Revealed: The trusts where A&E has slipped most

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Major A&E performance drops 29 percentage points in two years at one London trust
Seventeen trusts recorded 10 point dips between January 2017 and January 2019
Ten trusts recorded 10 point improvements over the same period

Waiting time performance for major emergency admissions at one London trust has deteriorated by 29 percentage points in the last two years, HSJ can reveal.

HSJ’s analysis of official accident and emergency performance data found 17 trusts reported a deterioration of 10 percentage points or more on their type 1 four-hour performance between January 2017 and January 2019 (See table 1: The biggest sliders).

Croydon Health Services Trust’s 29 percentage point slide was the largest drop. The trust reported 49.1 per cent type 1 performance in January – the worst in the NHS, and 27 points behind the 76.1 per cent average.

The next three biggest drops over the two year period were reported at United Lincolnshire Hospitals Trust (20.2 percentage points), Plymouth Hospitals Trust (19.8), and Barking, Havering and Redbridge University Hospitals Trust (19.1).

Conversely, a number of trusts made huge improvements over the last two years – a significant achievement given the system’s overall declining performance and increasing demand and acuity.

Ten trusts reported 10 percentage point improvements on their performance. Aintree University Hospital FT recorded a 19.4 point increase, while Weston Area Health Trust (18.7), which has closed its A&E at night, and London North West Healthcare Trust (16.4) were not far behind (See table 2: Ten of the most improved).

Every trusts’ performance is included in the spreadsheet attached (See below).

HSJ’s exclusive analysis follows national data last week revealing the NHS hit a record low in January on both the overall A&E performance and for the type 1 category for major emergency admissions, despite a comparatively stable November and December.

A&E performance was 84.4 per cent compared to 85.1 per cent in January 2017, and 85.3 per cent last January. Type 1 performance fell from 77.6 per cent in January 2017, to 77.2 per cent in January 2018 to 76.1 per cent last month.

There was also a large drop between January 2019 and December 2018, with Type 1 data dipping around three percentage points month-on-month from 79.3 per cent reported in December to 76.1 per cent.

Some of the shifts may reflect changes to recording practice over this period, including in the separation between Type 1 and Type 3 activity, which has been a focus of attention in recent years.

Table 1: The biggest sliders

Name	Type 1 Jan 2017	Type 1 Jan 2019	Jan 2017 v Jan 2019	Type 1 Dec 2018	Dec 18 v Jan 19
Croydon Health Services Trust	78.3%	49.2%	-29.1%	51.6%	-2.4%
United Lincolnshire Hospitals Trust	75.7%	55.5%	-20.2%	59.7%	-4.2%
Plymouth Hospitals Trust	78.9%	59.1%	-19.8%	77.4%	-18.4%
Barking, Havering And Redbridge University Hospitals Trust	74.3%	55.2%	-19.1%	67.3%	-12.1%
Wrightington, Wigan And Leigh FT	76.6%	60.2%	-16.4%	75.3%	-15.1%
Torbay And South Devon NHS FT	81.4%	66.1%	-15.3%	82.5%	-16.4%
Lancashire Teaching Hospitals Trust	72.7%	57.8%	-14.9%	57.9%	-0.1%
Nottingham University Hospitals Trust	75.2%	60.9%	-14.3%	55.3%	5.6%
Norfolk And Norwich University Hospitals FT	74.2%	60.6%	-13.6%	69.6%	-9.0%
Bradford Teaching Hospitals FT	86.8%	73.3%	-13.4%	75.5%	-2.2%
Warrington And Halton Hospitals FT	78.3%	64.9%	-13.4%	67.0%	-2.1%
University Hospitals Birmingham FT	73.2%	60.9%	-12.3%	71.0%	-10.2%
Wirral University Teaching Hospital FT	74.3%	62.3%	-11.9%	63.6%	-1.2%
The Queen Elizabeth Hospital, King’s Lynn FT	86.3%	74.9%	-11.4%	84.0%	-9.1%
Blackpool Teaching Hospitals NHS FT	63.2%	52.5%	-10.7%	64.4%	-12.0%
The Dudley Group FT	77.9%	67.2%	-10.7%	68.7%	-1.6%
Northern Devon Healthcare Trust	88.2%	78.5%	-9.7%	81.4%	-2.8%

HSJ’s analysis focuses on type 1 A&Es as they are broadly seen as a more reliable indicator of how well a hospital is performing than the overall figure which includes a significant number of minor ailments.

Ten trusts reported a 10 percentage point drop between December 2018 and January, with Plymouth Hospitals NHS Trust (19.8), Torbay and South Devon FT (16.4) and Wrightington, Wigan and Leigh FT (15) all reporting at least a 15 point drop (See attached spreadsheet for further details on all trusts’ performance month-on-month).

Table 2: Ten of the most improved

Name	Type 1 Jan 2017	Type 1 Jan 2019	Jan 2017 v Jan 2019	December 2018	Dec 18 v Jan 19
Aintree University Hospital FT	58.2%	77.7%	19.4%	76.5%	1.2%
Weston Area Health Trust	63.9%	82.6%	18.7%	77.3%	5.3%
London North West Healthcare Trust	50.7%	67.1%	16.4%	77.1%	-10.1%
Maidstone And Tunbridge Wells Trust	72.7%	86.7%	14.0%	87.5%	-0.8%
East Sussex Healthcare Trust	73.4%	84.0%	10.6%	89.9%	-5.9%
Chelsea And Westminster Hospital FT	81.4%	92.0%	10.6%	93.2%	-1.2%
The Rotherham NHS Foundation Trust	70.1%	80.6%	10.5%	84.3%	-3.7%
Dartford And Gravesham NHS Trust	73.0%	83.1%	10.1%	78.4%	4.7%
Gloucestershire Hospitals NHS Foundation Trust	74.6%	84.5%	9.9%	87.5%	-3.1%
East Kent Hospitals University NHS Foundation Trust	58.8%	68.6%	9.8%	75.2%	-6.6%

Croydon has faced significant demand increases, with its type 1 attendances up by “close to 1,000 more” between January 2017 and 2019, causing average length of stay to rise and huge capacity pressures.

Chief operating officer Lee McPhail added: “Our bed occupancy, which has run above 99 per cent for most days this winter, and has made it very challenging to improve our four-hour performance despite the very best efforts of our staff who are working extremely hard and well to provide timely and high-quality care.”

The trust has also opened a new £21m emergency department in December 2018 and is working with the NHS Improvement’s emergency care team on a range of improvement measures.

NHS Providers welcomed HSJ’s analysis and said it was a “useful” benchmark of where performance has changed significantly, both in terms of where there have been sharp rises in demand and deteriorating performance, but also where major improvements have been made.

NHS Providers director of policy and strategy, Miriam Deakin said: “It is hard to explain exactly what caused such a big drop in A&E performance between December and January.

“But when viewed over the last two years, it would appear to represent the extension of the trends we have long warned about: rising demand and the acuity with which patients present, much of which is driven by a growing number of older people presenting with increasing complex conditions.

“As ever A&E performance is a barometer for the health and care system as a whole and these figures highlight the need for sufficient investment in services which keep people well in the community and prevent them presenting at A&E in crisis or once their conditions have deteriorated, as well as in accident and emergency care.”

Updated at 11.57am on Thursday to point out that changes in recording approaches, such as between Type 3 and Type 1 activity, may have played a role in some of the shifts.