• Blackpool and Hillingdon’s type one performance sinks under 50 per cent
  • Performance sees rare deterioration from February to March
  • System also records worst ever quarter after “beast from the east” winter
  • Delayed discharges performance improves year on year

NHS performance against the four hour accident and emergency target hit its lowest level in 15 years in March, with two trusts sinking below 50 per cent.

Long term A&E strugglers Blackpool Teaching Hospitals and Hillingdon Hospitals foundation trusts both recorded performance under 50 per cent for major “type one” emergency attendances last month (see second table).

NHS England’s data, released this morning, revealed that unusually, performance deteriorated from February to March. The NHS’s overall figure was 84.6 per cent – a small drop from the previous low of 85 per cent recorded in February. In March 2017, performance overall was 90 per cent.

Figures showed the A&E deterioration was matched in other areas including planned operations. The number of patients waiting over a year for treatment went over 2,000 for the first time since August 2012.

Just three non-specialist acute providers hit the 95 per cent A&E target in March: Luton and Dunstable University Hospital FT; North Tees and Hartlepool FT; and Dorset County Hospital FT.

The system’s four hour performance slumped to its lowest level, both in overall performance, which includes urgent care attendances, and for type one emergency attendances.

Data for the fourth quarter, covering January to March, also hit a new low. Overall performance was 85 per cent compared to 87.6 for the corresponding quarter in 2016-17.

Overall quarter four performance from 2004-05 to 2017-18

QuarterPercentage of patients seen in four hours or less (type one)Percentage of patients seen in four hours or less (all)
Q4: 2004-05 96.4% 97.3%
Q4: 2005-06 96.6% 97.5%
Q4: 2006-07 96.8% 97.7%
Q4: 2007-08 96.5% 97.5%
Q4: 2008-09 96.8% 97.7%
Q4: 2009-10 96.9% 97.9%
Q4: 2010-11 94.8% 96.6%
Q4: 2011-12 93.7% 95.8%
Q4: 2012-13 91.1% 94.1%
Q4: 2013-14 92.7% 95.2%
Q4: 2014-15 87.5% 91.8%
Q4: 2015-16 81.8% 87.9%
Q4: 2016-17 81.4% 87.6%
Q4: 2017-18 76.8% 85.0%

The additional pressure on the system was underlined by the 3.3 per cent rise in emergency admissions compared with March 2017, while 31,000 more patients turned up at A&E compared to the same month last year.

One area that did deliver some positive news was delayed transfers of care. NHS England’s data release said: “There were 139,900 total delayed days in February 2018, of which 92,100 were in acute care. This is a decrease from February 2017, where there were 186,500 total delayed days, of which 124,600 were in acute care.”

Nuffield Trust chief executive Nigel Edwards said: “The number of days that patients were delayed in hospital, despite being ready to leave, has dropped by 25 per cent compared to this time last year – an impressive achievement in the current environment.

“But even with these steps, 76,054 people waited for longer than four hours on trolleys for admission to hospital in March, only five major A&E departments [including specialist trusts] met the four-hour A&E target, and overall performance against the four hour target dropped to the lowest levels seen in 15 years.

“The NHS simply cannot go on like this. Running a health system so close to capacity is highly risky and doing so endangers patient safety, as well as staff wellbeing.”

An NHS England spokesman said: “As expected, these figures for a month ago confirm what was widely reported at the time, namely that during March the NHS continued to experience severe winter pressures.”

The worst 20 trusts for type one performance in March 2018

TrustPercentage of patients seen in four hours or less (type one)Percentage seen in four hours or less (all)Number of patients spending more than 12 hours from decision to admit to admission
Blackpool Teaching Hospitals FT 48.3% 81.9% 62
The Hillingdon Hospitals FT 48.7% 77.6% 11
Lancashire Teaching Hospitals FT 53.3% 73.3% 7
Worcestershire Acute Hospitals FT 56.8% 71.3% 75
Wrightington, Wigan and Leigh FT 60.2% 63.7% 0
Norfolk and Norwich University Hospitals FT 60.4% 67.5% 0
Shrewsbury and Telford Hospital Trust 60.9% 67.2% 5
East Lancashire Hospitals Trust 61.0% 78.9% 23
Stockport FT 61.0% 65.3% 78
Nottingham University Hospitals  Trust 61.5% 72.0% 1
King’s College Hospital FT 61.8% 71.2% 26
Imperial College Healthcare Trust 61.9% 83.2% 8
Aintree University Hospital FT 62.2% 81.6% 0
United Lincolnshire Hospitals Trust 62.2% 65.2% 0
Walsall Healthcare Trust 62.6% 74.8% 0
Wirral University Teaching Hospital FT 63.2% 74.4% 0
Portsmouth Hospitals Trust 63.5% 71.0% 11
London North West University Healthcare Trust 64.0% 83.9% 0
Royal Liverpool and Broadgreen University Hospitals Trust 64.5% 86.0% 0
The Princess Alexandra Hospital  Trust 64.5% 64.5% 88

NHS Improvement chief executive Ian Dalton said: “These statistics highlight the mammoth pressures facing the NHS this winter, which have continued into March. Nobody working in the NHS will be happy with the effect this has had on how quickly we have seen and treated patients.

“It is thanks to the tireless work of staff that the NHS has coped. They have worked flat out to care for patients in the face of rising demand, record flu levels and bad weather. They have overseen a 5 per cent reduction in the number of patients facing delays to leave hospital compared to last year and they have done this while facing the highest number of emergency admissions seen since records began – 15,000 more patients admitted as emergencies this March compared to last year.

“April tends to mark the point where pressures on the NHS starts to decrease, but we cannot be complacent. Hospitals must work alongside GPs and other local community health services to plan for continued increased demand.”