• Trusts miss Next Steps aim to hit 90 per cent for A&E four hour target by September
  • Senior clinicians raise concerns about non-urgent waiting list
  • NHS bosses have called for funding boost in next month’s budget

Trusts have fallen short of NHS England’s first milestone towards hitting the national emergency performance waiting time target, official figures reveal today.

Accident and emergency attendees in September were seen within four hours 89.7 per cent of the time – down from 90.3 per cent in August and 90.6 per cent a year earlier, NHS England data shows.

The monthly data is significant because NHS England pledged in March that 90 per cent of A&E attendees would be seen within four hours by September, and then 95 per cent in 2018.

The results will fuel concerns about the NHS’s prospects for this winter. It follows NHS England chief executive Simon Stevens telling MPs this week more funding will be needed from next month’s budget.

The A&E waiting times target has not been hit since July 2015. The performance of the NHS’s major A&E units (type one) remained in the mid-80s – 84.6 per cent in September, against 86 per cent for September 2016.

Eleven trusts recorded performance at 80 per cent or below, while 34 trusts recorded performance below 85 per cent (see first table). The top performer was Luton and Dunstable University Hospital Foundation Trust with 98.5 per cent (see second table)

The news follows the coordinated departures of two hospital chief executives last month, which HSJ understands was designed to be a clear warning from the centre that poor performance against the key target will not be tolerated. It also follows chief executives being asked at a nationally convened meeting about the need to improve emergency performance to chant “we can do this” – a move which was ridiculed by local leaders.

NHS England pledged in the Next Steps for the Five Year Forward View in March that most trusts would be fully compliant at 95 per cent by March 2018, and the whole system would be by the end of 2018. As part of this process, it said trusts would be at 90 per cent by last month.

The goal has always been viewed as highly ambitious. Last winter performance, deteriorated to its lowest level since the four hour data collections began in 2004. Overall performance slumped to 85 per cent overall and 78 per cent for type one A&Es in January.

System leaders have become increasingly concerned about poor performance on emergency care becoming “normalised” at a rump of between 20 and 25 poor performing trusts.

East Kent Hospitals University FT’ Mathew Kershaw and North Middlesex University Hospital Trust’s Elizabeth McManus both resigned voluntarily last month. However, HSJ understands there was pressure from ministers and NHS Improvement over their trusts’ A&E performance.

East Kent’s performance slumped from 77 per cent in June to 70 per cent in July. Its performance remained at 70 per cent in August. North Middlesex had an average A&E performance of 81.6 per cent for the first five months of 2017-18.

Commenting on the 18 week waiting times data, Royal College of Surgeons president Derek Alderson raised concerns that performance was going in the wrong direction and called for fresh funding in the budget.

He said: “Our concern is now that waiting times are starting to go in the wrong direction…We’ve not met the 92 per cent target for a year and half now.

“As Simon Stevens told the health committee this week, more money is needed in this November’s budget if we are to meet current demand in the health service. In the shorter term we need a clearer focus on protecting beds in hospital, and reducing delayed transfers of care, in order to enable patients to have their operations. As things stand, the NHS is not well prepared going into this winter to prevent mass cancellations of operations.”

Trusts where A&E performance was below 85 per cent in September

Name Percentage in four hours or less (type one) Percentage in four hours or less (all)
The Princess Alexandra Hospital Trust 70.3% 70.3%
East Kent Hospitals University Foundation Trust 62.3% 70.5%
University Hospitals of North Midlands Trust 65.8% 76.5%
United Lincolnshire Hospitals Trust 76.7% 76.7%
Portsmouth Hospitals Trust 70.0% 77.0%
Shrewsbury and Telford Hospital Trust 77.6% 77.6%
University Hospitals Coventry and Warwickshire Trust 70.8% 78.6%
Stockport Foundation Trust 79.7% 79.7%
North Bristol Trust 80.0% 80.0%
Wye Valley Trust 78.3% 80.0%
Heart of England Foundation Trust 76.4% 80.0%
Royal United Hospitals Bath Foundation Trust 78.3% 80.9%
London North West Healthcare Trust 57.0% 81.4%
West Hertfordshire Hospitals Trust 72.4% 81.6%
The Rotherham Foundation Trust 81.8% 81.8%
Walsall Healthcare Trust 71.9% 81.8%
Worcestershire Acute Hospitals Trust 72.3% 82.2%
University Hospitals Birmingham Foundation Trust 82.6% 82.6%
Nottingham University Hospitals Trust 80.8% 82.7%
Norfolk and Norwich University Hospitals Foundation Trust 78.5% 82.7%
Oxford University Hospitals Foundation Trust 80.3% 82.8%
York Teaching Hospital Foundation Trust 70.9% 83.1%
North West Anglia Foundation Trust 82.2% 83.3%
Medway Foundation Trust 83.8% 83.8%
Blackpool Teaching Hospitals Foundation Trust 62.5% 83.9%
University Hospitals of Leicester NHS Trust 82.6% 84.0%
East Cheshire Trust 83.5% 84.0%
Lancashire Teaching Hospitals Foundation Trust 68.3% 84.1%
Brighton and Sussex University Hospitals Trust 82.9% 84.3%
Royal Free London Foundation Trust 81.7% 84.3%
Kettering General Hospital Foundation Trust 84.4% 84.4%
Aintree University Hospital Foundation Trust 70.4% 84.5%
Bolton Foundation Trust 82.9% 84.5%
Pennine Acute Hospitals Trust 83.2% 85.0%

Top 10 acute providers on four hour waiting time performance (95 per cent target)

NamePercentage in four hours or less (type one)Percentage in four hours or less (all)
Luton and Dunstable University Hospital Foundation Trust 97.8% 98.5%
Yeovil District Hospital Foundation Trust 97.7% 97.7%
South Tees Hospitals Foundation Trust 96.8% 97.3%
South Tyneside Foundation Trust 96.6% 97.0%
North Tees and Hartlepool Foundation Trust 89.6% 96.9%
County Durham and Darlington Foundation Trust 95.0% 96.8%
Homerton University Hospital Foundation Trust 95.6% 95.6%
Royal Surrey County Hospital Foundation Trust 95.6% 95.6%
Western Sussex Hospitals Foundation Trust 94.6% 95.4%
Northumbria Healthcare Foundation Trust 91.1% 95.4%