Two-year breaches rise by 15pc to record high

The NHS England data laid bare the immense stress on the system overall. A record number of category 1 ambulance calls were dealt with, 12-hour-after-decision-to-admit breaches in A&Es rose again and the number of medically fit for discharge patients in hospitals also jumped significantly.

The substantial rise in two-year waiters revealed in this morning’s official monthly performance data is of particular significance because NHS England last year pledged to eliminate 104-week breaches by March. NHSE bosses have privately accepted it won’t meet this ambition.

In more positive news, the overall list size appeared to stabilise with the overall number only nudging up slightly from 5,975,216 patients in October to 5,995,156 in November - more than one-in-10 of England’s population.

The number of 52-week breaches also remained stable – falling from 312,665 in October to 306,996 in November.

This stabilisation appears to have been driven by an increase in non-admitted clock stops. However, what is not clear is whether the NHS is genuinely carrying out more outpatient activity or if the increase is being driven by cases being removed from lists as part of validation exercises.

Planning guidance drives focus on clock stops

Leading waiting expert Rob Findlay told HSJ: “The data suggests that the stabilisation is due to non-admitted clock stops running at a higher level, roughly halving the gap between the recent rate and pre-covid.

“What we can’t tell from the published data is how many of these non-admitted clock stops reflect discharges following an outpatient appointment, and how many reflect patient pathways being removed administratively from waiting lists following validation to check the data quality. Both types of clock stop were incentivised equally by the planning guidance.

“Improving data quality is important, but when it is done as a one-off validation exercise rather than as a continuous process, it can obscure what is really happening for patients on the waiting list.”

The five trusts recording the most two-year breaches as a proportion of their overall referral to treatment list size were Norfolk and Norwich University Hospital Foundation Trust, University Hospitals of Leicester, Lancashire Teaching Hospitals FT, Countess of Chester Hospital FT and Manchester University FT (see table below).

Discharge woes show no signs of easing

Meanwhile the weekly winter sitrep data, also published this morning, underlined the NHS’s struggles with discharging patients from hospital and widespread staffing shortages.

The number of patients who were medically fit to be discharged from hospital but could not leave, largely due to lack of social care capacity, rose by almost 2,000 from an average of 9,857 in week of 27 December to 11,794 in the latest week.

They now make up 13.6 per cent of adult patients, excluding maternity, in NHS acute trusts, up from 12 per cent in the week before.

Today’s weekly performance also underlined the “substantial and damaging levels of staff absences,” according to Nuffield Trust deputy director of research Sarah Scobie. There were on average over 88,500 staff absent every day across NHS hospitals in the week ending 9 January, an increase of 10 per cent from the previous week.

She added: “The system is running on a depleted and exhausted workforce and does not have the flex to make meaningful progress on clearing the backlog or reducing waits across urgent care services with so many demands placed on it.”

NHSE national medical director Stephen Powis said: “Once again, NHS staff pulled out all the stops to keep services going for patients – there have been record numbers of life-threatening ambulance call outs, we have vaccinated thousands of people each day and that is on top of delivering routine care and continuing to recover the backlog.”

“But staff aren’t machines and with the number of covid absences almost doubling over the last fortnight and frontline NHS colleagues determined to get back to providing even more routine treatments, it is vital that the public plays their part to help the NHS by getting your booster vaccine, if you haven’t already.”

The monthly performance data going to the end of November also showed record low performances in key cancer wait metrics.

The proportion of patients waiting more than two months for treatment following an urgent GP referral was 67.5 per cent, against a target of 85 per cent.

Two week wait performance from GP urgent referral to first consultant appointment was 77 per cent against the 93 per cent national target, with activity up nearly 20 per cent on November 2020 and November 2019.

The proportion of trusts’ incomplete referral to treatment pathways which have breached two years

Source: NHS England November RTT performance data