1. Health care-acquired infections

Monthly counts of C difficile continue to be low, though NHS England acknowledge the historic rates of reduction achieved appear to be slowing (NHSE 2014). Targets for this year reflect this, with national reductions set at around 13 per cent, compared to 29 per cent last year (figure 32).

In May 2014 there were 23 cases of MRSA, the second lowest number on record. Monthly counts are low for MRSA compared to other infections – good news for the NHS as it tries to eradicate MRSA from hospitals altogether (figure 32).

Figure 32: Monthly counts of C difficile and MRSA

Data source: Trust-apportioned monthly counts of C difficile infection http://www.hpa.org.uk.

Post-infection review assigned monthly counts of methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia www.hpa.org.uk.

2. Workforce

Total staff numbers increased for the ninth month in a row in March 2014, with total full-time equivalent roles increasing to more than 1.059 million (figure 33).

There were increases for all staff groups apart from scientific, therapeutic and technical staff who were fractionally down on the previous month but still up compared to the same time last year (figure 33).

The total number of full-time equivalent nurses, midwives and health visitors continues to increase and was up by almost 630 posts in March and more than 5,900 posts compared with the same month last year. It is the highest number of nurses, midwives and health visitors on record (figure 34).

Figure 33: Index change in NHS full-time equivalent staff: September 2009 – March 2014

Data source: Monthly NHS Hospital and Community Health Service (HCHS) Workforce Statistics in England – March 2014, Provisional statistics www.hscic.gov.uk.

Figure 34: Total numbers of full-time equivalent qualified nurses, midwives and health visitors

Data source: Monthly NHS Hospital and Community Health Service (HCHS) Workforce Statistics in England – March 2014, Provisional statistics www.hscic.gov.uk.

3. Waiting times

The proportion of inpatients waiting more than 18 weeks from referral to treatment breached the 10 per cent target for the first time in almost three years in February and March 2014. In April and May 2014 the target was met (figure 35).

The proportion of patients waiting more than six weeks for a diagnostic test has now missed its performance target (no more than 1 per cent to wait longer than six weeks) for the past six months in a row. In May 2014 more than 18,600 patients waited longer than six weeks for a diagnostic test, more than double the number compared to a year ago (figure 35).

For all other waiting lists the operational standards were met throughout the last quarter of 2013/14 and the opening months of 2014/15 (figure 35).

The total waiting list in England breached 3 million patients for the first time in six years in April and May 2014. The reported size of the waiting list is now 3,090,000, more than 5 per cent of the population of England (figure 36).

Figure 35: Percentage still waiting/having waited more than 18 weeks (more than 6 weeks for diagnostics)

Data source: Referral-to-treatment waiting times statistics www.england.nhs.uk.

Diagnostic waiting times statistics www.england.nhs.uk.

Figure 36: Referral-to-treatment total waiting list size in millions, England

Data source: Referral-to-treatment waiting times statistics www.england.nhs.uk.

The target that 85 per cent of patients should wait no longer than 62 days from an urgent GP referral to first definitive treatment for cancer was missed for the first time since its introduction in quarter 4 2013/14 (figure 37).

Figure 37: Maximum 62-day wait for first treatment: all cancers (urgent GP referral to treatment)

Data source: Provider-based cancer waiting times www.england.nhs.uk.

4. Accident and emergency

The proportion of patients waiting more than four hours from arrival to admission, transfer or discharge in the first quarter of 2014/15 was 4.9 per cent – within the 5 per cent target, but the highest first quarter level since the introduction of the revised 5 per cent target (figure 38).

The latest weekly A&E waiting times data (for the week ending 6 July) shows that across all types of departments 4.8 per cent of patients waited more than four hours. However, for major A&E departments which treat around 65 per cent of all patients, the four-hour target has now been missed for the past 51 weeks (figure 39).

Figure 38: Waiting times: Percentage waiting more than four hours in A&E from arrival to admission, transfer or discharge

Data source: Weekly A&E SitReps 2014–15 www.england.nhs.uk.

Figure 39: A&E weekly performance against target that no more than 5 per cent of patients wait longer than four hours from arrival to admission, transfer or discharge. Weekly data: November 2010-July 2014

Data source: Weekly A&E SitReps 2014–15 www.england.nhs.uk.

The first quarter of data for A&E has shown a shift away from previous trends over the same period for previous years. Though there was a long winter in 2012/13 the picture for spring was much the same as previous years, with weekly A&E data showing the proportion of patients waiting longer than four hours in A&E to be well below the 5 per cent target (figure 40).

But figures for spring 2014 are stark in that they are much higher than previous years. In fact for the first quarter of 2014/15 there were breaches in 7 of the 13 weeks (figure 40).

Figure 40: Proportion of A&E patients waiting longer than four hours from arrival to admission, transfer or discharge: comparison of winter and summer 2013 and 2014

Data source: Weekly A&E SitReps 2014–15 www.england.nhs.uk.

5. Delayed transfers of care

Seasonal increases in delayed transfers of care were observed in May 2014 for both the number of patients delayed and the total number of delayed days (figures 41 and 42).

Delayed transfers for acute patients, those receiving the most intense care, now account for 64 per cent of all delays. This has increased from 54 per cent four years ago, showing that the patients who are being delayed are increasingly likely to be in need of higher intensity follow-on care (figures 41 and 42).

This perhaps in part explains why a number of finance directors in our survey reported that delayed transfers were a particular issue for their organisation.

Figure 41: Delayed transfers: Average number of patients delayed per day each month

Data source: Acute and non-acute delayed transfers of care, patient snapshot, 2014/15 www.england.nhs.uk.

Figure 42: Delayed transfers: Total number of days delayed each month

Data source: Acute and non-acute delayed transfers of care, total delayed days, 2014/15 www.england.nhs.uk.

References

  • NHS England (2014). Clostridium difficile infection objectives for NHS organisations in 2014/15 and guidance on sanction implementation. Available at: www.england.nhs.uk (accessed on 8 July 2014).