England

Last updated:

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 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.

 

BMA analysis

Despite another uncharacteristically warm month (per the Met Office, "The provisional UK mean temperature was 6.8 °C" significantly higher than the 3.8 °C March 2018), last month proved to be another intensely difficult period for NHS trusts in England.

Major A&Es continued to perform poorly against the four-hour wait target this month. With emergency admissions up 6%, hospitals struggled to cope with demand and trolley waits over 4 hours were again common.

Trusts continued to implement A&E diverts this month, with 5 diverts across England on 3 March. NHS guidance states that A&E diverts should be ‘an action of last resort’ and ‘should only happen in exceptional circumstances’. Their continued use is therefore a serious concern.

Curiously the bed occupancy recorded during the winter situational reports (3 Dec – 3 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.

Furthermore, while overall bed occupancy dropped, thousands of escalation beds were still in use into March, and, despite their use, occupancy remained dangerously high across most trusts.

Trusts are now trying to recover from the winter pressures as best they can while preparing for a tough summer and tackling a waiting list that remains as long as it has ever been.

Look out for our report on Winter 2018/19 which we’ll be publishing later in April. 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.

 

Data from previous months

  • 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