• NHS Improvement chief raised concerns over “organisations who consistently deliver very low levels of performance”
  • January was “a very difficult month” for A&E departments, Jim Mackey said
  • Trusts “left in no doubt whatsoever that there needs to be a sustained improvement”

The 30 worst performers on the accident and emergency four hour standard were summoned to London by regulators this week.

Child in A&E

Child in A&E

Representatives met with NHS Improvement chief executive Jim Mackey, who had written to trusts to raise concerns over “a number of organisations who consistently deliver very low levels of performance”.

The letter, seen by HSJ, suggested that January had “clearly been a very difficult month” for the trusts’ A&E departments. The four hour target performance data for this period is not yet available, after NHS England stopped its weekly publication at the start of the winter.

The 30 trusts called to the meeting

  • North Middlesex Univeristy Hospital Trust
  • Aintree University Hospital Foundation Trust
  • University Hospital of South Manchesters Foundation Trust
  • Tameside Hospital Foundation Trust
  • Stockport Foundation Trust
  • Torbay and South Devon Foundation Trust
  • Portsmouth Hospitals Trust
  • Hull and East Yorkshire Hospitals Trust
  • University Hospitals of North Midlands Trust
  • Nottingham University Hospitals Trust
  • Norfolk and Norwich University Hospitals Foundation Trust
  • Kettering General Hospital Foundation Trust
  • North Bristol Trust
  • Warrington and Halton Foundation Trust
  • Countess of Chester Foundation Trust
  • West Hertfordshire Hospitals Trust
  • Weston Area Health Trust
  • Great Western Hospitals Foundation Trust
  • The Princess Alexandra Hospital Trust
  • Pennine Acute Hospitals Trust
  • North Cumbria University Hospitals Trust
  • Mid Essex Hospital Services Trust
  • Northampton General Hospital Trust
  • Worcestershire Acute Hospitals Trust
  • Medway Foundation Trust
  • Gloucestershire Hospitals Foundation Trust
  • Maidstone and Tunbridge Wells Trust
  • Royal United Hospital Bath Foundation Trust
  • Shrewsbury and Telford Hospital Trust
  • East and North Hertfordshire Trust

It is not clear how the organisations were selected, but most of the trusts in attendance were among the worst performers in the most recent A&E data published by NHS England, covering the three months to December (see table below).

This showed only 19 out of 136 acute trusts met the headline standard, for 95 per cent of patients to be admitted, transferred or discharged from A&E within four hours.

At least half of the trusts invited to the meeting were performing at under 85 per cent in this period.

One attendee told HSJ: “We were left in no doubt whatsoever that there needs to be a sustained improvement.” The 30 trusts were told there needed to be consistent improvement by June, they said.

They added that worst performers among the 30 were told they would need to consistently achieve 85 per cent by the second quarter of 2016-17, and 95 per cent by the end of 2017.

There was also a suggestion that NHS England will start publishing weekly performance data again soon.

The attendee said: “Jim Mackey said he wants this information to be published, so there’s probably a concern about the media interest and political reaction that could come with that, and they want to try and do something.”

Gloucestershire Hospitals Foundation Trust was one of the providers represented at the meeting, and Monitor this week announced an investigation into its poor A&E performance.

NHSI offered to support trusts to improve performance. Cambridge University Hospitals FT, City Hospitals Sunderland FT, Ipswich Hospital Trust and South Warwickshire FT were cited as “exemplar” trusts who had managed to turn around their performance.

Four out of the eight acute trusts in Greater Manchester were among the 30.

In the letter calling the meeting, which took place on Tuesday, Mr Mackey said: “Whilst some organisations have managed to consistently maintain good performance, it has become clear to me over the last few weeks that there are also a number or organisations who consistently deliver very low levels of performance.

“Your organisation is in the group of 30 worst performers. Various attempts have been made to address this over the last couple of years, but none of this effort has resulted in sustained improvement.

“Given the importance of this standard, and its significance in terms of patient safety, we need to find a way, quite urgently, of addressing this issue, and doing so on a sustained basis.”

Acute trust performance on the four hour target, October-December 2015

OrganisationPatients seen in four hours or less (type 1 A&E)Percentage seen in four hours or less (all A&E)
Tameside Hospital Foundation Trust 77.7% 77.7%
Portsmouth Hospitals Trust 72.4% 78.1%
North Middlesex University Hospital Trust 78.5% 78.5%
Stockport Foundation Trust 80.6% 80.6%
East And North Hertfordshire Trust 71.2% 80.6%
Pennine Acute Hospitals Trust 77.3% 80.7%
Hull And East Yorkshire Hospitals Trust 78.6% 80.7%
Colchester Hospital University Foundation Trust 81.0% 81.0%
The Princess Alexandra Hospital Trust 80.7% 81.1%
Royal Cornwall Hospitals Trust 77.1% 81.6%
University Hospital Of South Manchester Foundation Trust 82.1% 82.1%
North Bristol Trust 82.3% 82.3%
Nottingham University Hospitals Trust 81.1% 82.9%
Walsall Healthcare Trust 74.1% 83.3%
Mid Yorkshire Hospitals Trust 83.5% 83.5%
Dartford And Gravesham Trust 84.2% 84.2%
Norfolk And Norwich University Hospitals Foundation Trust 83.0% 84.3%
North Cumbria University Hospitals Trust 84.4% 84.4%
University Hospitals Of North Midlands Trust 74.7% 84.4%
University Hospitals Of Leicester Trust 75.8% 85.2%
Gloucestershire Hospitals Foundation Trust 85.6% 85.6%
Southend University Hospital Foundation Trust 85.7% 85.7%
United Lincolnshire Hospitals Trust 85.9% 85.9%
Shrewsbury And Telford Hospital Trust 84.6% 85.9%
Weston Area Health Trust 86.3% 86.3%
Brighton And Sussex University Hospitals Trust 85.0% 86.3%
Medway Foundation Trust 86.4% 86.4%
Barts Health Trust 82.0% 86.5%
West Hertfordshire Hospitals Trust 80.0% 86.7%
Barking, Havering And Redbridge University Hospitals Trust 84.6% 86.8%
Aintree University Hospital Foundation Trust 75.3% 86.9%
Ashford And St Peter’s Hospitals Foundation Trust 84.9% 86.9%
York Teaching Hospital Foundation Trust 78.8% 87.1%
St Helens And Knowsley Hospital Services Trust 82.9% 87.4%
Warrington And Halton Hospitals Foundation Trust 82.0% 87.5%
Basildon And Thurrock University Hospitals Foundation Trust 87.5% 87.5%
Countess Of Chester Hospital Foundation Trust 86.3% 87.6%
Heart Of England Foundation Trust 85.7% 87.7%
Maidstone And Tunbridge Wells Trust 87.7% 87.7%
Hampshire Hospitals Foundation Trust 86.1% 87.7%
The Queen Elizabeth Hospital, King’s Lynn Foundation Trust 87.8% 87.8%
Kettering General Hospital Foundation Trust 87.8% 87.8%
University Hospital Southampton Foundation Trust 85.7% 87.9%
Wirral University Teaching Hospital Foundation Trust 84.1% 88.0%
East Kent Hospitals University Foundation Trust 84.2% 88.0%
London North West Healthcare Trust 72.4% 88.1%
Torbay And South Devon Foundation Trust 83.7% 88.3%
Oxford University Hospitals Foundation Trust 86.7% 88.3%
Isle Of Wight Trust 81.1% 88.4%
Mid Essex Hospital Services Trust 88.3% 88.8%
Wye Valley Trust 81.0% 89.0%
Royal United Hospitals Bath Foundation Trust 87.3% 89.1%
Plymouth Hospitals Trust 89.0% 89.2%
East Sussex Healthcare Trust 87.5% 89.2%
King’s College Hospital Foundation Trust 85.7% 89.3%
Northampton General Hospital Trust 88.6% 89.7%
Imperial College Healthcare Trust 77.1% 89.9%
Worcestershire Acute Hospitals Trust 85.2% 90.0%
University Hospitals Coventry And Warwickshire Trust 86.7% 90.0%
University Hospitals Bristol Foundation Trust 88.4% 90.2%
Southport And Ormskirk Hospital Trust 84.8% 90.2%
The Royal Wolverhampton Trust 86.3% 90.3%
St George’s University Hospitals Foundation Trust 89.3% 90.3%
The Rotherham Foundation Trust 90.5% 90.5%
University College London Hospitals Foundation Trust 90.6% 90.6%
Great Western Hospitals Foundation Trust 83.5% 90.9%
East Cheshire Trust 89.8% 90.9%
Bolton Foundation Trust 90.9% 90.9%
Salford Royal Foundation Trust 90.9% 90.9%
Lewisham And Greenwich Trust 88.8% 90.9%
Poole Hospital Foundation Trust 91.1% 91.1%
University Hospitals Birmingham Foundation Trust 91.3% 91.3%
Blackpool Teaching Hospitals Foundation Trust 80.2% 91.3%
University Hospitals Of Morecambe Bay Foundation Trust 90.2% 91.5%
Lancashire Teaching Hospitals Foundation Trust 91.8% 91.8%
Buckinghamshire Healthcare Trust 86.7% 91.9%
The Whittington Hospital Trust 92.1% 92.1%
Taunton And Somerset Foundation Trust 92.2% 92.2%
Barnsley Hospital Foundation Trust 92.2% 92.2%
Leeds Teaching Hospitals Trust 91.5% 92.2%
Yeovil District Hospital Foundation Trust 92.3% 92.3%
The Hillingdon Hospitals Foundation Trust 80.4% 92.4%
Royal Surrey County Hospital Foundation Trust 92.5% 92.5%
Central Manchester University Hospitals Foundation Trust 85.6% 92.7%
City Hospitals Sunderland Foundation Trust 88.8% 92.8%
Croydon Health Services Trust 89.7% 92.8%
Sandwell And West Birmingham Hospitals Trust 90.5% 93.1%
Guy’s And St Thomas’ Foundation Trust 91.1% 93.2%
Royal Liverpool And Broadgreen University Hospitals Trust 83.5% 93.2%
The Royal Bournemouth And Christchurch Hospitals Foundation Trust 91.6% 93.2%
Gateshead Health Foundation Trust 91.2% 93.3%
Royal Devon And Exeter Foundation Trust 93.3% 93.3%
Bradford Teaching Hospitals Foundation Trust 93.3% 93.3%
Royal Free London Foundation Trust 92.3% 93.4%
The Newcastle Upon Tyne Hospitals Foundation Trust 90.3% 93.6%
James Paget University Hospitals Foundation Trust 93.7% 93.7%
Northern Lincolnshire And Goole Foundation Trust 92.9% 93.7%
County Durham And Darlington Foundation Trust 86.3% 93.8%
Cambridge University Hospitals Foundation Trust 92.0% 93.9%
South Tyneside Foundation Trust 93.0% 94.0%
Wrightington, Wigan And Leigh Foundation Trust 94.0% 94.0%
Kingston Hospital Foundation Trust 93.6% 94.0%
Epsom And St Helier University Hospitals Trust 93.8% 94.0%
George Eliot Hospital Trust 94.1% 94.1%
Salisbury Foundation Trust 94.1% 94.1%
North Tees And Hartlepool Foundation Trust 92.8% 94.1%
Hinchingbrooke Health Care Trust 94.1% 94.1%
East Lancashire Hospitals Trust 90.7% 94.1%
Burton Hospitals Foundation Trust 89.2% 94.1%
Derby Teaching Hospitals Foundation Trust 92.3% 94.2%
Chesterfield Royal Hospital Foundation Trust 94.2% 94.2%
Peterborough And Stamford Hospitals Foundation Trust 94.0% 94.4%
Surrey And Sussex Healthcare Trust 94.6% 94.6%
Airedale Foundation Trust 94.6% 94.6%
South Warwickshire Foundation Trust 94.1% 94.7%
Sherwood Forest Hospitals Foundation Trust 92.9% 94.8%
Northumbria Healthcare Foundation Trust 94.4% 95.0%
Milton Keynes University Hospital Foundation Trust 91.8% 95.0%
Royal Berkshire Foundation Trust 94.3% 95.0%
West Suffolk Foundation Trust 95.1% 95.1%
Western Sussex Hospitals Foundation Trust 95.1% 95.1%
Calderdale And Huddersfield Foundation Trust 95.1% 95.1%
Bedford Hospital Trust 95.2% 95.2%
Doncaster And Bassetlaw Hospitals Foundation Trust 94.2% 95.2%
Ipswich Hospital Trust 95.2% 95.3%
Homerton University Hospital Foundation Trust 95.3% 95.3%
Harrogate And District Foundation Trust 94.7% 95.4%
Dorset County Hospital Foundation Trust 95.4% 95.4%
Frimley Health Foundation Trust 95.6% 95.6%
South Tees Hospitals Foundation Trust 93.3% 95.7%
Chelsea And Westminster Hospital Foundation Trust 94.0% 95.7%
Northern Devon Healthcare Trust 88.0% 95.8%
Mid Cheshire Hospitals Foundation Trust 95.3% 96.5%
Luton And Dunstable University Hospital Foundation Trust 97.8% 98.4%
The Dudley Group Foundation Trust 97.8% 98.8%