NHS performance dashboard

There are thousands of possible statistics available to measure the performance of the NHS. Here, we have selected a small group that reflect key issues of concern to the public and patients as well as providing some indicative measures of the impact of tackling the productivity and reform challenges confronting the NHS.

1. Health care-acquired infections

Numbers of C difficile infections decreased over the latest quarter, from 442 in December 2014 to 424 in February (Figure 22). And the number of MRSA infections continues to be low; in February 2015 there were 28.

The number of reported E coli infections continues to be subject to large seasonal variations. In the latest quarter numbers reduced further – an expected seasonal pattern over the winter months.

Figure 22: 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 number of full-time equivalent (FTE) staff working in hospital and community health services (excluding, for example, general practitioners) was just over 1.07 million in December 2014. Though down on the previous month, this is still the second highest number since this data was reported in September 2009.

Since September 2009, there has been an increase in all staff of more than 23,176 FTE posts (2.2 per cent) (Figure 23). There has been an increase in the numbers across all staff groups except for managers. Consultant numbers have increased by more than 19 per cent; scientific, therapeutic and technical staff by 6 per cent; nurses, midwives and health visitors by 3 per cent. The number of managers has decreased by more than 16.5 per cent – although there has been a slow increase since April 2013.

Figure 23: Index change in NHS full-time equivalent staff: September 2009 - December 2014

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

The latest annual count of all personnel working in the NHS provides a longer historic view on the change in staff numbers (and also includes general practitioners). Since 2003 there have been increases across all NHS staff groups and GPs. Notable is the consistent 4 to 5 per cent annual average growth in the number of consultants and the erratic changes in the number of managers (Figure 24). Although numbers in all groups increased in 2014, the number of ambulance staff fell by just under 1 per cent.

Figure 24: Index change in hospital and community health service full-time equivalent staff, Annual census: September 2003 - September 2014

Data source: General and Personal Medical Services, England - 2004-2014, As at 30 September www.hscic.gov.uk

3. Waiting times

Having been reinstated in December 2014, contractual penalties for missing referral-to-treatment waiting times performance standards were dropped in 2015 as part of a ‘managed breach’ policy to deal with patients still waiting to be seen and waiting over 18 weeks.

The latest figures reflect this policy, with waiting times for both non-admitted (outpatient) and admitted (inpatient) patients breaching in February 2015 (Figure 25).

The proportion of admitted patients waiting longer than 18 weeks rose to 13 per cent, the highest since this target was introduced.

The proportion of non-admitted patients waiting more than 18 weeks rose to 5.3 per cent. This is the third breach of the non-admitted referral-to-treatment (RTT) target in the past four months.

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

The proportion of patients waiting more than 6 weeks for a diagnostic test has now missed its target (1 per cent) for the past 15 months in a row.

Figure 25: Percentage still waiting/having waited more than 18 weeks (more than six 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 has remained below 3 million for the past 4 months. However, a number of trusts have not submitted data for several months, and NHS England predicts the true waiting list in February 2015 to be around 3.1 million given (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

The standard for a maximum 62-day wait from urgent GP referral through to first treatment for cancer is useful to monitor as it measures how well the whole cancer pathway is able to respond to the demands placed on 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 had been met since quarter 4 2008/9, but not since quarter 4 2013/14. In the latest quarter (October to December 2014) performance improved to 83.8 per cent, but this is still the second 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 4 2014/15 the proportion of patients waiting more than four hours from arrival to discharge, admission or transfer in all A&E departments was 8.2 per cent (more than 440,950 patients) – a 6 per cent increase on the previous quarter and 69 per cent higher than the same quarter a year previously (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 12 per cent of patients waited more than four hours, and less than 12 per cent of providers achieved the target.

For all providers, 48 per cent missed the four-hour target in the fourth quarter of 2014/15, the second highest seen since this data has been collected.

Alongside attendances, numbers of patients waiting to be admitted into a hospital bed from A&E (‘trolley waits’) were also much higher in this quarter; 11.5 per cent of patients (114,630 people) waited for more than four 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

5. Delayed transfers of care

At the end of February 2015 there were just under 4,950 patients delayed in hospitals. This was down on the previous month but is still high compared to recent years (Figure 30).

The number of total days delayed decreased to just over 134,500 in February 2015, again a reduction on the previous month but still high compared to recent years (Figure 31).

Figure 30: Delayed transfers of care: Number of patients delayed on last day of month

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

Figure 31: 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