• Data seen by HSJ suggests December will set a new record high for 12-hour ‘trolley waits’
  • Shortages of beds and waiting for covid test results are both factors in admission delays
  • London trusts report very low four-hour A&E performance

Very long waits for emergency hospital care have surged in London since mid December, due to a rapid rise in covid-19 admissions combined with limited capacity, according to figures leaked to HSJ.

Data sent to HSJ indicates that December will set a new record high nationally for the number of 12-hour “trolley waits”. This is when there are 12 hours or longer from the decision is made to admit a patient from the emergency department to hospital, to when they are actually admitted to a bed.

It adds to fears about what will happen if rising covid occupancy — which has left some hospitals running out of staff and acute beds, and intensive care well over normal capacity —  combines with potential additional winter demand in coming weeks.

The provisional NHS figures, likely to be an underestimate which is revised upwards, show 2,930 were recorded in December. The largest previous number in published data is 2,847, for January 2020. 

But they were heavily concentrated in London, which recorded 1,325, several times its January rate of just under 400. Most of these in the second half of December — as covid admissions grew to very high levels, and the number of covid patients in the capital’s hospitals passed its first wave peak, with a very large spike on 30 December.

Several senior hospital managers in areas heavily affected by covid said there were two main factors. One is shortage of beds and operational issues: there are about 6,300 fewer general and acute beds open nationally this winter, due to infection prevention measures. The beds that remain have to be split between covid positive and negative, often taking time to convert more.

Two sources said bed shortages were exacerbated by problems with discharge, particularly of covid patients who no longer need acute care, including “local authorities taking their eye off the ball on designated settings and covid-positive pathways”, according to one.

And another reason behind delays is waiting for covid test results before admitting patients.

One source also said there was less focus in hospitals on curbing 12-hour trolley waits, which is normally heavily performance managed, because the situation was extreme enough that “everyone is focusing on safety”.

This is despite what is thought to be relatively low levels of ED attendances — meaning delays are likely to get worse if non-covid demand rises, as is often the case in the first weeks of the year, and while covid admissions and cases continue to climb.

The number of ambulance handovers taking more than an hour also rose steeply in the second half of December, figures show.

Another set of performance figures seen by HSJ shows ED performance on 72.8 per cent of patients admitted or discharged within four hours in the capital over the week to 2 January, which is among the worst ever performance.

Four trusts under pressure from covid had performance of less than 70 per cent against the 95 per cent target (Barking, Havering and Redbridge; Barts; King’s College; North Middlesex; and Whittington). Even the Homerton, a normally high performing trust but facing high covid admissions, saw performance dip to 76 per cent. Until now it has run above 90 per cent, even during the winter.

*Updated 9.30 4 January: Corrected London’s January 2020 12-hour wait number.