Increasing numbers of accident and emergency patients are being treated outside the maximum four hour wait year on year over the past four summers, an HSJ analysis shows.
Our examination of NHS England data on type 1 incidents - the most serious - suggests a significant proportion of trusts will fail to hit the target to treat, discharge or admit 95 per cent of A&E patients within four hours at the end of 2013-14.
The April-September period we examined is traditionally the half of year in which services are under the least pressure, suggesting that many trusts will struggle as winter pressures set in.
In 2010-11, over the first six months of the financial year, 97.4 per cent of patients across all trusts were seen within the target period; the corresponding figure for 2011-12 was 95.8 per cent and that for 2012-13 was 95.1 per cent. But in the same period for 2013-14 the average was only 93.9 per cent.
In quarters 1 and 2 of 2011-12 the bottom 10 trusts had an average percentage of 90 per cent. This rose in 2011-12 to 95 per cent but this year the average has dropped significantly to 87 per cent.
The number of trusts missing the government’s four-hour waiting time target over the first two quarters of the year has more than doubled, from 35 in 2011-12 to 78 this year. The proportion of trusts breaching the target has risen from 24 per cent to 34 per cent to 55 per cent over the past three years.
As the pressured winter period approaches the government has injected £250m into A&E departments to counter the rise in demand this year. However, the data indicates that A&Es are already falling behind in meeting the four-hour target before they have entered the winter period.
NHS England board papers for October made note of this drop in A&E performance. The papers state: “…performance against the standard [four-hour waiting time] remains a cause for concern as we approach winter. Although the standard was achieved in quarter 2, performance has generally been weaker than in similar weeks in previous years.”
A spokesperson from NHS interim management and support emergency care intensive support team said: “The presenting population has got older and frailer and that’s caused additional pressures. It won’t get any easier across winter.”
The bottom 10: worst summer period performers over the past three years
2011-12 quarters 1 and 2
1) Surrey and Sussex Healthcare Trust (75.8 per cent)
2) Kettering General Hospital Foundation Trust (91.2 per cent)
3) Mid Staffordshire Foundation Trust (91.4 per cent)
4) University Hospitals of Leicester Trust (91.9 per cent)
5) Worcestershire Acute Hospitals Trust (92 per cent)
6) Ashford and St Peter’s Hospitals Foundation Trust (92.2 per cent)
7) Barking, Havering and Redbridge University Hospitals Trust (92.6 per cent)
8) Pennine Acute Hospitals Trust (92.8 per cent)
9) East Lancashire Hospitals Trust (93.4 per cent)
10) Nottingham University Hospitals Trust (93.5 per cent)
1) Barking, Havering and Redbridge University Hospitals Trust (88.5 per cent)
2) Milton Keynes Hospital Foundation Trust (89.9 per cent)
= Croydon Health Services Trust (89.9 per cent)
4) North Bristol Trust (90.5 per cent)
5) Portsmouth Hospitals Trust (91.9 per cent)
6) Shrewsbury and Telford Hospital Trust (92.1 per cent)
7) Worcestershire Acute Hospitals Trust (92.2 per cent)
8) Oxford University Hospitals Trust (92.3 per cent)
9) Mid Cheshire Hospitals Foundation Trust (92.4 per cent)
10) University Hospital of North Staffordshire (92.7 per cent)
1) University Hospitals of Leicester Trust (81 per cent)
2) Portsmouth Hospitals Trust (86.2 per cent)
3) Barking, Havering and Redbridge University Hospitals Trust (87.5 per cent)
4) North West London Hospitals Trust (87.8 per cent)
= Medway Foundation Trust (87.8 per cent)
6) University Hospitals Coventry and Warwickshire Trust (88.9 per cent)
7) South London Healthcare Trust (89.1 per cent)
8) Kettering General Hospital Foundation Trust (89.3 per cent)
9) County Durham and Darlington Foundation Trust (89.5 per cent)
10) Barnet and Chase Farm Hospitals Trust (89.7 per cent)