NHS performance dashboard
1. Urgent care
Since June 2012, ambulance trusts have been given eight minutes to respond to the most urgent cases and nationally no more than 25 per cent of these calls should be responded to outside of this time.
This standard was met until 2013/14 but for all subsequent years has been missed. The most recent data shows performance remains challenged. Category A Red 1 calls are the most time-critical and immediately life-threatening category of ambulance calls – these cover conditions such as cardiac arrest. In August 2017, 69.7 per cent of Red 1 calls received a response within eight minutes (Figure 30).
Accident and emergency
In the first half of 2017/18, the percentage of patients waiting more than four hours from arrival to discharge, admission or transfer in all A&E departments was 9.8 per cent, showing some recovery against the 95 per cent standard compared to the second half of the previous financial year, but at a similar level to the same period in the previous financial year (Figure 31). Slightly more than 580,000 patients waited more than four hours on average during quarter one and quarter two this year.
The four-hour standard has not been met in any month since July 2015.
The performance figures for the first half of 2017/18 are similar to those in the previous year: both the percentage of people seen in four hours and the number of attendances in quarters one and two of 2017/18 are similar to the same quarters in 2016/17 (Figures 31 and 32).
This means that notably higher numbers of patients attended A&E in 2017/18 and 2016/17 compared to previous years: in quarters one and two of 2016/17 and 2017/18, attendances have been at least 6 per cent higher each month on average than in 2012/13.
The most noticeable trend in the data from the first half of this year is in the number of admissions from A&E, which have been 4 per cent higher on average each month in 2017/18 than they were in 2016/17 (Figure 33). In some ways this is not surprising, as the number of admissions typically increases each year, but the size of the increase is particularly notable; the average increase in emergency admissions from A&E going back to 2003/4 is 1.4 per cent per year.
- 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’) remains at a similar level to last year, with 109,000 and 118,000 patients waiting more than four hours in quarter one and quarter two 2017/18 respectively (Figure 34). However, the number of patients waiting longer than 12 hours has fallen, from 387 and 254 in quarter one and quarter two 2016/17 respectively to 311 and 211 in the same quarters in 2017/18.
2. Waiting times
After showing some improvement in quarter four 2016/17, performance against the 18-week referral-to-treatment waiting time standard has worsened again, with more than 10 per cent of patients waiting more than 18 weeks for treatment for two months in a row for the first time since 2010/11. The standard has now not been met for 18 months.
In August, for the first time since the standard was introduced, more than 400,000 patients were left waiting for more than 18 weeks for treatment, while the number of people waiting more than 12 months also increased to 1,729, the most since August 2012.
The number of people waiting to begin treatment rose once again in the first half of 2017/18, with 14 per cent more people added to the waiting list between April and August 2017 (when 63,000 people were added to the waiting list) than in the same period in 2016 (when 55,000 were added to the waiting list).
2017/18 to date also represents the first period in which both diagnostic and referral-to-treatment waiting times have both worsened compared to their standards (Figure 35). Previously, one or both has improved or remained steady.
The proportion of patients waiting more than six weeks for a diagnostic test has now missed its standard (1 per cent) every month since November 2013 (Figure 35).
In each month between April and August 2017, the number of people waiting for a diagnostic test has been 3 per cent higher on average than the same month in 2016, with 875,000 people waiting for a diagnostic test by August 2017.
The reported total elective waiting list grew to 3.87 million in August 2017. This is 180,000 more patients than in August 2016 (Figure 36).
This total, however, does not include data from several trusts that have not been reporting their waiting list size. Including these trusts, NHS England estimates that the true waiting list in August 2017 was more than 4.1 million patients (Figure 36). This is the first time the total number of people waiting for treatment has been more than 4 million since the same period in 2007.
Data source: Referral-to-treatment waiting times statistics www.england.nhs.uk.
- The overall waiting times standard 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 standard was met from quarter four 2008/9 until quarter four 2013/14, since when it has been missed in each quarter (Figure 37).
Data source: Provider-based cancer waiting times www.england.nhs.uk.
For patients accessing mental health services, there are currently three waiting time standards: 75 per cent of patients referred to the Improving Access to Psychological Therapies (IAPT) service should begin treatment within 6 weeks of referral, with 95 per cent beginning treatment within 18 weeks. For patients experiencing a first episode of psychosis, more than 50 per cent should be treated within two weeks of referral using a National Institute for Health and Care Excellence-approved package of care.
For patients accessing psychological therapies, both standards were met for every month in 2016/17 (to date).
Data from 2016/17 show that, during 2017/18 so far, 74 per cent of patients accessed early intervention in psychosis services within two weeks (Figure 38).
Data source: Early Intervention in Psychosis Waiting Times www.england.nhs.uk.
3. Delayed transfers of care
After reaching a seasonal high in March, since this collection started, fewer people experienced delayed discharge from hospital between April and August 2017 compared to the same months in 2016. This is the first time that the number of patients delayed has fallen for more than two months in a row since 2012. The number of people experiencing a delay fell from 7,100 in January 2017 to 5,800 in August 2017 (Figure 39).
The number of total days delayed has fallen during 2017/18 from 199,000 in March to 180,000 in August (Figure 40). The number of total days delayed in July and August were both lower in 2017 than in 2016, the first year-on-year monthly reduction since January 2014.
Data source: Acute and non-acute delayed transfers of care, patient snapshot, 2016/17 www.england.nhs.uk.
Data source: Acute and non-acute delayed transfers of care, total days delayed, 2016/17 www.england.nhs.uk.
The total amount of staff in the NHS has remained steady since November 2016, with 1.05 million full-time equivalent staff employed across England as of July 2017.
Within this total, however, the number of nursing staff has fallen by 1.67 per cent since January (Figure 41), and has been lower year on year since April, the first time that the total amount of nursing staff in the NHS has fallen year on year since the publication of the Francis Report in mid-2013.