primary and secondary care. The Government must act now before it’s too late.

 

Data from previous months

  • July / August 2019

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

    • Only 86.3% of people were admitted, transferred or discharged from A&E within four hours, down from 89.8% last year.
    • The fall in four hour wait performance was even bigger in major A&Es, down to 78.3% from 83.9%. Both these figures make August 2019 the worst August on record and are comparable to some of the worst winters on record.
    • Following on from July being the busiest month ever, there were 2.1 million attendances at A&E in August. 1.3 million of those were at major A&E departments. This makes this month the busiest August on record for A&E departments. (All trusts)
    • Trolley waits of over four hours were up an enormous 40.5% on last August to 56,500. Trolley waits of over 12 hours more than doubled to 372, compared with last August. Comfortably the worst August on record. (All trusts)

    Cancer (July)

    • 77.6% of cancer patients were treated within two months of an urgent GP referral, making July the 43rd consecutive month that the government target - to treat 85% within two months - has been missed. More than two thirds (69.9%) of providers missed the target. 3,300 patients waited over two months to start treatment, the second highest figure on record.
    • 90.9% of cancer patients seen by a specialist within two weeks of urgent GP referral. The 93% target has now been missed in 14 of the last 16 months. Over a third of all providers (38.6%) missed the target. More patients than ever before (20,200) waited over two weeks to be seen by a specialist.
    • Both these figures make this July the worst July since records began in October 2009.

    RTT waiting list (July)

    • The waiting list for treatment grew to its highest level since records began, reaching 4.52 million people. Compared to last July, there are an additional 200,000 people waiting for treatment, a rise of 4.6%.
    • The average wait for treatment was 7.3 weeks in July 2019.
    • Only 85.8% of patients were treated within 18 weeks, falling well below the 92% target. This is the worst performance since January 2009.
  • June / July 2019

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

    • There were 2.3 million attendances at A&E in July, making it the busiest month on record for A&E departments. 1.4 million of those were at major A&E departments, also the highest figure on record. (All trusts)
    • Only 86.5 per cent of people were admitted, transferred or discharged from A&E within four hours, down from 89.4 per cent last year.
    • The fall in four hour wait performance was even bigger in major A&Es, down to 78.9 per cent from 83.3 per cent. Both these figures make July 2019 the worst July on record.
    • Trolley waits of over four hours were up an enormous 34.7 per cent on last July to 57,700. Trolley waits of over 12 hours almost tripled to 436 compared with last July. Comfortably the worst July on record. (All trusts)

    Cancer (June)

    • 76.7 per cent of cancer patients were treated within two months of an urgent GP referral, making June the 42nd consecutive month that the Government target, to treat 85 per cent within two months, has been missed. More than three quarters (75.2 per cent) of providers missed the target.
    • 90 per cent of cancer patients were seen by a specialist within two weeks of an urgent GP referral. The 93 per cent target has now been missed in 13 of the last 15 months. Almost half of all providers (46 per cent) missed the target.
    • Both these figures make this June the worst June since records began in October 2009.

    RTT waiting list (June)

    • The waiting list for treatment grew to its highest level since records began, tipping over 4.5 million people for the first time on record. Compared to last June, there are an additional 197,500 people waiting for treatment, a rise of 4.6 per cent.
    • The average wait for treatment was 7.5 weeks in June 2019.
    • Only 86.3 per cent of patients were treated within 18 weeks, falling well below the 92 per cent target. This is the worst performance since January 2009.

    Cancelled operations (quarter one 2019/20)

    • There were 20,000 cancelled operations in the quarter to June 2019. This is up 6 per cent on the same quarter last year. This is the highest figure for this quarter (Apr-Jun) since 2001.
    • 1,025 urgent operations were cancelled.
    • May / June 2019

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

      • Only 86.4 per cent of people were admitted, transferred or discharged from all A&E within four hours, down from 90.9 per cent last June.
      • The fall in four hour wait performance was even bigger in major A&Es, down to 78.8 per cent from 85.5 per cent. Both these figures make June 2019 the worst June on record.
      • Trolley waits of over four hours were up 71 per cent on last June to 57,800. (All trusts)
      • 471 trolley waits of over 12 hours were recorded, a 376 per cent increase compared with last June. (All trusts)

      RTT Waiting List (May)

      • The waiting list for treatment grew to its highest level since records began, reaching 4.5 million people in May 2019 (includes estimates for missing data). Compared to last May, there are an additional 220,000 people waiting for treatment, a rise of 5.2 per cent.
      • The median wait for treatment grew to 7.7 weeks in May 2019.
      • 86.9 per cent of patients were treated within 18 weeks, falling well below the 92 per cent target (a small of improvement of 0.4 percentage points from April).

      Cancer (May)

      • 90.8 per cent of cancer patients seen by a specialist within two weeks of urgent GP referral. This is a small improvement from April (0.9 percentage points). The 93 per cent target has now been missed for three consecutive months.
      • 77.5 per cent of cancer patients were treated within two months of an urgent GP referral (down by 1.9 percentage points), making May the 41st consecutive month that the government target, to treat 85 per cent within two months, has been missed.
    • April / May 2019

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

      • Only 86.6 per cent of people were admitted, transferred or discharged from A&E within 4 hours, down from 90.3 per cent last May.
      • The fall in 4 hour wait performance was even bigger in major A&Es, down to 79.1 per cent from 84.7 per cent. Both these figures make May 2019 the worst May on record.
      • Trolley waits of over 4 hours were up 57 per cent 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 per cent of cancer patients seen by a specialist within 2 weeks of urgent GP referral. Falling below 90 per cent for the first time on record. The 93 per cent target has now been missed in 10 of the last 12 months. Almost half of all providers (46 per cent) missed the target.
      • 79.4 per cent 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 per cent within 2 months, has been missed. 63 per cent 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 per cent.
      • The average wait for treatment grew over 7 weeks in April 2019.
      • Only 86.5 per cent of patients were treated within 18 weeks, falling well below the 92 per cent target. This is the worst performance since January 2009.
    • 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