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Statistics show A&E departments struggling to cope

Figures released today (February 8) confirm the growing pressure on Accident & Emergency departments across England. The statistics from NHS England reveal that as patient numbers presenting at A&E continue to increase, hospitals suffered their worst performance ever against the four-hour treatment target. 


Just 77.1% of patients were seen within four hours in type 1 A&E departments compared to 77.3% in December 2017 and 77.6% in the same month last year. The target is for 95% of patients to be seen or assessed within four hours. This is the lowest type 1 performance since this collection began.


The total number of attendances in January 2018 was 2,000,000, an increase of 5.5% on January 2017. Of these, attendances at type 1 A&E departments were 1.6% higher. Attendances over the latest 12 months are 1.1% higher than levels in the preceding 12-month period. 


There were 81,003 four-hour delays from decision to admit to admission in January, which compares to 79,600 in the same month last year. This is the highest number since the collection began. Of these, 1,043 were delayed over 12 hours, which compares to 989 in the same month last year. Again, this is the highest number since the collection began.


Just five from 137 reporting Trusts with type 1 departments achieved the 95% standard on all types during January; when additional local activity is taken into account this number rises to eight.


The four-hour A&E target has not been met in England since July 2015. In ‘Refreshing NHS Plans for 2018/19’, published earlier this week, it was confirmed that the government was expected to move the goalposts around this target. 


Whereas previously the Health Secretary Jeremy Hunt has stressed that meeting the four-hour target is a priority, which he expected would be hit during 2018, the latest guidance from NHS England and NHS Improvement states: “Our expectation is that the Government will roll forward the goal of ensuring that aggregate performance against the four-hour A&E standard is above 90% for the month of September 2018, that the majority of providers are achieving the 95% standard for the month of March 2019, and that the NHS returns to 95% overall performance within the course of 2019.” 


Muddy waters

The publication of these figures comes hot on the heels of the BBC’s report that cast doubt over the accuracy of the recording of A&E performance figures this winter – and that they could in fact be even worse. In response, NHS Improvement announced it would conduct a review and Jonathan Ashworth MP, Labour’s Shadow Health Secretary wrote to the Secretary of State for Health, Jeremy Hunt, calling for an urgent investigation. 


The concern is over the inclusion of data from walk-in centres, urgent treatment centres or other providers that are not run by the hospital and are not on hospital grounds and therefore should not be included. 


Mr Ashworth’s letter states: “We therefore share the UK Statistics Authority’s concern that these changes could have left people reaching ‘misleading conclusions’ because the implication is that including these centres would help improve overall performance.


“Indeed, the Royal College of Emergency Medicine has confirmed that these changes do tend to pull up the overall performance of a Trust. It is thought some Trusts have seen their four-hour performance improve by nearly 5%.”