1. Health care-acquired infections

Numbers of C difficile infections decreased over the latest quarter, from 443 in September 2014 to 415 in November (Figure 23).

There was a record low-number of MRSA infections in November 2014 of 15. This follows previous months of low counts for MRSA (Figure 23).

This quarter, levels of infection for MSSA, the strain of S aureus that is sensitive to methicillin, were higher than the same quarter last year, but the trend is relatively stable, and seasonal variance indicate this is an expected pattern (Figure 23).

The number of reported E coli infections continues to be subject to large seasonal variations. In the latest quarter numbers had once again dipped below 3,000 cases ahead of an anticipated drop in recorded infections over the winter period (Figure 23).

Figure 23: Monthly counts of selected health care-acquired infections

Data source: Clostridium difficile infection: monthly data by NHS acute trust http://www.gov.uk.

Monthly counts of methicillin resistant Staphylococcus aureus (MRSA) bacteraemia by post infection review (PIR) assignment http://www.gov.uk.

Monthly counts of trust apportioned methicillin susceptible Staphylococcus aureus (MSSA) bacteraemia by NHS acute trust http://www.gov.uk

Monthly counts of Escherichia coli (E coli) bacteraemia by NHS acute trust http://www.gov.uk

2. Workforce

The total full-time equivalent (FTE) number of NHS staff was just over 1.064 million in September 2014. This is higher than the previous month and the highest since this data was reported in September 2009.

Since September 2009, there has been an increase in all staff of more than 16,970 FTE posts (1.6 per cent). There has been growth in all staff groups except for managers. Consultant numbers have increased by more than 18 per cent; scientific, therapeutic and technical staff by 5.4 per cent; nurses, midwives and health visitors by 1.9 per cent; and others by 1 per cent. The number of managers has decreased by more than 17.5 per cent – although there has been a slow increase since April 2013 (Figure 24).

Figure 24: Index change in NHS full-time equivalent staff: September 2009 – September 2014

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

3. Waiting times

With the Secretary of State for Health having extended the deadline to carry out an additional £250 million worth of elective activity over the summer months to the end of the year (December 2014 data released in February 2015), we are still in a period of ‘managed breach’.

The latest figures reflect this with waiting times for both non-admitted (outpatient) and admitted (inpatient) patients breaching in November 2014 (Figure 25).

The proportion of admitted patients waiting longer than 18 weeks rose to 12.5 per cent, the highest since this target was introduced (Figure 25).

The proportion of non-admitted patients waiting more than 18 weeks rose to 5.4 per cent. This is the first breach in the non-admitted referral-to-treatment (RTT) target since the summer of 2008 (Figure 25).

The number of patients still waiting to begin their treatment (both admitted and non-admitted) reduced fractionally to 6.9 per cent. This suggests the managed breach is having some positive impact (Figure 25).

However, the targets of the managed breach were to have all RTT standards met by December 2014 and have 115,000 fewer patients waiting more than 16 weeks to begin treatment. While in November 2014 there were 9,000 fewer patients waiting 16 weeks or more to begin treatment, it seems very unlikely the remaining reduction will have been achieved or that breaches in other parts of the patient pathway will have returned to target in December (Figure 25).

The number of patients waiting more than 6 weeks for a diagnostic test is still declining following a recent peak in May 2014. The percentage of patients waiting more than 6 weeks has reduced to 1.2 per cent which, though still in breach of target (1 per cent), is heading in the right direction (Figure 25).

Figure 25: 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.

The total elective waiting list dipped below 3 million in November 2014 for only the second time since April last year. However, NHS England predicts the true waiting list in November 2014 to be around 3.2 million given that several trusts have not submitted data for several months (Figure 26).

Figure 26: Referral-to-treatment total waiting list size in millions, England

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

There are further waiting list targets for cancer care. The standard for a maximum 62-day wait from urgent GP referral through to first treatment is useful to monitor as it measures how well the whole cancer pathway is able to respond to the demands placed upon it.

The standard is that 85 per cent of patients receive treatment for their cancer within 62 days of urgent referral from their GP. This standard had been met since quarter 4 2008/9 (from when we have data) but since quarter 4 2013/14 performance has been below the target. In the latest quarter (quarter 2 2014/15 – from July to September 2014) performance has slipped further to 83.5 per cent, the lowest on record (Figure 27).

Figure 27: 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

In quarter 3 2014/15 the proportion of patients waiting more than 4 hours from arrival to discharge, admission or transfer in all A&E departments was 7.4 per cent (more than 414,000 patients) – a 47 per cent increase on the previous quarter and the poorest performance since quarter 3 2003/4 (Figure 28).

Figure 28: 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.

For major A&E departments more than 14 per cent of patients waited more than 4 hours and less than 10 per cent of providers achieved the target.

For all providers nearly 50 per cent missed the 4-hour target in the third quarter of 2014/15, the highest we’ve seen since we started recording the data.

Alongside attendances, much higher numbers of patients waiting to be admitted into a hospital bed from A&E (‘trolley waits’) were also seen in this quarter. Almost 9 per cent of patients (accounting for more than 90,500 patients) waited for more than 4 hours to be admitted into hospital, the highest for more than a decade (Figure 29).

Figure 29: Patients waiting more than four hours in A&E from decision to admit to admission

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

The latest weekly data for all types of A&E departments show that performance continued above target into the first two weeks of 2015, with national performance for both weeks showing more than 10 per cent of patients waited more than 4 hours (figure 30). For major A&E departments (which treat about 65 per cent of all patients), the 4-hour target has now been missed for the past 78 weeks.

Figure 30: Percentage waiting more than four hours in A&E from arrival to admission, transfer or discharge; weekly data

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

5. Delayed transfers of care

Over the past quarter the number of patient delayed transfers of care has increased by more than 300, increasing the total number of patient delays to more than 5,000 per day in November 2014, the highest number for more than four years (Figure 31).

The number of total days delayed passed 143,000 in October 2014, a level not reached since July 2008 (Figure 32).

Figure 31: 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 32: Delayed transfers of care: Total number of days delayed each month

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