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 continue to remain under 500 cases a month, a trend seen since the first quarter of 2013, while there continue to be low numbers of MRSA infections – a total of 35 in August (Figure 25).
The number of reported E coli infections continues to be subject to large seasonal variations. In the latest quarter, numbers increased – an expected seasonal pattern.
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
The total full-time equivalent (FTE) number of staff working in hospital and community health services (excluding, for example, general practitioners) was more than 1.075 million in June 2015.
Compared to June 2014, there has been an increase in all staff of more than 18,305 FTE posts (1.7 per cent) (Figure 26). This increase has been across all staff groups: consultant numbers have increased by 4.1 per cent; total managers by 2.7 per cent; scientific, therapeutic and technical staff by 1.3 per cent and nurses, midwives and health visitors by 1.1 per cent.
Data source: Monthly NHS Hospital and Community Health Service (HCHS) Workforce Statistics in England – June 2015, Provisional statistics www.hscic.gov.uk
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, though the data is still collected for the old targets allowing us to estimate performance against all previous targets.
The main target showing the proportion of patients on the waiting list for more than 18 weeks and still waiting to be seen increased to 7.4 per cent in August 2015 (Figure 27). This is the second highest proportion since its introduction and suggests that the early success from the ‘managed breach’ policy from 2014 might be difficult to sustain.
The proportion of patients waiting more than six weeks for a diagnostic test has now missed its target (1 per cent) for the past 21 months.
For the targets no longer included in the official statistics, estimates show that the proportion of admitted patients treated after having waited more than 18 weeks has increased for the past four months. It now stands at 12.9 per cent – higher than the same month last year and one of the highest proportions over the past seven years.
The proportion of non-admitted patients waiting more than 18 weeks has also increased for the past four months in a row and is now at 5.5 per cent, the worst performance against this (now abolished) target for seven years.
The total elective waiting list has now increased for eight consecutive months – from January to August 2015 – and at 3.33 million patients, is now at its highest level since January 2008. However, this still does not include several trusts that have not been reporting their waiting lists. Including these, NHS England estimates that the true waiting list in August 2015 is around 3.5 million patients (Figure 28). This is the longest waiting list since January 2008.
Data source: Referral-to-treatment waiting times statistics www.england.nhs.uk
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 1 2015/16 – from April to June 2015) performance increased to 18 per cent, the highest on record (Figure 29).
It is not known how the recent change in cancer guidelines from National Institute for Health and Care Excellence will affect these waiting times. Under the new guidance GPs can send patients directly for some diagnostic tests where previously they had to be sent to see a specialist first (National Institute for Health and Care Excellence 2015). The new rules mean that more patients will receive a diagnosis more quickly, but the impact these additional tests will have on the queue of patients needing diagnostic tests and total referral-to-treatment times is uncertain.
Data source: Provider-based cancer waiting times www.england.nhs.uk
4. Accident and emergency
As reported in the previous QMR, in quarter 1 2015/16 the proportion of patients waiting more than four hours from arrival to discharge, admission or transfer in all A&E departments was 5.9 per cent. Since then monthly performance has been mixed, in July 2015 the NHS met the waiting times target, almost one full year since it had met the target previously. But performance deteriorated again in August 2015 when, at 5.7 per cent, performance was once again below target (Figure 30).
Performance against the four-hour target fell in August despite reductions in both the number of attendances and admissions (Figures 31 and 32). So far this year A&E attendances are 1 per cent down on the previous year and hospital admissions from A&E are up by 1 per cent. This represents an additional 4,925 hospital admissions from A&E each month in 2015/16. Compared to 2013/14, admissions to hospital from A&E this year are 7 per cent higher.
There is an increasing number of patients waiting to be admitted to a hospital bed from A&E (‘trolley waits’). There have been more than 108,000 patients in 2015/16 who spent more than four hours from decision to admit from A&E to admission to a hospital bed on a ward. This is more than 27,300 patients, or 34 per cent more than the same period last year (Figure 33). Compared to 2013/14, trolley waits are 76 per cent higher in 2015/16.
5. Delayed transfers of care
At the end of August 2015 there were 5,169 patients delayed in hospitals. The last time the number of patients delayed breached 5,000 in one month was in January 2015, which is typically one of the worst performing months of the year. The last time there were more than 5,000 patient delays in August was in 2007 (Figure 34).
The number of total days delayed decreased to 145,065 in August 2015, a reduction on the previous month but an increase of more than 6,865 (5 per cent) compared to the same month last year (Figure 35). Since April 2015 the number of delayed days is running approximately 11 per cent higher each month in 2015/16 compared to the same month last 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
National Institute for Health and Care Excellence (2015). Suspected cancer: recognition and referral. NICE guideline 12. Available at: www.nice.org.uk (accessed on 8 July 2015)
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)