The NHS can expect to see performance this summer as poor as that seen in recent winters, as so-called “winter pressures” extend right through the year, according to new analysis from the British Medical Association.
The health service came under unprecedented pressure this winter, with A&E attendances, waiting times and admissions reaching alarming levels, and while summer would normally see the situation ease, the BMA says levels of demand and activity this summer will mirror winters of just two or three years ago.
Using official data from the last five years, the BMA’s health policy team were able to forecast1 a number of scenarios for this summer’s NHS performance, measured in A&E attendances, waiting times, admissions and trolley waits.
The worst-case scenario would see the health service see a repeat of scenes experienced during winter 2016.
Best-case scenario for July, August, September 2018 (projected):
- 5.89 million attendances at A&E
- 613,000 people waiting over four hours at A&E
- 89.6 per cent of patients seen, admitted or discharged within four hours
- 1.51 million emergency admissions
- 127,000 trolley waits of four or more hours
- Comparable winter: 2015
Worst-case scenario for July, August, September 2018 (projected):
- 6.2 million attendances at A&E
- 774,000 people waiting over four hours at A&E
- 87.5 per cent of patients seen, admitted or discharged within four hours
- 1.57 million emergency admissions
- 147,000 trolley waits of four or more hours
- Comparable winter: 2016
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, the BMA’s analysis for this year paints a different picture.
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.
Dr Chaand Nagpaul, BMA council chair, said:
“This data clearly shows what doctors working on the front line have been saying for some time – that the “winter crisis” has truly been replaced by a year-round crisis.
“Doctors and patients have just endured one of the worst winters on record, resulting in thousands of cancelled operations, unacceptable long waits to be seen and people who are already at their most vulnerable having to face the indignity of being treated in hospital corridors. These scenes have become an all-too-familiar annual occurrence, each year stretching further into spring and appearing again earlier the next winter. We cannot accept that this is the new normal for the NHS.
“The government gave the health service £335m in November to prepare for winter, but as we know, this proved a temporary sticking plaster that came too late in the day to avert another crisis. This research proves that this approach of cash top-ups and short-term fixes will no longer do.
“The BMA estimates that health funding in England is more than £7billion a year behind comparable European countries2 and this could rise to over £11billion over the next three years.
“While we cautiously welcomed the prime minister’s commitment last week to a long-term funding plan for the NHS, this must be met with the reality of urgent and tangible new investment that will properly address the year-round pressures faced by the health service and ensure that patients receive safe, high-quality care.”
Notes to editors
The BMA is a trade union representing and negotiating on behalf of all doctors in the UK. A leading voice advocating for outstanding health care and a healthy population. An association providing members with excellent individual services and support throughout their lives.
- In order to create a plausible range for the rest of the year’s data, the BMA’s health policy team used three different methods to project forward. The first was to calculate the rate of growth between calendar months of different years (e.g. 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 they used that rate of increase to project data for the relevant indicator for the next nine months. The team also used the same method based on the last 12 months. The rate of increase/decrease between adjacent months (eg March to April 2017) was also calculated, then used this to work out the likely change between the same months in the following year. All data used in the projections is published by NHS England.
- The BMA is calling on the UK government to match or exceed the average spend of other comparable European countries on health and social care. If the UK had spent as much on health as the average of these countries, £10.3 billion more would have been spent in 2015. This could rise to as much as an extra £22.9 billion by 2022/23. Read the full briefing here.