Essential insight into England’s biggest health economy, by Ben Clover

The big picture

It’s a crunch time of the year for one of the key parts of running a hospital trust: accident and emergency performance.

It’s well known how England as a whole fared: a dreadful March and two trusts slipping below the 50 per cent mark for patients waiting in a type one A&E.

One of those trusts, Hillingdon Hospitals, is inside the M25. But the bigger picture first: London’s five Sustainability and Transformation Partnership areas are above the national average for quarter four on the all types A&E performance (the more flattering measure that includes attendances at walk in centres). North West London STP is 4.5 percentage points higher than the 85 per cent England performance. (This is still below the unofficial national target of 90 per cent but pretty close.)

However, the picture becomes more complicated and alarming when you consider the type one performance (access performance for 24 hour, consultant led units) in NWL in quarter four.

Performance on this measure was 73.4 per cent, the lowest in London. Also, it has the largest disparity between all types and type one performance.

Nationally there are 8.2 percentage points between all types and type one – in NWL the difference is nearly double that.

NWL contains three of the worst performing trusts in London on type one – Hillingdon, Imperial College Healthcare Trust and London North West Healthcare Trust.

The first two recorded large falls in their year on year performance – both around the eight percentage point mark – and Hillingdon’s was from a very low base, even by contemporary standards.

LNWH saw a much stronger quarter four than last year – moving from the mid-50s on type one to the mid-60s. Did downgrading Central Middlesex’s A&E to an urgent care centre work as planned, meaning the main site at Northwick Park was better staffed to handle its type one workload? Or was it the long overdue revamp of Northwick Park?

Imperial has had some problems with its urgent care centre so the apparent contradictions in the figures there and across the STP are intriguing.

Sadly, after improvements in recent years, Barking, Havering and Redbridge University Hospitals Trust’s year on year decline was the steepest in London. On an attendance increase of roughly 3 per cent to type one A&E, access slid 11.5 percentage points to 70.3 per cent – sixth from bottom in the country. It is not clear if this is a stutter on its journey out of the bottom of the table or a reversion to its historic form. Everyone is hoping BHRUHT can turn itself around in medium term.

Most improved

At the other end of the table, the competition between Homerton University Hospital Foundation Trust and Chelsea and Westminster Hospitals FT continues.

Chelsea was the only trust in London to improve year on year on both measures, and did so significantly from an already high base, putting it at 91.9 per cent for all types and within 0.7 per cent of the official national target of 95 per cent for type one – a significant achievement that might have something to do with the investment made in West Middlesex University Hospital’s A&E.

But Hackney based Homerton Hospital continues to be the highest performing trust in the capital with 93.4 per cent for both measures.

An honourable mention to Epsom and St Helier University Hospitals, which has seen a slide year on year in the face of a 5 per cent rise in attendances. The London borders trust still came in third overall in quarter four.