NHS England Status Update: Oct 2023
An overview of key NHS England hospital metrics for October 2023 covering emergency and elective care.
Introduction
This is the first in a series of posts that will take a deep-dive into some of the key performance metrics published each month by NHS England. As we head into Winter, the main focus will be on emergency care covering the performance of the ambulance and Accident and Emergency (A&E) services. However, hospitals are not only for emergencies so I will also cover performance metrics for planned elective care waiting lists.
Summary
Ambulance response times for October 2023 were longer than in September, particularly for urgent incidents showing symptoms of strokes and chest pain.
Ambulance response times for these urgent incidents (60% of overall demand) increased in most regions with the South West and East of England continuing to have the longest response times.
Excess time lost for each ambulance handover to A&E increased significantly in October 2023 to 25 minutes from 19 minutes in September. A clear sign of increasing pressures in A&E!
In October 2023, 30% of people attending A&E spent more than four hours from arrival to admission, transfer or discharge, similar to October last year’s 31%.
Trolley waits (the time between a decision to admit a patient and them being admitted) of over 12 hours exceeded 44,600 in October 2023. This is the second highest number ever recorded!
The size of the waiting list of people waiting for planned treatment continues to increase as do those for waiting times.
The number of people waiting for diagnostic tests remains at record levels and waiting times far exceed targets.
Ambulance Performance
Ambulance performance often gives an early indication of trouble ahead for the Accident and Emergency service. Unfortunately, all of the key ambulance metrics were worse in October 2023 when compared to September although they were not as bad as in October 2022.
Of particular concern are the response times for life threatening (heart attacks and serious injury) and urgent (strokes and chest pain) incidents which both increased and continued to exceed their targets. Despite this poor performance, October 2023 was better than October 2022. As you can see in the ‘Change from 2022’ column, in October 2023 the NHS attended 21% more life threatening and urgent incidents than in October 2022 but their response times were better.
The dashboard shows that the largest increase in response times (10.7%) was for urgent incidents (strokes and chest pain) which now average 42 minutes. This exceeds both the target of 18 minutes and the Winter Plan target of 30 minutes for 2023/24 by some margin.
By way of context, urgent incidents make up by far the largest proportion of ambulance demand. In October, there were 12,500 urgent incidents per day which was 60% of all incidents attended.
The following chart compares this years performance with previous year’s.
Although October 2023 response times are high (and rising) they are below the two previous year’s levels. Unfortunately, they are well above pre-Covid levels.
Finally, the following interactive chart shows that there are wide variations across the regions. The South West and East of England have the longest response times for urgent incidents and the Midlands saw the largest monthly increase.
Accident and Emergency (A&E) performance
An important measure of A&E performance is the excess time it takes for ambulances to hand patients over to the A&E department. This is because it occurs as a result of a mismatch between A&E/hospital capacity and the number of emergency patients arriving.
National guidance states that patients arriving at an emergency department by ambulance must be handed over to the care of A&E staff within 15 minutes. The following chart shows the average ‘excess’ time above the 15 minutes guidance lost per ambulance handover.
There was a significant increase in ambulance handover times in October 2023 although they have not reached the high levels seen in October 2022.
The following interactive chart shows that there are wide variations in handover times across the Ambulance Trusts.
Whilst the Ambulance Trusts don’t map directly to the NHS regions its clear that the geographical areas with the highest handover times also have the highest ambulance response times for urgent incidents.
The following interactive chart shows the percentage of people attending A&E who spent more than four hours waiting from arrival to admission, transfer or discharge. The long-standing target is for this percentage to be below 5% but this was last achieved in August 2014! The NHS Winter Plan target is to get below 24% by March 2024.
In October, 30% of people attending A&E spent more than four hours waiting from arrival to admission, transfer or discharge. This is much higher than the Winter Plan target (24%) and pre-Covid standard (5%). This is very similar to the percentage in October last year, but is an increase of 14% compared to October 2019.
The following interactive chart shows the number of so called ‘trolley waits’ where patients waited longer than 12 hours in A&E from when the admission decision was made to the time they were admitted.
Historically this number has been very low, but in October 2023 there were 44, 655 people waiting longer than 12 hours — the second highest on record! This is a serious problem as ‘trolley waits’ longer than 12 hours have been linked to higher death rates.
Planned elective care performance
The waiting list to start elective treatments increased from 7.75 million in August 2023 to 7.77 million in September. This is the highest the waiting list has been since records began, but is a smaller month-on-month increase than in recent months.
There were 6.5 million people waiting to start elective care in September 2023. This is lower than the overall waiting list of 7.77 million because some people are waiting for multiple treatments.
The time waiting for elective treatment to start is also a problem. There is an objective to have no people waiting over 65 weeks to start consultant-led elective treatment by March 2024 (except where patients choose to wait longer). However, the following chart shows there were over 109,000 waits this long in September 2023 (red line), very similar to the previous month, with no improvement seen since March.
The number of waits of over 52 weeks to start elective care stood at just over 390,000 in September 2023. In September 2019, there were only 1,537 people waits of over 52 weeks. The aim is to have nobody having to wait this long by March 2025.
Finally, lets look at the waiting list for diagnostic tests which remain at record high levels and have not improved since March 2022.
In September, 26% of people waited over six weeks for a diagnostic test. This is far above the long-standing 1% target, as well as the Winter Plan objective of 5% by March 2025. Again there has been no improvement since March 2022.
In Conclusion
As we head in to the winter season, hospitals in England are showing signs of increased pressure particularly in the ambulance service. At the moment, performance measures are bad but not as quite as bad as in 2022. We can only hope that we don’t have the ‘double hit’ of Covid and a bad flu season that we saw last winter. Fortunately, the latest data shows that hospital admissions for Covid are declining and flu admissions are very low.