• Waiting list likely to have breached 4 million in June for first time in a decade
  • NHS Providers say DTOCs performance “particularly worrying” and calls for more cash
  • Clinicians warn concerning summer performance data is a “wake up call”

Pressure is mounting on NHS bosses to intervene ahead of winter, as official data suggests the system failed to make headway against key performance measures in the first quarter of 2017-18.

NHS Providers repeated its call for up to an additional £350m of funding to be given to trusts ahead of winter, while senior clinicians said the fact that the waiting list likely breached 4 million patients for the first time in a decade in June must be a “wake up call”.

Official performance figures published today showed:

NHS Improvement attributed the stuttering performance to “high levels of bed occupancy”, driven in part by the lack of progress on delayed discharges, despite significant efforts by system leaders and the Treasury to address the issue.

The NHS mandate, published in March, set a target to cut NHS related delayed days to 3.5 per cent of the NHS bed base by September. NHS Providers estimated the figure stood at 5.6 per cent at the end of March.

NHS Providers also said the latest performance figures showed the system was at “full stretch” even in the middle of summer and the “urgent need” for additional capacity. The organisation said performance on delayed discharges was “particularly worrying”.

Analysis and research manager Deborah Gulliver told HSJ there had been some progress in bringing delayed transfers of care down between March and April but this had stalled.

She added: “The overall trend indicates there is not much seasonal variation in DTOCs performance, so the drop between March and April is likely to be genuine. But the data suggests trusts were unable to sustain this, and performance has plateaued.

“We will only be able to determine how the system is performing against the mandate target to cut delayed days to 3.5 per cent of the NHS bed base when overall bed numbers are published later this month.

“But, the data suggests not enough progress is being made on this, as NHS Providers has warned in recent months. NHS Providers has called for an additional £350m to help support trusts ahead of winter, but they will only be able to use this funding optimally if they get it now.”

Ministers allocated an extra £2bn to councils to support adult social care services, and in part to tackle DTOCs, in March. NHS England said the cash could help release between 2,000 and 3,000 beds if used optimally.

Delayed discharges performance compared

Time periodDelayed daysDTOC beds*

2016-17 Q1

April 2016



May 2016



June 2016



2016-17 Q4

January 2017



February 2017



March 2017



2017-18 Q1

April 2017



May 2017



June 2017



Source: Official NHS England data published August 2017. The DTOC beds figure is calculated by dividing the number of delayed days during the month by the number of calendar days in the month.

The growing waiting list provoked concerns from senior clinicians. The number of patients waiting to start treatment at the end of June was 3.83 million, but NHS England admitted that “factoring in estimates based on the latest data submitted for each missing trust suggests the total number… may have been just over 4 million patients”.

Royal College of Surgeons president Professor Derek Alderson said: “These statistics should act as wake up call. This is the real life impact of an NHS under severe pressure. As our population increases and demand for the NHS grows, the waiting list will likely only get worse unless more action is taken.

“Bed space available for surgery continues to be under significant pressure and is a key reason why waiting lists are lengthening. NHS England recently set the NHS a target of reducing bed occupancy down to 92 per cent.”

An NHS Improvement spokeswoman said: “We need to make sure there are sufficient beds available over the next few months and we are calling on the NHS and local authorities to work together to tackle delayed discharges, so that patients can continue to rely on safe, high quality care over the busy winter period.

“High levels of bed occupancy are also making it hard for hospitals to see patients who require planned care. The growing waiting list for NHS treatment highlights these pressures and we are working with providers to increase efficiency and productivity and ensure that patients receive the treatment they need as quickly as possible.”