NHS England Emergency Services Update: January 2024
An overview of key NHS England hospital metrics for January 2024 covering emergency care.
Introduction
A deep-dive into some of the key performance metrics published each month by NHS England (NHSE). It is best viewed using your browser or the Substack app.
In this status update I give an update on key performance metrics for the Emergency Services. A more detailed analysis of elective care including the impact of the NHS strikes in 2023 on the number of treatments and operations is the subject of a separate article I will post later.
Summary
The performance of the Emergency Services in previous years improves significantly in January compared to December. This year saw only slight improvements and, consequently, January 2024 performance for Emergency Services was worse than any other January.
January 2024 ambulance response times decreased from December for all categories but were much higher than any other January except for life threatening incidents.
Time lost from ambulance handovers increased slightly in January 2024 and is now the highest January ever
A&E performance metrics for January 2024 showed waiting times decrease very slightly but were worse than any other January.
Worryingly, January 2024 had the second highest ever number of people waiting longer than 12 hours in A&E from arrival to admission.
Ambulance Performance in January 2024
The following dashboard summarises the metrics showing demand for ambulance services in England. To recap, C1 incidents are life threatening, C2 require urgent attention (heart attacks and strokes), and C3 / C4 are the least serious incidents.
In January 2024, the average daily number of incidents attended by ambulance (21,585) was slightly lower (2%) that the demand seen in December 3023 (21,949). The mix of incidents attended also changed when compared to the prior month as there more 7% less life threatening C1 incidents with the more serious C2 incidents remaining roughly unchanged. The lower volume and less serious C3 /C4 incidents both increased by 4%.
The following table shows the ambulance response times for the all categories of incidents for England for January 2024 and the percentage change from December 2023.
Ambulance response times for all categories were lower than last month but continued to exceed response time targets for life threatening (C1) and urgent (C2) incidents.
However, ambulance response times are always lower in January than December. The next chart compares the ambulance response times for urgent C2 incidents (for example, strokes and chest pain) for 2023-24 (red line) with 2022-3 and 2019-20.
The average response time for urgent incidents in January 2024 was 40 minutes. This was higher than the response time for January 2023 (32 minutes) and much higher than the pre-Covid level of January 2020 which was 21 Minutes.
The following table shows the January response times for the years 2024 (in Red), 2024, and pre-Covid 2019 for each of the four categories together with the target times.
January 2024 had the longest ambulance response times for this month except for life threatening C1 incidents which were slightly less than January 2023.
Ambulance Handover Time in January 2024
An important performance measure of the Emergency Service 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 target, lost per ambulance handover by month and year.
There was a slight increase in the time lost per ambulance handover in January 2024 compare to December. As well as exceeding target, this month was higher than in January 2023 and was the highest time lost in January ever. This should indicate that that A&E is performing worse than last years record poor.
Accident and Emergency Performance in January 2024
Before looking at A&E performance it’s important to understand that there are three categories of A&E departments. Type 1 are the major A&E departments which in 2023 dealt with 50% of all A&E attendances. Type 2 A&E departments are single speciality units that dealt with 3% of the total volume. Finally, Type 3 A&E departments, which took 47% of all cases, are walk in centres, minor injury units and urgent care centres. Type 3 A&E departments don’t open 24 hours a day and can’t handle major injuries. Importantly, they don’t usually have problems meeting the 4 hour target and have very little impact on major A&Es unless they are co-located.
The next chart shows a yearly comparison of the percentage of people admitted, transferred, or discharged within four hours from arrival in A&E for all three types of A&E departments.
In January 2024 the percent of people waiting less than 4 hours was 70%. Although this was a very slight increase over the prior month it was worse than January 2023 and still below the NHS Winter Plan interim target to get above 76% by March 2024.
However, this does not tell the full picture as the following chart showing the performance against the 4 hour target for only the Type 1 Major A&E departments illustrates.
In December 2023, only 55% of people attending A&E in major Type 1 departments were seen before four hours from arrival to admission, transfer or discharge. This is slightly lower than November and the third worst performance ever. The performance is a far lower than the historic trend and a long way from the March 2024 ‘Interim Target’ of 76%.
The next chart shows the recent trend for the number of patients waiting longer than 12 hours in A&E from arrival to admission to a hospital ward. These would all be in Type 1 A&E departments.
Worryingly, January 2024 saw 177,805 people waiting longer than 12 hours from arrival to admission. The second highest number ever.
In Conclusion
Whilst the winter pressures from Covid and Flu continue to be much less that last year, the January 2024 performance levels for the Emergency Services in England were poor.
Although all Ambulance response times for January were better than those for December 2023 most were worse than any other January.
A&E performance metrics for January 2024 also follow the same story. The percentage of people waiting longer than 4 hours fell very slightly but was the worst performance for the month of January ever.