A third of foundation trusts had missed emergency waiting time target at end of 2012

BMJ 2013; 346 doi: (Published 18 March 2013) Cite this as: BMJ 2013;346:f1761
  1. Gareth Iacobucci
  1. 1BMJ

The growing pressure on hospitals’ emergency departments has been laid bare by new figures showing a “significant increase” in the number of foundation trusts failing to meet the government’s waiting time targets.

The latest report from the healthcare regulator Monitor shows that in the last three months of 2012 a total of 32 foundation trusts, 36% of the total that have emergency departments, missed the target to treat 95% of patients who arrive in the department within four hours.1

This was more than twice the number of trusts that breached the target in the same period in 2011 (14) and more than four times the seven that failed to reach the target in the previous quarter of 2012.

Monitor expressed concern at the trend, which it attributed to factors such as outbreaks of the winter vomiting bug, delays in discharge caused by problems in accessing community care services, and increased attendances by older patients. It forecasted that the pressure on emergency departments was likely to continue in the fourth quarter of the 2012-13 financial year.

Monitor said that it was also concerned that a small number of trusts were missing other waiting time targets such as the 18 week target from referral to treatment, but it said that overall “the trend across the sector was improving.”

The NHS Commissioning Board is currently carrying out a major review of urgent and emergency services in England, led by the NHS’s medical director, Bruce Keogh, to ensure consistency of standards of care across the country.2

Monitor’s report also shows that only a quarter of foundation trusts were delivering the cost savings that they had projected for the 2012-13 financial year. For the third quarter in a row, Monitor said, delivery of cost savings was “substantially behind plan,” with the cumulative slippage amounting to 16% of the total savings planned (£173m (€200m; $260m) of £1.07bn) for the year to date.

But despite the shortfall the regulator said that foundation trusts’ financial performance across the country was still 2% ahead of plan, with increased demand for hospital services contributing to an overall surplus of £365m.

Commenting on the pressure on emergency departments, Stephen Hay, managing director of provider regulation at Monitor, said, “There is a greater demand for A&E [accident and emergency] service across the NHS, but it is not acceptable that patients have to wait longer.

“Trusts need to work with local healthcare partners to understand and address these issues.”

On finances Hay said that it was “important for all trusts to make sure they deliver cost savings in this tight financial environment, while maintaining and improving the quality of care for patients.

“Monitor has regularly reminded trusts of the importance of making savings early in the year to prevent problems being stored up for later.”

Chris Hopson, chief executive of the Foundation Trust Network, said that demand for emergency department services was “skyrocketing” in many areas, especially those that had seen big cuts in local authorities’ social care services and those with poorer quality out of hours GP services.

He added, “NHS trusts and foundation trusts are, as usual, doing the best they can, but the current financial arrangements don’t help. Trusts can lose 70% of the normal payment for patients admitted via emergency departments and 100% on the payments for planned operations they have had to cancel because all the theatres and beds are being used for emergency patients. The FTN [Foundation Trust Network] and the College of Emergency Medicine are both arguing that we need an urgent debate on whether the current approach to A&E services is sustainable clinically or financially, and these latest figures just confirm the need for that debate to happen now rather than later.”


Cite this as: BMJ 2013;346:f1761