1. Health care-acquired infections
C difficile and MRSA
The recent downward trend in reported cases of C difficile continued in the latest figures for November 2013. The 420 cases reported in that month were 15 per cent fewer than at the same time last year and around 1 per cent down on the previous month (figure 28).
Though monthly counts of MRSA in November 2013 were 29 per cent higher than the previous month and more than 8 per cent higher than a year ago, absolute numbers remain small – 40 in November 2013 – and month-on-month variations unpredictable (figure 29).
Figure 28: Monthly counts of C difficile
Figure 29: Monthly counts of MRSA
Note: It is not known what impact the change in recording MRSA cases has had on the comparability of data pre- and post-April 2013
Data source: Post-infection review assigned monthly counts of methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia
2. Workforce
Redundancies and staff numbers
Redundancies for clinical and non-clinical posts fell in quarter 1 2013/14: there were a total of 1,612 compulsory and voluntary redundancies compared to more than 3,200 in the previous quarter (figure 30).
The total number of hospital and community health services staff rose in September 2013 by 7,540. The large reductions in management staff since March 2010 have been slightly reversed over the six months since the beginning of the financial year (figure 31).
Figure 30: Compulsory and voluntary clinical and non-clinical redundancies
Figure 31: Index change in NHS full-time equivalent staff: September 2009 – September 2013
Note: Most recent dip in figures for April 2013 due to usual seasonal variation in voluntary and compulsory redundancies (though these increased in 2013), in addition to an increase in the number of fixed-term contracts finishing with the advent of the new NHS environment and a continued policy to reduce management layers following the White Paper: Liberating the NHS (Department of Health 2010).
3. Waiting times
Inpatients, outpatients and diagnostics
Median waits in November 2013 reduced for inpatients and diagnostics, remained the same for outpatients and increased for those still on waiting lists. These changes are in line with previous seasonal patterns (figure 32).
In November 2013 the proportion of patients waiting longer than 18 weeks for treatment (6 weeks for diagnostics) were up for all waiting lists. This broadly follows seasonal variations for this month. However, the percentage waiting longer than 18 weeks for outpatient treatment is now at its highest since October 2008. The adjusted inpatient wait (the target measure) is at its highest level since November 2011.
Figure 32: Waiting times: Median wait (weeks)
Figure 33: Waiting times: Percentage still waiting/having waited more than 18 weeks (more than 6 weeks for diagnostics)
Data source: Diagnostic waiting times statistics.
Accident and emergency
In quarter 3 2013/14 the proportion of patients waiting longer than four hours from arrival to admission, transfer or discharge increased to 4.4 per cent. This is an increase on the quarter 1 and 2 figures from this year, but performance against the 95 per cent target has been maintained (figure 34).
The weekly A&E has been highly variable, though only 2 out of the previous 13 weeks that make up quarter 3 breached the 95 per cent target. The latest data point, one week (5 January 2014) after the end of quarter 3 is above the 95 per cent threshold however, at 5.7 per cent (figure 35).
More than a quarter (26 per cent) of hospitals breached the four-hour standard in quarter 3 of 2013/14. This is an increase on both the previous quarters in 2013/14 and the highest proportion seen in quarter 3 over the past three years (figure 36).
Figure 34: Waiting times: Percentage waiting more than four hours in A&E from arrival to admission, transfer or discharge
Data source: Weekly A&E SitReps 2013–14.
Figure 35: Percentage waiting more than four hours in A&E from arrival to admission, transfer or discharge. Weekly data: November 2010 – January 2014
Data source: Weekly A&E SitReps 2013–14
Figure 36: Percentage of providers reporting more than 5 per cent of patients waiting longer than four hours in A&E departments from arrival to admission, transfer or discharge
Data source: Weekly A&E SitReps 2013–14.
‘Trolley waits’ (those patients delayed for more than four hours in type 1 (major) A&E departments from decision to admit to admission) were up to 4.2 per cent in the latest quarter. This is 0.7 percentage points higher than the previous quarter but down on quarter one, and similar to figures at the same time last year (figure 37).
Weekly data shows high variation in the figures for trolley waits, with some identifiable seasonal variation. From August through to December 2013 there has been an increase in the proportion of patients experiencing long trolley waits, which is a similar pattern to recent years (figure 38).
Figure 37: ‘Trolley waits’: The proportion of patients spending more than four hours in major A&E departments from decision to admit to admission into hospital
Data source: Weekly A&E SitReps 2013–14.
Figure 38: ‘Trolley waits’: The proportion of patients spending more than four hours in major A&E departments from decision to admit to admission into hospital. Weekly data: November 2010 to January 2014
Data source: Weekly A&E SitReps 2013–14.
4. Delayed transfers of care
The average number of patients delayed per day was up in November 2013 compared to the previous month and to the same month last year. This is roughly in line with previous seasonal trends, though the long-term trend remains relatively flat (figure 39).
Comparing the total number of days delayed with the average daily number of patients delayed shows that both metrics follow a similar pattern. The number of days delayed shows high monthly variation but has remained relatively stable over the past four years (figure 40).
Closer analysis of the sources of delays suggests that reasons attributable to the NHS have risen from around 60 per cent in 2010/11 to 70 per cent in 2013/14 while those attributable to social services have fallen from 35 per cent to 25 per cent of total delayed days.
Figure 39: Delayed transfers of care: Monthly counts of patients
Figure 40: Delayed transfers of care: Patients and days delayed
References
- Department of Health (2010). Equity and Excellence: Liberating the NHS. London: Department of Health: Available at: www.dh.gov.uk (accessed on 21 January 2014).