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
C difficile infections fell below 400 cases a month in March 2016 for the first time since June 2014, an achievement in the face of continued operational and financial pressures. Similarly, the number of MRSA infections remains low – a total of 22 in March across England (Figure 29).
The number of reported MSSA infections in March 2016 was the highest (279) in this data series. Together with growing numbers of E coli infections (albeit with large seasonal variations) we will continue to monitor these to see if this reflects increases in population or is a sign of growing 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 www.gov.uk
In April 2016 there was a significant change to the way the Health and Social Care Information Centre (HSCIC) presents figures on the NHS workforce. While data is still collected in the same way, the numbers published are only for those NHS staff who are involved in delivering patient care. Data for staff who are non-executive directors or staff on maternity leave, for example, are excluded.
The result of the changes is that it is very difficult to compare the latest data with previous data. Once the HSCIC complete re-calculations of the historical workforce figures using the new methodology we will chart the data.
On the basis of the new definitions, in January 2016 the total number of full-time equivalent (FTE) staff working in hospital and community health services (excluding, for example, general practitioners) was more than 1.024 million.
Compared to January 2015, there has been an increase in all staff of 21,799 FTE posts (2.2 per cent). This has been across all staff groups: consultant numbers have increased by 3.7 per cent; total managers by 5.6 per cent; scientific, therapeutic and technical staff by 1.8 per cent; and nurses and health visitors by 1.1 per cent.
3. Waiting times
Following Sir Bruce Keogh’s review of waiting time measures in June 2015 (NHS England 2015) there are now just two official waiting times targets; however, some waiting times data that is still collected allows us to estimate performance against previous targets.
The proportion of patients on the waiting list for more than 18 weeks and still waiting to be seen increased to 8.5 per cent in March 2016 (Figure 30). This breaches the target (8 per cent) and is the worst performance since this target was introduced in April 2012. In total, there were more than 298,747 patients waiting to begin their treatment at the end of March 2016, and 865 of these patients have been waiting for more than a year.
For the targets that were dropped last year, our estimates show that the proportion of (adjusted) admitted patients treated after having waited more than 18 weeks decreased in March 2016, and the proportion of non-admitted patients waiting more than 18 weeks increased in March 2016.
Data source: Referral-to-treatment waiting times statistics www.england.nhs.uk
Diagnostic waiting times statistics www.england.nhs.uk
NB: From October 2015 no official data has been collected for admitted (adjusted) waits. However, from the close historical statistical relationship between this dataset and the unadjusted admitted waits it is possible to model the missing data. The modelled figures are denoted with hollow data points from October 2015.
- The total elective waiting list increased each month in the final quarter of 2015/16. Between January and March 2016 the total waiting list increased by more than 212,000 patients, from 3.29 million to 3.5 million.
- Furthermore, this total does not include several trusts that have not been reporting their waiting lists. Including these, NHS England estimates that the true waiting list in March 2016 was around 3.7 million patients (Figure 31). This puts the waiting list back to the highest level since December 2007.
Data source: Referral-to-treatment waiting times statistics www.england.nhs.uk
The proportion of patients waiting more than six weeks for a diagnostic test has now missed its target (1 per cent) for the past 28 months in a row.
The overall waiting times target for cancer treatment is that no more than 15 per cent of patients should wait more than 62 days from an urgent referral from their GP to receiving treatment for their cancer. This target was met from quarter 4 2008/9 until quarter 4 2013/14, when it was missed. In the latest quarter (quarter 4 2015/16 – from January to March 2016) performance deteriorated to 17.9 per cent. This standard has not been met for the past two years (Figure 32)
Data source: Provider-based cancer waiting times www.england.nhs.uk
4. Urgent care
Since June 2012 ambulance trusts have been given 8 minutes to respond to the most urgent cases, nationally no more than 25 per cent of these calls should be responded to outside this time (Figure 33).
This standard was met in 2013/14 but for all subsequent years has been missed. In the most recent data for March 2016 performance worsened to 33.5 per cent of calls being responded to after 8 minutes. Performance hasn’t been this low since December 2014 and is the worst ever performance seen in March since this target was introduced.
Data source: Ambulance quality indicators www.england.nhs.uk
Accident and emergency
In quarter 4 2015/16 the proportion of patients waiting more than four hours from arrival to discharge, admission or transfer in all A&E departments was 12.1 per cent. This is above the 5 per cent target and is the highest proportion spending more than four hours in A&E in any quarter since targets were introduced (Figure 34).
For the year as a whole, more than 8 per cent of patients spent longer than four hours in A&E departments, the worst annual performance since 2003/4.
- Performance against the four-hour target fell in the final quarter of the year as the pressures to admit more patients increased (Figures 35 and 36). In 2015/16 A&E attendances were 2.5 per cent higher than the previous year and hospital admissions from A&E increased by 3.1 per cent.
- These small percentages represent large numbers. The increase equates to more than 567,700 more attendances and almost 125,000 more admissions to hospital in 2015/16 compared to 2014/15.
- To put it another way, for each month in 2015/16 it’s the equivalent of an additional 47,308 attendances at A&E departments and 10,416 admissions from A&E compared to the previous year.
- There has been an increase in the number of patients waiting more than four hours from decision to admit from A&E to admission to a hospital bed on a ward (‘trolley waits’): more than 389,420 patients in 2015/16, 83,889 patients (27.5 per cent) more than 2014/15 (Figure 37). Overall, trolley waits were 131 per cent higher in 2015/16 than in 2013/14.
5. Delayed transfers of care
At the end of March 2016 more than 5,700 patients were delayed in hospitals, an improvement on previous months but still historically high. Comparing figures in March 2016 to those in March 2015 shows an increase of more than 15 per cent this year (Figure 38). Across the year there were an additional 6,241 patients delayed at the end of the month in 2015/16 compared to 2014/15.
The number of total days delayed increased to 169,928 in March 2016, the highest number of delayed days we have seen in this data (Figure 39). In 2015/16 there were more than 1.8 million total delayed days reported; this was up 11 per cent – or an additional 184,849 delayed days – compared to the previous year.
Data source: Acute and non-acute delayed transfers of care, patient snapshot, 2015/16 www.england.nhs.uk
Data source: Acute and non-acute delayed transfers of care, total days delayed, 2015/16 www.england.nhs.uk
- NHS England (2015). ‘Making waiting time standards work for patients’. Letter from Sir Bruce Keogh to Simon Stevens, 4 June. Available at: www.england.nhs.uk (accessed on 8 July 2015).