Daily Insight: The long game

More than one in five acute trusts are seeing long accident and emergency waits get worse, despite national numbers improving. 

HSJ found 28 of 119 acute trusts (23.5 per cent) had more 12-hour waits in A&E from patients’ time of arrival so far this year compared to last.

The trusts’ worsening position on 12-hour waits bucks an improving national trend on the longest waits – with both the number of 12-hour waits, and their share of attendances, improving across England since last year.

The analysis, which used published and unpublished data, shows 12 trusts have improved their four hours A&E performance at the same time as delivering increasing 12-hour waits.

And 11 trusts with worsening 12-hour waits are at or around NHS England’s headline 76 per cent four hours target.

Adrian Boyle, of the Royal College of Emergency Medicine, said HSJ’s analysis “shows an unintended and perverse consequence of setting the four-hour access standard so low at 76 per cent”.

NHSE, which has prioritised the four hours target, along with category two ambulance response times, as the key emergency care performance metrics this year, said it “will continue to work with the most challenged trusts to focus on speeding up discharge, boosting patient flow and freeing up beds”.

Momentum lost on sepsis care

The quality of care provided to patients with suspected sepsis has “fallen backwards” in recent years, experts have warned, as HSJ analysis revealed declining rates of prompt antibiotic treatment and several deaths deemed avoidable.

Despite major progress on improving sepsis care with the proportion of A&E patients with suspected sepsis receiving antibiotics within an hour improving from 54 per cent in 2015 to 80 per cent by 2019, internal data suggests performance had fallen to 67 per cent during 2022-23.

Health chiefs are also failing to act on failures raised a decade ago, a watchdog has said, after HSJ identified 31 formal reports issued by coroners since 2019 warning of systemic problems. Survival rates for the condition also appear to have fallen, according to mortality data collected by the NHS. 

Health ombudsman Rob Behrens, who issued a report on sepsis failures last year, said the same mistakes were “clearly being repeated time and time again” and described HSJ’s findings as “chilling”.

Repeated failings raised by coroners, including nine relating to deaths of children or babies, include delays or failures to administer antibiotics, not following protocols for identifying sepsis, alongside inaccurate, missed or skipped observations.