Latest NHS performance in England, Oct 2023
An overview of the latest NHS stats: things still trending worse
The latest NHS Key Performance Indicators (KPIs) were published by NHS England last week and Indie SAGE’s heroic volunteer Bob Hawkins has gone through all the stats.
In the post, I’ll highlight the main ones across ambulance services, A&E, hospital treatment and diagnosis. Overall, things are getting worse across both emergency and routine care. Could be another bad winter.
Ambulance services
Activity remains about the same as over the last several years, at around 20,000 incidents attended every day, but response times are significantly longer than they were before the pandemic. Take, for instance, C2 calls for serious but not immediately life threatening conditions. The target is a 20 minute response time which was mostly reached until the summer of 2021. During the winter ambulance disaster last December, response times got up to 90 minutes and while they came down this year, they never got below 30 minutes and are now rising again.
C2 response times are worse in the South West (48 minutes), but have increased in all English regions over the past month. The lowest response time in the North West is still 29 minutes (9 minutes above target).
A&E waits
For a long time, the NHS target for time from arrival to A&E to either admission or discharge, was that it should be less than 4 hours 95% of the time. That target has not been met since 2015, but waits have worsened considerably since the pandemic, especially since 2021. Even during this summer, we never saw fewer than 25% of patients waiting more than 4 hours and waits are getting longer again.
An even starker measure is the percentage of patients waiting longer than 12 hours from the decision to admit them. For years this was essentially zero, but shot up in 2021. It reached over 10% last winter and while times recovered somewhat this summer, waits are increasing sharply again and over 6% of patients waited longer than 12 hours in September.
NHS routine treatment
The number of people waiting for treatment in the NHS rose to yet another new record last month - 7.68 million people (1 in 8 of the population).
Only 58% of non-emergency patients are starting treatment within 18 weeks of referral (92% target) as waits get longer. While the NHS is now treating as many people each month as it did pre-pandemic, it has not been able to make up for the backlog that built up during the first 18 months of the pandemic.
Diagnosis waits
By the end of August, over a quarter of people were waiting longer than 6 weeks for diagnostic tests. The target is 1% and hardly anyone was waiting pre pandemic. Essentially, as is clear from the chart below, we’ve simply never been able to tackle the backlog that built up during 2020.
These delays are also hitting the very urgent referrals, such as for cancer, with more than twice as many people waiting more than 2 weeks for their first consultant appointment after an urgent referral, or waiting more than 2 months to start treatment, compared to pre pandemic.
Fixing it
It is not clear how these backlogs are going to be cleared - hospital infrastructure is creaking, and while numbers of nurses and doctors have increased, they have not increased enough to meet increasing demand. Vacancy rates for doctors and nurses remain stubbornly high.
To reduce these backlogs, to prevent delays in emergency care, we need to improve and increase NHS capacity in buildings, in equipment and in staff. None of these are going to happen any time soon. In the longer term, we also need to reduce demand by supporting a healthier population.
Summary
The NHS has been really struggling over the last couple of years. Pre pandemic stresses were then compounded by Covid and lack of any breaks afterwards to catch up backlogs, particularly with large Covid waves in the summers of 2021 and 2022 (when activity normally lessens). Last winter it came to a head with the near collapse of emergency care in December. The latest data indicates that the NHS is likely in for another very tough winter. Hopefully it will not reach the crisis of last year, but that will not be because of more capacity but beacuse we get lucky with avoiding the triple whammy of large Covid, flu & RSV virus waves we saw last year. Without concerted investment, one winter our luck will run out.
Alarming, and a reminder to take Covid precautions seriously. Also to see the GP about any other health concerns, pre-emptively.