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Pressure points in the NHS

healthcare

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 target performance

Trusts' performance against targets for August 2018:

See the maps below which indicate the level of pressures on trusts, and cover different points in the care pathway of patients treated at hospitals.

In each map, the larger circles indicate higher pressures or worse performance against a target. These will be updated monthly.

Scroll through all four graphs and click on the double-edged arrow in the bottom-right to see larger versions.


All data is from NHS England

 

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

Key indicators for 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. 

Key graphs for July/August 2018:

 

All data is from NHS England

 

BMA analysis

After a difficult July, pressures did ease in August, with fewer attendances and admissions via A&E. The small decrease in burden was reflected in an incremental improvement in the number of patients waiting over four hours on trolleys or at A&Es.

This improvement should be viewed in context though, as historically August has almost always seen an uptick in performance as demand falls compared with July. The main cause for concern this summer remains the waiting list, which continues to reach levels not seen for over a decade.

Currently over 4m people are waiting to start treatment, and it seems unlikely that this figure will decrease without the resourcing for extra beds and staff.

September typically represents the beginning of the increase in end-of-year pressures, so how trusts will reduce the number of patients waiting for treatment remains unclear. Urgent intervention is clearly needed, but will it be forthcoming?

See the BMA's projections

 

Winter pressures

During periods of colder weather, pressures are often exacerbated, leading to an unprecedented burden being placed on trusts across England. The effect of sustained increases in demand often entails massive, systemic difficulties at trust level, meaning long delays across the NHS, from general practice to emergency care.

These pressures manifested themselves in a dramatic way in the most recent winter, with dangerously high bed occupancy, long waits for elective care, patients stuck in ambulances at A&E or in hospital beds waiting to be discharged.

Winter pressures - news, briefing and analysis

Last spring, the BMA produced an analysis of key datasets which indicated levels of pressure and demand in the NHS during the winter of 2016/17. One year on, we revisit the same data to see how the NHS coped during the most recent winter. This year's report also includes evaluation of the responses from over 2000 members to a BMA survey including questions on workload, pressures and future planning.

Almost 60% of respondents told us their workload was higher last winter, and while over 45% said the cancellation of elective surgery had no impact on pressures where they work, a further 38% felt the measure had a negative impact.

Read the winter pressures analysis 2018

Download the 2017 briefing

Download the 2016 briefing

  

 

Data from previous months

  • 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).

  • April 2018

    • There were 1.98m attendances at A&Es in April, an increase of 36,000 from the previous April.

    • 503,300 emergency admissions were recorded, a 30,000 increase from April 2017.

    • Performance against the four-hour wait target improved by almost four percent from March, reaching 88.5% last month. This was 2% lower than the previous April however, which meant that 42,000 more patients waited over four hours than in April 2017.

    • There were 48,000 trolley waits of four or more hours, which represents a fall of 28,000 from March, but an increase of 14,000 from the previous April.

    • Including estimates for missing data, the waiting list for elective treatment grew to 4.09m. This is the highest figure since August 2007. The 87.2% figure for patients seen within 18 weeks is the worst since February 2009. The 2755 patients waiting over 52 weeks is the highest figure for almost 6 years (Aug 2012).

  • March 2018

    Key indicators for March 2018:

    • Attendances at A&E grew from the previous March by 31,300, while emergency admissions grew by 16,600. Both represent increases in line with general trends.

    • The four-hour wait performance at all A&Es was 84.6%. This is the worst figure on record. At major A&Es, it was 76.4%, also a historic low. The figure of 84.6% is also 5.4% worse than March 2017.

    • 315,000 patients waited over four hours at A&Es, the largest number ever recorded, and 114,000 (or 56%) more than March 2017.

    • 76,054 trolley waits of four or more hours were recorded. This represents an increase of 33,084 from the previous March, which is also the largest increase across the same month in consecutive years ever recorded.

    • The proportion of patients beginning treatment within 18 weeks fell to 87.9%, which is the worst figure since March 2009.

  • February 2018

    Key indicators for February 2018:

    • Attendances at A&E increased from the previous February by 84,500 (emergency admissions increased by 29,100).

    • The four hour wait performance at all A&Es was 85%. This is the worst figure on record. At major A&Es, it was 76.9%, also a historic low. The figure of 85% is also 2.5% worse than February 2017, which is the most severe drop in performance between years so far this winter.

    • 68,707 trolley waits of four or more hours were recorded. This represents an increase of 14,216 from the previous February, which is also the largest year-to-year increase this winter.

    • The proportion of patients beginning treatment within 18 weeks remains at 88.2%, which is the worst figure since March 2009.

    • Delayed transfers of care increased for the first time this winter, rising from 145,300 delayed days in December to 152,300 in January. This remains significant lower the previous January however (197,500 delayed days).
  • January 2018

    Key indicators for January 2018:

    • There were just over 2m attendances at A&E, 16,000 fewer than December, but an increase of 105,000 from January 2017.

    • There were 525,897 emergency admissions, the most ever recorded in a single month.

    • Whilst there was a small improvement in the four-hour wait target performance at all A&E units (85.3% of patients were seen, discharged or admitted within four hours, up from 85.1%), at major A&Es performance continued to deteriorate, reaching a new low of 77.1% (down from 77.3% in December, and 77.6% in January 2017).

    • New records were established for both four and 12 trolley waits (81,003 and 1,043 respectively). Four-hour trolley waits increased by almost 12,000 from December, and by 1,452 from January 2017. 12-hour waits increased by 543 from December, and by 54 from January 2017.

    • The number of patients waiting over a year for elective treatment reached its highest level since August 2012 (1750). 88.2% of patients began treatment within 18 weeks, the lowest figure since March 2009.

  • December 2017

    Key indicators for December 2017:

    • There were just over 2m attendances at A&E in December, about 70,000 more than December 2016.

    • Performance against the four wait target was the worst on record (data available from 2010 onwards). 85.1% of patients were admitted or discharged from all A&Es in December, which means that 300,000 patients waited over 4 hours. At major A&Es, just 77.3% of patients were seen within four hours (also a historic low).

    • 69,071 patients experienced trolley waits of over four hours, 7,300 more than December of last year. During the whole of 2017, there were just over 565,000 instances, which is more than were recorded in the whole of 2012, 2013 and 2014 combined.

    • Emergency admissions also reached a historic monthly high of 520,000, more than 22,000 than December 2016.

    • Delayed transfers of care continued to fall (latest data from November). 155,000 delayed days were recorded, the lowest since December 2015.

    • The waiting list for elective treatment fell slightly to 4.0m In November, down from 4.1m. It’s worth noting that these figures predate more recent policy related to cancellations of elective procedures.
  • November 2017

    The key indicators for November 2017 are:

    • November saw 1.9m attendances at A&E, an increase of 4.4% compared with November 2016. Despite this increase, there was a small improvement against the four hour wait target, meaning that 88.9% of patients were discharged or admitted in four hours or less, half a percent more than November of the previous year.

    • Emergency admissions remained high last month, with 513,000 instances during November, an increase of 4% compared with 2016. Trolley waits also maintained a consistent upward trend, exceeding 48,000.

    • The waiting list for elective treatment remains steady at 4.1m.  Generally speaking, the number of patients on the waiting list tends to fall towards the end of summer, before rising again at the end of winter. However, this fall is yet to materialise this year, meaning that an almost record number of patients remain waiting for treatment.

    • Delayed transfers of care remained fairly stable in October compared with the previous month, reaching 171,000 delayed days. This is a significant improvement from 2016 however, which saw delayed transfers reach a historic high of over 200,000 delayed days.
  • October 2017

    The key indicators for October 2017 are:

    • Despite a particularly busy month at A&Es (141,000 more attendances than September) there was a small improvement against the four hour wait target. Trusts achieved an average of 90.1%, an improvement of 1% compared with October 2016. The 95% target has now been missed for 27 consecutive months.

    • The number of emergency admissions exceeded 510,000 for the first time ever; consequently, the number of trolley waits increased by more than 3,000 from September. There have been 448,000 trolley waits so far in 2017, 24,000 than took place in the first ten months of 2016.

    • Including estimates for those trusts that did not return data this month, the waiting list for elective treatment has increased in eight consecutive months. It now stands at 4.1m, just 100,000 short of exceeding the highest ever recorded figure. The proportion of patients treated within 18 weeks reached its lowest level (89.1%) since February 2011.

    • Delayed transfers of care fell from both the previous month, and compared with September 2016. There were 28,000 fewer bed days lost to delayed transfers of care than in September 2016, the lowest total in a year and a half. However, the number of delayed days so far this year still exceeds the figure from the first 9 months of 2016 by 77,000.
  • September 2017

    The key indicators for September 2017 are:

    • Despite a small decrease in attendances from 2016 (25,000 fewer this year), performance against the four hour wait target was almost a full percent worse (89.7% discharged, transferred or admitted within four hours this year, compared with 90.6% in September 2016).

    • Trolley waits of four hours or more reached a new high in 2017-18 of 42,000, 6,500 higher than in September 2016. Having decreased slightly from 2016-17 prior to September, the average number per month is now 1,000 higher in 2017-18. This is presumably in part due to the increase of over 11,500 emergency admissions compared to September last year.

    • Including non-reporters (i.e. trusts that did not return data this month, but including their last known reported figures as an estimate), the latest RTT (referral to treatment) waiting list reached 4.1, just shy of the highest ever reported total (4.2m in August 2007).

    • There was an improved performance with regard to delayed transfers of care, which fell by 1,800 delayed days compared with July 2017, and by 16,500 compared with August 2016. Patients awaiting care packages in their own home remains the most frequently cited reason for delays (responsible for 11,000 more delayed days than any other reason).
  • August 2017

    The key indicators for August 2017 are:

    • In the first four months of 2017-18, the proportion of patients waiting more than 18 weeks to begin their treatment was 9.9%. This is an increase of 1.5% from 2016-17, and is the highest figure for these months since 2009-10.

    • So far there have been just under 10m attendances at A&Es in 2017-18, an increase of just about 85k from the same period in 2016-17. There were just under 2.5m emergency admissions, an increase of about 70k.

    • The average proportion of patients waiting over four hours at A&E was roughly the same in the first five months of 2017-18 (9.7%) as it was in the same period the year before (9.6%).

    • There was a small fall in the number of twelve-hour trolley waits (444 in 2017-18, down from 557 the year before) while the number of four-hour trolley waits plateaued (183k in both years).

    • The number of days on which patients experienced delayed transfers of care increased by 19k between 2016-17 and 2017-18. Social care has been responsible for an average of 37.6% of those days in 2017-18, compared with 32.6% of the delayed days a year earlier.

    • The DH (Department of Health) set a target of 75% for ambulances arriving at the most serious incidents within 8 minutes. This target has not been met for over 2 years.
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