Biggest ever monthly rise in 12-hour trolley waits, stats show

Statistics published by NHS England showed 43,792 patients waited more than 12 hours in accident and emergency from decision to admit to admission in October – a rise of 11,016 from the 32,776 12-hour waits recorded in September.

The monthly performance data also revealed ambulance response times for category two patients, which include suspected heart attacks and strokes, were the worst ever recorded in October – breaching over an hour on average against the 18-minute target.

Meanwhile, progress has stalled against the NHS’s most pressing elective target – to eliminate 78-week breaches on the waiting list by March. The number of year-plus waiters breached 400,000 for the first time since recent records began, while the overall waiting list rose further above 7 million.

A&E long waiters crisis deepens

The 43,792 patients who breached the 12 hours past decision to admit benchmark last month meant there were six times as many cases this October as there were the same month last year, when there were 7,058.  

Previously the biggest monthly rise in 12-hour breaches was between June and July this year, when they rose by 7,283 from 22,034 to 29,317.

The official 12-hour waits figure from decision to admit omits many of the tens of thousands of patients who waited 12 hours or more from time of arrival. Though NHSE collects these stats, it does not publish them on a monthly basis.

Performance against the four-hour target also hit a new low of 54.8 per cent for type one A&Es, down from 56.9 per cent in September and 61.9 per cent in October last year.

That was despite attendances at these A&Es being 1.3 per cent lower than October 2021, with high levels of bed occupancy and delayed discharges among the key factors behind the urgent care crisis.

At some trusts, including Barking, Havering and Redbridge University Hospitals Trust and Manchester University Foundation Trust, little over a third of type one A&E patients were admitted, transferred or discharged within four hours.

Trusts where largest proportion of admissions wait at least 12 hours

Performance against 78-week elective target stalls

Progress has also stalled against the NHSE’s most pressing elective target, which is to eliminate 78-week breaches by March and which system leaders have been bullish about hitting.

Trusts posted another month-on-month reduction in patients waiting over 78 weeks, cutting the further 349 off the total, to hit 50,539 in September. The total has been coming down since it peaked at nearly 124,000 in September 2021.

But the rate of progress has significantly slowed in the last few months. The reduction of 349 between August and September followed a reduction of 950 between August and July, over 2,000 between July and June, and over 5,000 between June and May.

The number of year-long breaches also continues to rise, up by nearly 15,000 month-on-month to pass the 400,000 mark in September. Pre-pandemic, just 1,600 patients had waited over a year for treatment, and that was considered a poor position.

The overall list rose a fraction further, up by nearly 77,000 to 7.1 million.

Average Cat 2 ambulance waits breach hour mark again and hit new low

Meanwhile, ambulance response times for category two patients, which have an 18-minute target, also reached a new low point in October.

The average response time was 1:01:29, with one in 10 calls taking more than 2:16:11 for an ambulance to reach the patient.

East of England Ambulance Service Trust took an average of 1hr 26mins 54secs to reach category two patients, with one in 10 taking more than 3:13:50 to reach. The trust had declared a major incident in early October due to “extreme pressure”, with lengthy handover delays at some hospitals. Average category one call times hit 10 minutes against the 7 minutes target.

NHSE medical director Sir Stephen Powis said the NHS was now facing “a tripledemic of covid, flu and record pressure on emergency services”.

Professor Powis added: “Pressure on emergency services remains high as a result of more than 13,000 beds taken up each day by people who no longer need to be in hospital.”

He also warned: “We have always said the overall waiting list would rise as more patients come forward, and with pressures on staff set to increase over the winter months, the NHS has a plan – including a new falls service, 24/7 war rooms and extra beds and call handlers.”