• Five hospital trusts see less than 50 per cent of patients in their consultant-led A&E departments within four hours
  • Dramatic slide in type one A&E performance from last winter
  • Two trusts in London, two in Lancashire and Isle of Wight Trust lead decline

An unprecedented five trusts saw less than half of their accident and emergency attendances within four hours in December, HSJ analysis reveals.

The statistics for performance against the 95 per cent target, released yesterday, show two trusts in Lancashire, two in London and one serving the Isle of Wight with a score below 50 per cent. No trusts went under the 50 per cent mark in December 2018.

Type one performance, which measures the performance of consultant-led units, was 68.6 per cent nationally, compared to 79.8 per cent for all types of A&E and urgent care unit.

The overall type one performance has fallen 10.7 percentage points since December 2018.

Lancashire Teaching Hospitals Foundation Trust saw the lowest performance last month, at 43.4 per cent. The multisite trust and Barking, Havering and Redbridge University Hospitals Trust were below 50 per cent for the whole of the third quarter in 2019-20. No trust recorded a performance below 6 per cent for the same period in 2018-19.

NamePercentage in 4 hours or less (type-1) - 2019Percentage in 4 hours or less (type-1) - 2018
England 68.6% 79.3%
Lancashire Teaching Hospitals Foundation Trust 43.4% 57.9%
Blackpool Teaching Hospitals Foundation Trust 44.2% 64.2%
Barking, Havering And Redbridge University Hospitals Trust 44.6% 67.3%
Isle of Wight Trust 48.0% 77.8%
Croydon Health Services Trust 48.2% 51.6%

The five trusts had a total attendance of 37,265 in their type-one units in December 2019.

Twenty trusts had a performance in the 50s in December 2019, and they saw 232,000 attendances.

In April last year HSJ reported that two hospital trusts had fallen beneath the 50 per cent mark on type-one performance for the first time – Hillingdon Hospitals FT in west London and Blackpool were the first to do so.

Isle of Wight Trust saw the biggest year-on-year slide in the country, down from 77.8 per cent in December 2018 to 48 per cent last month.

Health Education England and the General Medical Council last month threatened to withdraw trainees from the trust if it did not “urgently” recruit more senior staff.

Barking’s chief operating officer Shelagh Smith said the trust was under “extreme pressure”.

She said: “As well as seeing a high volume of patients in our emergency departments, the patients coming to us are sicker and require more intensive treatment, which can take longer.

“To help meet the demand we have introduced a frailty unit, bringing together specialist teams in one place to care for our older, frail patients, and get them home again as quickly as possible. We’ve also opened 28 additional beds.”

Lancashire and South Cumbria Integrated Care System said in a statement winter was “an especially busy time for hospitals across the country” but offered no explanation for the decline of the two trusts’ performance.

Lancashire Teaching Hospitals’ chief executive Karen Partington said in a statement: “We are looking after more acutely unwell patients than usual, and despite our best efforts there are inevitably delays when we are exceptionally busy, which we know is not ideal.”

The London regional director’s office said flu “had come early and around twice as high as this time last year”.

A spokeswoman said: “[Last month] London A&Es treated over 25,000 more patients compared to December 2018.”

Kevin McGee, the chief executive of Blackpool Teaching Hospitals, said: ”One of the challenges we face is having a suitable place to discharge a patient to and this can sometimes cause a lack of flow throughout the hospital.”