A&E performance in the capital

Accident and emergency performance declined more dramatically in London during the first quarter of this year than it did anywhere else in the country – and it declined pretty rapidly in the rest of England in that period.

Quarter one is supposed to be one of the easier periods of the year for A&E departments. Not this year.

Nationally, performance fell from close to target with 94.1 per cent of patients admitted or discharged within four hours a year ago, to being some way off at 90.3 per cent this year.

London started from a lower base: in Q1 2015-16 performance stood at 93.2 per cent, but it fell further, to 88.5 per cent (all these figures are from an analysis of the nationally reported data and London Eye is referring to trust performance for all types of attendance and treatment, not the more stringent type 1 attendances).

First, congratulations to south west London, which as a sector largely bucked the downward trend.

Kingston Hospital Foundation Trust and Croydon Health Services Trust improved their performance against the four hour target year-on-year, something not many trusts achieved. And neither did it from a particularly low starting point.

It’s a particular achievement for Croydon, which has had a difficult reputation in A&E over the years and had struggled to recruit emergency consultants.

St George’s University Hospitals Foundation Trust, which has had its share of problems in other areas, maintained its performance year on year.

The Tooting trauma centre’s 92.5 per cent was still below the national target but considering the national downward trend and a 3.3 per cent growth in attendances, credit is due.

But overall the picture is poor.

The number of patients breaching the target at London’s 18 type one A&E trusts nearly doubled year on year, going from 62,000 to 116,000.

These extra 54,000 breaches are not evenly distributed across the capital.

Five trusts are responsible for 31,000 of the increase in breaches.

Two of them are where you might expect – large, multi-site trusts: Barts Health Trust and King’s College Hospitals Foundation Trust.

Number one contributor is North Middlesex University Hospital Trust, whose problems with A&E have been covered in this column and elsewhere.

Lewisham and Greenwich Trust are also a large provider (having taken over an A&E in Woolwich from the former South London Healthcare Trust) but the numbers show they now contribute a disproportionate number of breaches to the capital’s total, where the opposite was true for quarter one 2015-16.

Sad to report, Barking, Havering and Redbridge University Hospitals Trust saw a significant year-on-year decline in quarter one.

Considering its long held and healthcare economy wide issues in A&E (among others) its performance of 93.4 per cent in quarter one last year was encouraging.

Its decline to just 81.8 per cent in the same period this year is one of the steepest in the country and sad for a health economy that everyone would have liked to have seen turned around for good.