Revealed: The trusts where A&E has slipped most

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.

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).

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.