• Some larger NHS hospitals will need to justify why A&E performance is poor relative to their resources, says Getting It Right First Time co-lead
  • Chris Moulton says data will “shine light” on significant issue
  • Has visited 50 A&Es so far and will visit all emergency departments before report in late 2019

A number of teaching trusts are “not putting enough priority” on tackling poor emergency waiting times performance, a major review due later this year will indicate.

The Getting it Right First Time co-lead told HSJ the programme’s emergency care data would “really shine a light on” why some teaching hospitals performed worse on both the four-hour and 12-hour target than their district general hospital counterparts, despite better staffing ratios, capacity and resources.

Chris Moulton, who co-leads GIRFT’s emergency workstream, told HSJ: “The findings from the GIRFT programme will raise some very challenging questions [for major teaching hospitals].

“The data suggests that some [teaching] hospitals are not putting enough priority on their duty as a district hospital that serves their local population because they are concentrating on their [other roles].”

“This is an issue that’s been around for a while, but I think the GIRFT data will really shine a light on it.”

The Bolton Hospital emergency consultant has already visited around 50 accident and emergency departments to gather intelligence and data alongside Cliff Mann, NHS England’s A&E clinical lead and fellow co-lead of the GIRFT emergency care stream.

The pair said they would visit every department in person before completing their report later this year for the flagship NHS efficiency programme looking into unwarranted variation across the NHS.

Dr Moulton said he did not “think it was fair to single out individual trusts at this point, especially as the exact circumstances vary so much”.

However, teaching hospital trusts featured prominently at the bottom of the four-hour performance official data.

Twelve of the 20 worst performing trusts against the type-1 four-hour target in the most recent official quarterly data were trusts which were the main provider allied to a medical school (see table below).

Two of those – University Hospitals Birmingham and King’s College Hospital – are both members of the prestigious Shelford Group, which represents the 10 largest teaching and research hospitals.

Dr Moulton acknowledged “larger teaching hospitals of course have much wider commitments than many smaller trusts and we understand trauma centre EDs have special staffing requirements”.

He also stressed he was not questioning the work ethic in such hospitals but he thought some trusts should look at their clinical priorities and how they allocate their staffing resources between front line work and other commitments.

He continued: “We have gone into a number of struggling DGHs of all sizes and have been able to quickly see why their four-hour performance is poor. They usually have relatively few staff, very little space and not enough supporting hospital capacity.

“But in some of the larger specialist hospitals, you find yourself asking, ‘Should there really be so many breaches here given the relatively good staffing ratios and ample space and facilities?’.

There are no official staffing ratio rules for A&E departments, which are already known to vary significantly across the NHS.

However, the Royal College of Emergency Medicine set out guidelines in September 2018, revised in February. These state a medium-sized A&E (60,000 to 100,000 attendances a year) should have between 18 and 25 full time consultants; a large A&E (over 100,000) should have between 25 and 36; and a very large A&E (over 150,000) should have between 34 and 48.

The GIRFT programme has found significant variation in staffing levels, although no data has been published yet. Read more in this week’s Performance Watch newsletter on the interim findings from the GIRFT emergency care workstream.

NameMain trust allied to a medical school?Total attendancesPercentage in four hours or less (type 1)Percentage in four hours or less (all)
Croydon Health Services Trust No 61,684 57.3% 83.9%
The Hillingdon Hospitals FT No 42,350 57.7% 81.5%
Portsmouth Hospitals Trust No 54,656 59.2% 77.8%
Worcestershire Acute Hospitals Trust No 47,157 61.3% 74.3%
Barking, Havering And Redbridge University Hospitals Trust No 99,583 61.4% 80.3%
West Hertfordshire Hospitals Trust No 39,314 62.1% 74.9%
The Princess Alexandra Hospital Trust No 29,837 67.1% 70.1%
Wrightington, Wigan And Leigh FT No 34,186 67.3% 78.8%
Lancashire Teaching Hospitals FT Yes 38,005 52.3% 79.9%
United Lincolnshire Hospitals NHS Trust Yes 59,726 56.7% 76.2%
Nottingham University Hospitals NHS Trust Yes 67,401 58.7% 70.9%
Blackpool Teaching Hospitals FT Yes 53,672 59.6% 85.6%
Norfolk And Norwich University Hospitals FT Yes 49,940 60.8% 76.7%
Shrewsbury And Telford Hospital Trust Yes 41,130 62.7% 73.9%
University Hospitals Birmingham FT Yes 160,560 62.8% 78.4%
King’s College Hospital FT Yes 107,367 63.1% 80.4%
Wirral University Teaching Hospital FT Yes 51,081 64.2% 84.5%
Plymouth Hospitals Trust Yes 38,067 64.4% 75.5%
Medway FT Yes 40,085 65.7% 79.8%
The Dudley Group FT Yes 44,427 67.1% 79.6%

Table: The worst 20 trusts on Type 1 four-hour performance in quarter 4 2018-19 based on NHS England data, and whether they are the main trust allied to a medical school