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NHS Performance Tracker

NHS Performance Tracker

Tracking the performance of the NHS in England, Scotland, Wales & Northern Ireland.

The NHS service across the four nations of the UK regularly publish important datasets relating to the performance of the urgent and emergency care system. The Royal College of Emergency Medicine  analyses this data which is used to inform our policy and campaigns work.

NHS Performance Tracker

Type 1 ED Attendances

Since May 2021, attendances have remained consistent with pre-COVID attendances. Although there have been fluctuations in demand, attendances have remained relatively stable and consistent with pre-COVID-19 levels.

The Four-Hour Standard

The four-hour standard is an operational standard pledged in the NHS constitution that 95% of patients should be admitted, transferred, or discharged from an ED within four hours. It is an indicator of patient outcomes and safety, and accountability. The standard has not been met in England since June 2013. In December 2022, the UK Government announced a threshold target of 76% to be hit in England by March 2024. Scotland last met the standard in June 2020; before this Scotland hadn’t met the target since July 2017. Since records began, Wales and Northern Ireland have not met the standard.

12- Hour Waits from Time of Arrival

Data from each UK nation on 12-hour waits from the patient’s time of arrival shows that more patients than ever before are experiencing extremely long waits in our EDs. In England, the NHS requirement is that no more than 2% of patients should wait 12 hours or more from their time of arrival. This pledge has not been met in England since April 2021.

Devolved Performance Figures

+ England

England

Analysis of October’s NHS England performance figures can be found below.

In summary, October 2023 witnessed an increase in both the number of patients attending Type 1 Emergency Departments and patients subsequently admitted into hospital. Performance against the four-hour target for October hit record lows so far in 2023. On the aggregate four-hour target is 5.8 percentage points below the Government’s intermediary threshold target of 76% to be hit by March 2024.

October saw the greatest number of patients waiting 12-hours or more for any month so far this year, with more than 1 in 10 patients who attended A&E waited this long. There were 2,675 less Type 1 G&A beds available than January 2022, when 5000 new beds were promised. Bed occupancy stood at 94.1%, nearly 10 percentage points more than the recommended safe levels. A daily average of 12,493 patients remained in hospital despite no longer meetings the criteria to reside.

Supplementary ECDS Analysis September 2023 final (12-hour length of stay data measured from the time of arrival) data show:

  • In October 2023, 152,115 patients waited 12-hours or more from their time of arrival.
  • This is the greatest number of patients waiting 12-hours or more so far in 2023 and accounts for 10.7% of all Type 1 Emergency Department attendances in October.
  • This is an increase of 22.8% from September 2023 (123,870) and a 10.1% decrease from October 2022 (169,234).
  • The number waiting more than 12-hours has increased by more than six times (525%) since October 2018 (24,342). This despite attendances only increasing by 1.07 times (7%) in the same period.

The latest Emergency Department performance figures published by NHS England for October 2023 for show:

  • There were 1,413,560 attendances, a 3.3% increase since September (1,369,045). This represents the highest level of attendance for Type 1 Emergency Departments so far in 2023.
  • There were 401,523 emergency admissions via Type 1 Emergency Departments, a 4.8% increase since the previous month (383,225). This is the highest number of admissions in 2023 and the third highest number of admissions since 2021.
  • 28.4% of Type 1 attendances were admitted into hospital – despite the increase in numbers of patients admitted to hospital, the proportion of admissions has only increased by 0.4 percentage points since September 2023.
  • The four-hour target for Type 1 Emergency Departments stood at 55.9%, the lowest so far in 2023. There was a 1.7 percentage point decrease since September 2023 (57.6%) and a 2.1 percentage point decrease since January 2023 (58.0%)
  • The aggregate four-hour target stood at 70.2%, the lowest so far in 2023. This is 5.8 percentage points lower than the Government’s intermediary threshold target of 76% to be hit by March 2024.
  • There is a 14.3 percentage point difference between aggregate and type 1 four-hour performance.
  • The number of patients waiting 12 hours or more from the decision made to admit them stood at 44,655, a 34.9% increase since the previous month (33,107).

Beds data for October 2023 show:

  • There were 97,371 type 1 G&A beds available.
    • This is an increase of 39 beds from September 2023 (97,332). And an increase of 84 beds from October 2022 (97,287).
  • Since it was announced in January 2023 that 5000 new beds would be made available by winter, there has been a decrease of 2,675 beds (down from 100,046 in January).
  • Bed occupancy stood at 94.1%.
    • A one percentage point increase from last month. And a 0.2 percentage point decrease from October 2022.
    • This is the second highest Type 1 bed occupancy rate for any October since recording began.

Delayed Discharge data for October 2023 show:

  • A daily average of 12,493 patients remained in hospital despite no longer meeting the criteria to reside.
    • This is an increase of 121 patients compared to September 2023, but a decrease of 1120 compared with October 2022.
+ Scotland

Scotland

Performance data for Scotland, September 2023:

This was the second worst September on record for four-, eight- and 12- hour performance. 33.5% of patients waited more than four-hours or more, 10.4% waited eight-hours or more, and 3.7% waited more than 12-hours in an ED. Winter 2024/25 is on track to be the second worst on record.

We are well below pre-pandemic performance levels. Since September 2019, the numbers waiting more than four hours increased by 2.5 times, the numbers waiting more than eight hours increased by 8 times, and the numbers waiting more than 12 hours increased by 14 times. This is despite attendance decreasing by 6.9%.

It is important to note that the pandemic is not the only reason for poor performance, as evidenced from historical analysis, performance was already significantly decreasing in the years leading up to the pandemic.

In September 2023, there were 113,864 attendances at major Emergency Departments in Scotland.

  • 66.50 % of patients were seen within four-hours at major (Type 1) Emergency Departments.
    • This is a decrease of 1.4 percentage points from the previous month.
    • 38,114 (33.5%) patients waited over four-hours in major Emergency Departments, this is a 1.7% increase from the previous month and a 2.3% decrease from September 2022.
    • The number waiting more than four-hours has increased by 145.5% compared with September 2019 (15,526).
  • 11,788 (10.4%) patients waited eight-hours or more in an Emergency Department
    • This is an increase of 1.1 percentage points from the previous month. And a 1.5 percentage point decrease compared with September 2022.
    • The number waiting more than eight-hours has increased by more than eight times (701%) compared with September 2019 (1471).
  • 4263 (3.7%) patients waited more than 12-hours before being seen, admitted, discharged, or transferred
    • This figure has increased by 0.4 percentage points from the previous month. And has decreased by 1 percentage point compared with September 2022.
    • The number waiting more than 12-hours has increased by 14 times (1307%) compared with 2019 (303).
  • There were 1,811 beds occupied due to delayed discharges, the second most for any September on record.
+ Wales

Wales

Wales Performance Data Summary for October 2023

Visualisations can be found here

This was the second worst October for more than 12 hour waiting time figures. Nearly 1 in 7 people waited 12 hours or longer in an Emergency Department and nearly 1 in 4 waited eight hours or longer.

We are lagging far behind pre-Covid performance. Compared with October 2019, 29% more patients have waited longer than four hours, 49.6% more patients have waited longer than eight hours, and 77.1% more patients have waited longer than 12 hours. This is in spite of a 0.7% decrease in attendance for October 2023 compared with pre-pandemic average October attendance (2011-2019).

It is important to note that the pandemic is not the only reason for poor performance, as evidenced from historical analysis, performance was already deteriorating in the years leading up to the pandemic.

67,401 people attended major emergency care facilities in October.

  • Overall, 58.2% of patients in major EDs were admitted, transferred, or discharged within four hours from arrival.
    • This is a 1.3 percentage-point decrease from last month. And a 1.4 percentage-point increase on October 2022.
    • 41.8% of patients in major EDs waited longer than four hours (28,204 patients). The number of patients waiting more than four hours has increased by 6% compared with last month.
  • 23.4% of major ED attendances waited more than eight hours (15,793 patients).
    • This means that nearly 1 in 4 patients were delayed eight hours or more at a major emergency department.
    • It is the second largest number of patients who waited this long for any month so far in 2023.
    • The number of people waiting more than eight hours has increased by 49.6% compared with October 2019.
  • 14.6% of major ED attendances waited more than 12 hours (9,821 patients).
    • This means nearly 1 in 7 patients were delayed by 12-hours or more.
    • It is the third largest number of patients who waited this long for any month so far in 2023.
    • The number of people waiting more than 12 hours has nearly doubled compared with October 2019.
+ Northern Ireland

Northern Ireland

Northern Ireland Quarter 2 2023 performance data:

July to September 2023 was the worst Quarter 2 on record for 12-hour performance, with 16.6% of patients waiting more than 12 hours in an Emergency Department. Indeed, this was the second worst Quarter 2 on record for four-hour performance, with only 44.5% of patients waiting less than four hours.

Quarter 1 (October to December) and Quarter 4 (January to March) are usually associated with the worst performance as they make up the coldest months. However, Quarter 2 2023 was worse for four- and 12- hour performance than any Quarter 1 and 4 from 2011-2021.

We are well below pre-pandemic levels, with a 232.2% increase in the number of people waiting 12 hours from Quarter 2 2019. And a more than double median waiting time for admitted patients. This despite attendance decreasing by 1%.

On average, 56,769 people attended type 1 emergency care facilities each month across Quarter 2 2023.

  • On average, 44.5% of patients were seen and resulted in a subsequent admission, transfer, or discharge within four-hours for each month.
    • This is the second worst four-hour Quarter 2 performance on record. September was the worst on record for four-hour performance.
    • More than half of patients waited longer than four hours.
  • 16.6% of patients waited more than 12 hours in an Emergency Department.
    • This is the worst 12-hour Quarter 2 performance on record.
    • 1 in 6 patients had to wait longer than 12 hours.
    • 28,341 people waited longer than 12 hours. This is a 232.2% increase on Quarter 2 2019.
  • The average July-September for the median time that admitted patients spent in an Emergency Department was 13 hours 40 minutes.
    • This is 6 hours and 90 minutes more than the average for Quarter 2 2019.
    • Admitted patients spent nearly four times longer in an Emergency Department than those who were discharged home (3 hours 47 minutes).

Excess Deaths

Using the best available evidence, a scientific study published in the Emergency Medicine Journal, we calculate an estimated number of excess deaths occurring across the United Kingdom associated with crowding and extremely long waiting times. These figures are based on modelling from the EMJ study which show that for every 72 patients waiting between eight- and 12-hours from their time of arrival in the Emergency Department there is one patient death.

You can read more information here.

UEC Winter Situation Report

Urgent and Emergency Care Daily Situation Reports (UEC SitReps) are a data collection system administered by NHS England. These daily reports on metrics provide us with a real-time understanding of on-the-ground pressure on NHS frontline services over the winter months.

UEC Winter Situation Report – Week 19

Flourish slides can be found here.

Beds

  • There was an average of 100,703 beds open across all acute trusts, and 99,008 open at type-1 acute trusts. Occupancy at type-1 acute trusts was 94.2%.
  • Of 137 trusts with general and acute beds, 126 recorded an occupancy of >85%, 3 more than in week 18. 64 recorded an occupancy of >95%, 10 more than in week 18.

Ambulance Offloads

  • There was an average of 11,381 arrivals by ambulance (total: 79,665). In total, 27.5% of handovers involved a delay, a 4.5 percentage point increase from the previous week.
  • An average of 2,088 hours were lost each day, for a total of 21,617 hours. This is an increase of 51.9% from week 18.

Beds Occupied by Long-Stay Patients

  • On average, 47,929 patients occupied a bed for over 7 days, for patients occupying a bed for 21 or more days, this figure was 18,862.

Flu

  • The average number of G&A beds occupied by flu patients was 300. This figure has fallen for 12 consecutive weeks and is the lowest figure recorded this winter.

Criteria to Reside

  • The average number of patients remaining in hospital while no longer meeting the criteria to reside was 13,300.
  • On average, 58.7% of patients who no longer met the criteria to reside remained in hospital.

Diverts

  • The average number of diverts in week 18 was 2.6, a decrease of 0.3 from the previous week.

Total number of staff absent from work through sickness or self-isolation (Acute Trusts)

  • The average number of total absences was 47,993. Covid absences averaged 5,804, this figure has increased in 7 of the last 8 weeks.



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