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 remain at fewer than 500 cases a month, a trend seen since the first quarter of 2013, and the number of MRSA infections remains low – a total of 27 in December (Figure 24).
The number of reported E coli infections continues to be subject to large seasonal variations. In the latest quarter, numbers decreased – 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 number of full-time equivalent (FTE) staff working in hospital and community health services (excluding, for example, general practitioners) was more than 1.089 million in October 2015.
Compared to October 2014, there has been an increase in all staff of 21,885 FTE posts (1.8 per cent) (Figure 25). This increase has been across all staff groups: consultant numbers have increased by 4 per cent; total managers by 2.7 per cent; scientific, therapeutic and technical staff by 1.6 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 – October 2015, Provisional statistics http://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 only- two official waiting times targets; however, 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 8.2 per cent in December 2015 (Figure 26). This is the first time since its introduction that this target (8 per cent) has been breached. In total there were more than 268,900 patients waiting to begin their treatment at the end of December 2015, and 755 of these patients have been waiting for more than a year.
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 decreased in December 2015; however, this follows month-on-month increases for the previous seven months.
Though the data for the previous official target (10 per cent) for admitted patients was stopped in October 2015, we are able to estimate that the level of admitted pateints now stands at 13.6 per cent – one of the highest proportions ever for this waiting list.
The proportion of non-admitted patients waiting more than 18 weeks also decreased in December 2015 following seven successive months of increases. It now stands at 6.8 per cent, the second worst performance against this (now abolished) target (5 per cent) for seven years.
NB: From October 2015 no official data has been collected for admitted (adjusted) waits. However, from the close historic 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 had increased for eight months in a row between January 2015 and August 2015, but has levelled off since then. In December 2015 there were 3.29 million patients on the list. Though lower than previous months, this number reflects seasonal trends and is higher than the number in December 2014 (2.92 million patients).
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 December 2015 is around 3.5 million patients (Figure 27). This puts the waiting list back to the highest level since January 2008.
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 two years.
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 3 2015/16 – from October to December 2015) performance has improved, for the second quarter in a row, to 16.5 per cent, but it is still eight continuous quarters since the target was last met (Figure 28).
It is not known how the recent change in cancer guidelines from the National Institute for Health and Care Excellence will affect these waiting times. Under the new guidance GPs can send patients direct for some diagnostic tests where previously they had to be referred to 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
In quarter 3 2015/16 the proportion of patients waiting more than four hours from arrival to discharge, admission or transfer in all A&E departments was 8.5 per cent. This is the highest proportion spending more than four hours in A&E in quarter 3 since 2003/4. The monthly performance against this target has now been missed for all months (apart from one) since August 2014 (Figure 29).
Performance against the four-hour target fell in December as the pressures to admit more patients this year increased (Figures 30 and 31). So far this year A&E attendances are 0.3 per cent down on the previous year whereas hospital admissions from A&E are up by 1.4 per cent. Though a small percentage, this represents an additional 4,708 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, or almost 209,000 admissions, higher.
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 232,000 patients in 2015/16, which is more than 34,950 patients (18 per cent) more than December 2014 (Figure 32). Overall, trolley waits are 101 per cent higher in 2015/16 than in 2013/14.
5. Delayed transfers of care
At the end of December 2015 more than 5,000 patients were delayed in hospitals. Compared to previous Decembers – typically a month with low counts due to patients going home for Christmas – this is the highest number since 2007 (Figure 33).
The number of total days delayed increased to 154,060 in December 2015, a small increase on the previous month but an increase of more than 14,900 (11 per cent) compared to December 2014 (Figure 33). Since April 2015 the number of delayed days is running approximately 10.5 per cent higher each month in 2015/16 (Figure 34) compared to the same month in 2014/15.
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).