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NHS pressures – future trends

The NHS has come under unprecedented pressure this winter, with A&E attendances, waiting times and admissions rising to alarming levels. The BMA is undertaking regular analysis on our new pressure points in the NHS webpage, where we have highlighted several worrying trends as spiraling demand outstrips the ability of services to cope.

 

What pressures will the NHS be under this summer?

Based on current trends, our assessment is that rather than experiencing the customary fall in pressures this summer, the NHS will experience similar levels of demand and activity this summer as it did in the winter of just two or three years ago. Our assessment of the issues has been picked up by national media

But how does it feel to work under this kind of pressure? One doctor writes about the looming summer crisis.

Read My Working Life

 

What do the projections tell us about this summer (July, August & September)?

Best case scenario:

  • 5.89m attendances at A&E.
  • 613,000 people waiting over 4 hours at A&E.
  • 89.6% of patients seen, admitted or discharged within four hours.
  • 1.51m emergency admissions.
  • 127,000 trolley waits of four or more hours.
  • Comparable winter: 2015.

Worst case scenario:

  • 6.2m attendances at A&E.
  • 774,000 people waiting over 4 hours at A&E.
  • 87.5% of patients seen, admitted or discharged within four hours.
  • 1.57m emergency admissions.
  • 147,000 trolley waits of four or more hours.
  • Comparable winter: 2016.

 

Key graphs

These visualisations show the deterioration of key NHS performance indicators projected through to the end of the year. Scroll through all three graphs and click on the double-edged arrow in the bottom-right to see larger versions.

 

How did we arrive at these projections?

In order to create a plausible range for the rest of the year’s data, we used three different methods to project forward. The first was to calculate the rate of growth between calendar months of different years (eg the rate of increase between January 2016 and January 2017), then determined the average rate of increase for that month over the past five years. Then we used that rate of increase to project data for the relevant indicator for the next nine months. We also used the same method based on the last 12 months. We also calculated the rate of increase/decrease between adjacent months (eg March to April 2017), then used the same rate of change to calculate the likely change between the same months in the following year.

For the purposes of simplification, winter refers to the months of January, February and March, while summer refers to July, August and September.

All data used in the projections is published by NHS England.

 

What does this mean for the NHS?

Traditionally the summer offers a period of respite for the NHS. While attendances at A&E tend to increase, bed occupancy falls as emergency admissions go down. With more beds available, trusts can improve performance against the four-hour wait target and cut down on things like trolley waits.

However, in terms of performance and demand, this summer months looks likely to mirror the winters of just two or three years ago. The best-case scenario would see emergency admissions, trolley waits and patients waiting over four hours reached the same levels as they did in the first three months of 2015, while the worst-case scenario would see them reach similar levels as in the winter of 2016.

The implications for trusts are that winter contingency plans continue to remain in place; for example, the University Hospitals of North Midlands NHS Trust is planning to keep its extra winter capacity open until the summer.

As the process of dealing with the fallout of massive spikes in demand and pressures during the winter months now extends into summer, it begins to overlap with the early stages of planning for the following winter. The winter crisis has been replaced by a year-round crisis.

 

Action needed on funding

The continuing deterioration of waiting times highlighted by this analysis demonstrates the need for urgent government action to address the pressures facing NHS services.

Funding remains a key issue – the BMA has estimated that health funding in England is £7.3 billion behind the average spent by comparable European countries and this could rise to over £11.6 billion over the next three years.

Over the past five years, the NHS budget has increased at a much slower rate than at any time since the 1950s – by an average of 1.6% per year. This is set to slow to an increase of just 0.7% per year over the next three years.

In practice these small rises will not be enough to keep pace with increased patient need. Population growth and demographic change are likely to continue to raise the pressure on NHS services – for example, the number of people over the age of 85 – who tend to use NHS services most – in England has grown by 9% since 2013. Consequently, there will be a 1.3% drop in per capita spending.

The government must act to address this growing crisis and put in place plans to bring investment in the NHS in line with comparable European countries.