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Trolley waits in England rise sixfold in six years, show latest figures

BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j222 (Published 13 January 2017) Cite this as: BMJ 2017;356:j222
  1. Nigel Hawkes
  1. London

As the war of words over NHS financing becomes increasingly bitter,12 the statistics that track its performance have acquired a prominence they last enjoyed in the late 1990s, when Tony Blair’s first government was struggling to meet its promise to cut waiting lists.

A huge quantity of data are published by the NHS in England covering all parts of the service. As in the 1990s, the keenest attention is always paid to hospital performance, where data on key measures are published monthly. The latest release, covering the period to the end of November 2016, appeared on 12 January.3

Emergency department waits

The NHS Constitution sets the standard that 95% of patients attending hospital accident and emergency departments should be seen, admitted, or discharged within four hours. In July 2016 NHS Improvement changed the rules slightly, saying that for 2016-17 the aim of hospital trusts should be to improve so that by quarter 4 they could once more meet the standard. So they will be judged in the short term by their rate of improvement, rather than by whether they hit the target.

In November 2016 88.4% of patients waited less than four hours, down from 91.3% in November 2015. The lowest figure shown in any recent month was 87.3%, in March 2016. So the standard is not being met, and there is little sign of the improving trend sought by NHS Improvement.

Trolley waits

The NHS counts the number of people waiting to be admitted to hospital after four hours, so called trolley waits. In November 2016 these numbered 52 769, much more than the 34 170 in November 2015. The trend is steeply upward: in November 2010 only 7179 had to wait more than four hours, giving a rise of 635% in six years.

Tim Gardner, senior policy fellow at the independent healthcare research charity the Health Foundation, said that, in light of these figures, “The NHS has begun this winter in a worse position than at any time over the last five years.” Stephen Dalton, chief executive of the NHS Confederation, which represents NHS trusts, said, “We have been issuing warnings of the system approaching a tipping point for some time, but we are now starting to see proof that this point has been reached. The government must accept that limited investment at a time of increased demand has consequences.”

Delayed discharge

One reason why hospitals cannot find beds for new patients is that they have been unable to discharge patients who are ready to leave. The NHS gathers figures on the number of these “bed blockers” and the reasons for the delays. The data are gathered as a snapshot of a single day: the last Thursday of each month. On Thursday 24 November 2016 there were 6825 patients whose discharge was delayed, up from 5573 on the equivalent day in November 2015.

There are many possible causes for the delays, but the ones chiefly responsible for the recent growth in the figures are patients waiting for places in nursing or residential homes or who await a care package in their own home, which together accounted for almost 1000 extra delayed discharges over the number in 2015 and representing 75% of the year on year change. The other 25% was mostly accounted for by patients waiting for completion of assessments by hospital staff.

Margaret Wilcox, vice president of the Association of Directors of Adult Social Services, said that the delays were “a matter of enormous concern that reflects the crisis facing adult social care.”

She added, “Despite councils doing everything they can to protect adult social care budgets and look after the needs of their communities, more patients are experiencing delays in leaving hospital compared to this time last year. With care homes closing, councils projecting in-year overspends of almost £450m [€518m; $550m], and the cost of the welcome national living wage [for social care staff], services are in significant and increasing jeopardy.”

Waits for elective operations

The time patients have to wait from referral to a specialist to the treatment actually taking place has long been a key NHS statistic. The target is that more than 92% of patients should wait no more than 18 weeks from referral to treatment. In November 2016 90.5% of patients were seen within this period, so the target was missed. In November 2015 the equivalent figure was 92.4%, but that was the last month in which the target was met.

Performance varies among specialties, with ophthalmology, cardiology, and dermatology among those hitting the 92% target, while orthopaedics, ear, nose, and throat, and urology were among those missing it.

Waiting times for patients with cancer

More positive results were seen in the eight cancer standards, seven of which continue to be met, the exception being the target that 85% of patients with cancer should wait no longer than two months between an urgent referral by the GP for cancer and the treatment beginning. This has been achieved in only one month since May 2014. In November 2016 82.3% of patients were treated within the target, roughly the same proportion as every month for the past two years.

All these statistics need to be set in context. Demand is rising: in the year to November 2016 emergency department attendances rose by 1.7%, emergency admissions by 2.9%, and diagnostic tests by 1.9%, while the number of patients starting consultant led treatment rose by 4.4%. So the NHS is treating more patients but struggling to meet standards set in the fat years when money was plentiful and the 2008 financial crash had yet to happen.

References

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