• Twenty trusts responsible for most of the rise in A&E four hour target breaches
  • Eight of the trusts also drove last year’s decline
  • Smaller trusts disproportionately driving the decline
  • Eight trusts hit the 95 per cent target for 2015-16 overall

Twenty hospitals trusts are responsible for more than half the overall decline in the annual accident and emergency waiting times performance, HSJ analysis reveals.

Data released for urgent and emergency care this month shows performance against the four hour target at consultant led A&E departments in England fell from 93.5 per cent in 2014-15 to 90.4 per cent in 2015-16. The target is 95 per cent.

The number of patients not being seen within the four hour waiting time target rose from 1.4 million in 2014-15 to 1.8 million in 2015-16.

The 20 trusts (see box, below) saw approximately a fifth of the total attendances and admissions in England during 2015-16 – making their contribution to overall breach numbers even starker.

The data shows the position at outlying trusts has got worse. In 2014-15, 26 trusts seeing a quarter of all patients were responsible for half the growth in breaches.

The 20 trusts include large organisations such as Barts Health Trust and Imperial College Healthcare Trust, but also much smaller providers like Kettering General Hospital Foundation Trust and Tameside General Hospital FT.

The 20 trusts

These providers were responsible for more than half of the national year on year increase in four hour target breaches.

  • Pennine Acute Hospitals Trust*
  • Mid Yorkshire Hospitals Trust
  • North Middlesex University Hospital Trust
  • Barts Health Trust*
  • East And North Hertfordshire Trust
  • East Kent Hospitals University Foundation Trust*
  • Worcestershire Acute Hospitals Trust
  • St Helens And Knowsley Hospital Services Trust
  • United Lincolnshire Hospitals Trust*
  • Hull And East Yorkshire Hospitals Trust*
  • Blackpool Teaching Hospitals Foundation Trust
  • York Teaching Hospital Foundation Trust*
  • West Hertfordshire Hospitals Trust*
  • University Hospital Of South Manchester Foundation Trust
  • Hampshire Hospitals Foundation Trust
  • Imperial College Healthcare Trust*
  • Royal Liverpool And Broadgreen University Hospitals Trust
  • Tameside Hospital Foundation Trust
  • Shrewsbury And Telford Hospital Trust
  • Kettering General Hospital Foundation Trust

* = Trusts that had a disproportionate number of breaches in 2015-16 and 2014-15

Pennine Acute Hospitals Trust in Greater Manchester made the single biggest contribution to the increase, with the number of patients breaching the four hour target going from 19,000 in 2014-15 to more than 45,000 in 2015-16.

Against the main 95 per cent target for type one A&Es, the lowest performing trusts were Portsmouth Hospitals Trust, University Hospitals of the North Midlands Trust, and London North West Healthcare Trust.

The trusts that achieved the target in 2015-16 overall were:

  • Luton And Dunstable University Hospital FT;
  • Dudley Group FT;
  • Western Sussex Hospitals FT;
  • Airedale FT;
  • South Warwickshire FT;
  • Homerton University Hospital FT;
  • Wrightington, Wigan and Leigh FT; and
  • Bedford Hospital Trust.

HSJ understands NHS Improvement will be significantly expanding the teams it sends into trusts having the most trouble with A&E performance.

Senior figures have suggested that the downgrading of the four hour target from 98 per cent to 95 per cent in 2010 may have had an effect on trust performance.

HSJ understands senior policy figures are thinking of creating a new set of performance metrics for A&E which would include patient experience, staff morale and clinical metrics.

When the data was released earlier this month, NHSI chief executive Jim Mackey said: “March saw the NHS treat a record number of patients in A&E and the highest number of emergency admissions to hospitals ever.

“We are being told that more patients with minor illnesses are visiting A&Es, which is adding to the pressure. We are working with the system to find out how we can best support work locally to treat patients in the right setting, in a more timely way and improve the way patients are discharged.

“Our focus needs to be on making sure that we are supporting front line staff to respond to this unprecedented level of demand and put in place real and rapid improvements for patients.”