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

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London is fortunate that many of its worst-performing trusts for accident and emergency merged over the last two years, making the process of comparison difficult.

What is clear though is that performance decreased from 2014-15 to 2015-16. As always, it is less clear why.

But first of all, hats off to the Homerton.

The east London trust, an island of not-Barts-Health-Trust in a sea of Barts Health Trust, is the only one in the capital to have kept its head above water with the national A&E target for 2015-16.

Under the tougher type-one attendances target (which I will use throughout), Epsom and St Helier, and Chelsea and Westminster were close but slipped under the 95 per cent.

So what went right in Hackney?

Attendances increased only very little year-on-year, admissions rose rather more dramatically, up 11 per cent. So, as medical director Martin Kuper put it in an email to staff, well done to the emergency department staff AND “the rest of the hospital and community staff who support the urgent pathway and allow the hospital to ‘flow’”.

Homerton is one of London’s quieter pioneers, having taken over community services under the Transforming Community Services programme a while back. The £270m-turnover trust has long had a respected emergency department, but if it had actually cracked control of demand, discharge and all the related community services it would be worth wider celebration.

And perhaps its neighbour Barts, long pilloried by the centre for its performance, should be cut some slack.

Their figures are, on the face of it, bad.

The trust’s performance fell year on year by four percentage points, to 84 per cent. This came against the backdrop of a 7 per cent rise in attendances, but (perhaps surprisingly) a fall in admissions.

But Barts serves younger, more deprived Tower Hamlets and Newham as well as older, frailer Waltham Forest – and the picture is richer at that level.

Newham General is hitting the target – not something it was known for when it was an independent organisation.

So what’s the problem at the Royal London and Whipps? No one seems to know (theories welcome, I won’t name anyone -

But Barts is doing better than fellow giant Imperial, where performance fell six percentage points on the back of a 10 per cent rise in admissions.

Imperial blame an increase in lower acuity attendances, and says the number of adult patients attending St Mary’s Hospital with a high acuity score between November and January had doubled year-on-year.

By nearly five percentage points, London North West Healthcare Trust has the capital’s worst A&E performance for type-ones. Less than three quarters of patients meet the four-hour target. At 74.8 per cent, the north west London giant has the third lowest performance in the country.

Performance has always been problematic in outer north west London and the conventional wisdom is that this is a by-product of the poor access this population has to primary care, with its high proportion of single-handed practices.

LNWH hopes a new 63-bed ward block including an assessment unit and a short stay unit completed in January will turn the tide.

The significant performance difficulties in this corner of London make the case for further reconfiguration – here and elsewhere – more difficult.

London Eye has written before about the problems at North Middlesex’s emergency department – and the interesting reasons for it. But the full-year picture reveals just how stark that situation is. A 10.8 per cent year-on-year fall in performance on the back of a fall in attendances is noteworthy, but the 15 per cent rise in admissions even more so.

If sweating junior doctors for service rather than training them accounts for this kind of difference I’d be interested to know if it was happening elsewhere.

The experts on A&E say that changing the target from 98 per cent to 95 per cent didn’t help but that broadly the factors driving the national decline are the same as they were last year. So well done also to Barking, Havering and Redbridge University Hospitals Trust who saw a welcome uptick in their score.

2015-16’s 85 per cent is still a long way off the target but it’s moving in the right direction. BHR hitting the national A&E target would be a bunting and sparkling wine event for the NHS in London.

The capital’s younger population should mitigate the “older, frailer patients” problem faced by trusts outside metropolitan areas.

So how come Epsom and St Helier, on the Surrey border and serving care-home heavy Sutton as well as younger Merton, is also in the top three?

No one knows (Send me your ideas –