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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 April NHS England performance figures can be found below.

Flourish slides can be found here.

Summary:

  • It was the worst April for 12-hour performance since records began, with one in ten patients waiting this long. 131,440 patients waited 12-hours or more from their time of arrival.
  • There were 1,372,028 Type 1 attendances. A 6.2% decrease compared to last month.
  • There were 398,116 emergency admissions via Type 1 Emergency Departments – the highest number of admissions for any month on record.
  • Bed occupancy stands at 93.7% on average, and it would require 10,372 more beds to bring occupancy down to 85%.
  • More than half of patients who no longer met the criteria to reside remained in hospital (53.7%).
  • There was a weekly average of 112,429 additional bed days for patients with a length of stay over 21 days.

Supplementary ECDS Analysis April 2024 final (12-hour length of stay data measured from the time of arrival) data shows:

  • 10.1% of all Type 1 Emergency Department attendances waited 12 hours or more in April. This was a 0.3 percentage point decrease from last month but a 1.8 percentage point increase from April last year.
  • It was the worst April for 12-hour performance since records began, with one in ten patients waiting this long.
  • In April 2024, 131,440 patients waited 12 hours or more from their time of arrival. This is the highest number of 12-hour waits for April on record.

The latest Emergency Department performance figures published by NHS England for April 2024 for show:

  • There were 1,372,028 Type 1 attendances, a decrease of 6.2% compared with last month and an increase of 7.9% compared with April 2023.
  • There were 398,116 emergency admissions via Type 1 Emergency Departments.
  • The percentage of patients seen within four hours in Type 1 Emergency Departments stood at 60.4%, a decrease of 0.5 percentage points compared to last month and a 0.5 percentage point decrease compared to April 2023.
  • The aggregate four-hour target stood at 74.4%. This is 1.6 percentage points lower than the Government’s intermediary threshold target of 76% for this month.
  • There is a 14 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 42,078, a decrease of 890 patients compared to last month but an increase of 15,179 when compared to April 2023.

Beds data for April 2024 show:

  • There were 100,902 Type 1 G&A beds available. This is 281 fewer beds than last month and 2,471 more than April 2023.
  • Bed occupancy stood at 93.7%, representing a decrease of 0.3 percentage points compared to last month, but an increase of 1.1 percentage points compared to April 2023.
  • Based on the data for this month, there are 10,372 more beds required to bring bed occupancy down to 85%.

Delay Discharges

  • In April 2024, a daily average number of 12,772 patients remained in hospital while no longer meeting the criteria to reside. This is a decrease of 90 when compared with April 2023 and a decrease of 296 compared with last month.
  • More than half of patients who no longer met the criteria to reside remained in hospital (53.8%). This is a decrease of 3.7 percentage points from April 2023 (57.5), and a decrease of 0.3 percentage points from last month (54.1%).
  • There was a weekly average of 112,429 additional bed days for patients with a length of stay over 21 days, a decrease of 0.4% when compared with April 2023 but an increase of 6.6% compared to last month.
+ Scotland

Scotland

Emergency Department performance data for Scotland, March 2024:

Flourish graphs here.

Summary:

  • There has been some improvement since February. However, the big picture is still bleak. It was the worst March on record for four-hour performance.  And the second worst for eight and 12-hour performance.
  • One in three patients waited four hours or more in Emergency Departments, one in eight waited eight hours or more, and one in 20 waited 12 hours or more.
  • Since March 2017, the numbers waiting four hours or more has increased by more than five times (411%), eight hours or more by 23 times (2219%), twelve hours or more by 63 times (6260%). Despite attendance only increasing by 2.5%.
  • Delay to patients discharge from hospital is a key reason that ED doctors cannot admit patients into hospitals and therefore causes long waits. The number of beds occupied due to delayed discharges was 1,892 – an increase of 554 beds compared with March 2017.

Data:

  • In March 2024, there were 117,377 attendances at major Emergency Departments in Scotland. This is a significant increase of 10.2% from February.
    • 64%of patients were seen within four hours at major (Type 1) Emergency Departments. This is the worst four-hour performance for any March since records began.
    • This is a slight improvement of 0.2 percentage points from the previous month but a decrease of 0.5 percentage points from March 2023.
    • 42,240 (36%) patients waited over four hours in major Emergency Departments. This is a 9.5% increase from the previous month (38,560) and a 7.5% decrease from last March (39,307).
    • The number of patients waiting more than four hours has increased by more than five times compared to March 2017 (8,261).
  • 14,190 (12%) patients waited eight hours or more in Emergency Departments.
    • This is the highest proportion of eight hour waits for any March on record.
    • The proportion waiting this long has decreased by 0.9 percentage points from the previous month and has decreased by 0.3 percentage points compared to March 2023.
    • The numbers waiting more than eight hours is 23 times the numbers that waited this long in March 2017 (612).
  • 5,660 (4.8%) patients waited twelve hours or more in Emergency Departments.
    • This is the second highest proportion of 12-hour waits for any March on record.
    • The proportion waiting this long has decreased by 0.9 percentage points from last month and decreased by 0.4 percentage points from March last year.
    • The numbers waiting more than 12 hours is 63 times the numbers in March 2017 (89).
  • There were 1,892 beds occupied due to delayed discharges, an increase of one from the previous month and the highest March on record.
    • There was a total of 58,646 days spent in hospital by people whose discharge was delayed. This is a 9% increase on March 2023 (54,046).
+ Wales

Wales

Wales NHS Emergency Department Performance Data – April 2024

Flourish slides can be found here.

Summary:

  • This was the second worst April on record for four-hour, eight and 12-hour performance in Wales.
  • 40.6% of patients waited four hours or longer in an Emergency Department. 22.7% (nearly one in four patients) waited eight hours or longer, and 14.5% (more than one in seven) waited 12 hours or longer.
  • Since April 2017, the numbers waiting four hours or more increased by 82%, the numbers waiting more than eight hours has increased by more than two and a half times (179%), and the numbers waiting more than 12 hours has more than quadrupled (315%). This is despite attendance being 3.3% lower than in April 2017.

Figures:

  • 64,700 people attended major emergency care facilities in April 2024.
  • Overall, 59.4% of patients in major EDs were admitted, transferred, or discharged within four hours from arrival.
    • This is a 2.6 percentage-point decrease from last month, and a 0.7 percentage-point decrease compared to April 2023.
    • 40.6% of patients in major EDs waited longer than four hours (26,271 patients). The number of patients waiting more than four hours has decreased by 2.6 percentage points compared with last month (28,923).
    • The number of people waiting more than four hours has increased by 82% compared with April 2017 (14,406).
  • 22.7% of major ED attendances waited more than eight hours (14,669 patients).
    • This means that nearly one in four patients were delayed eight hours or more at a major emergency department. This figure has dropped by 1.3% compared to last month and has increased by 0.2 percentage points compared to April 2023.
    • The number of people waiting more than eight hours has increased by two and a half times (179%) compared with April 2017 (5,255).
  • 14.5% of major ED attendances waited more than 12 hours (9,351 patients).
    • This means that one in seven patients were delayed by 12 hours or more. This is 0.8 percentage points less than last month and a decrease of 0.5 percentage points compared to April 2023.
    • The number of people waiting more than 12 hours has more than quadrupled (315%) compared with February 2017 (2,253).
+ Northern Ireland

Northern Ireland

Northern Ireland Quarter 4 2023/24 (Jan-Mar 2024) performance data:

Flourish slides can be found here.

Summary:

  • January to March 2024 was the worst quarter on record for four and 12-hour performance in Northern Ireland
  • Only 37.4% of patients spent less than four hours in ED
  • One in five patients (20.2%) had to wait longer than 12 hours in the ED
  • The median time that admitted patients waited in an ED was just under 16 hours. More than three times longer than the time spent by discharged patients
  • Average attendance was lower than any quarter since Quarter 4 2020/21.

Figures:

  • The average number of monthly attendances for this quarter was 45,503. 5.7 percent less than last quarter and 14.3 percent less than Quarter 4 2022-23
  • On average, 37.4% of patients were seen and resulted in a subsequent admission, transfer, or discharge within four hours for each month.
    • This is the worst four-hour performance for any quarter on record
    • It is 2.9 percentage points less than last quarter and 5.4 percentage points less than Quarter 4 2022-23
    • January was the worst month ever for four-hour performance.
  • On average, 20.2% of patients waited more than 12 hours in an Emergency Department.
    • This is the worst 12-hour performance for any quarter on record
    • More than one in five patients had to wait longer than 12 hours in the ED
    • A total of 27,553 people waited longer than 12 hours. This is nine times more than Quarter 4 2016/17.
  • The average January to March for the median time that admitted patients spent in an Emergency Department was 15 hours 57 minutes
    • This is nearly two hours more than the previous quarter (14 hours 0 minutes)
    • This is 10 hours 14 minutes more than the average for Quarter 4 2016/17 (5 hours 43 minutes)
    • Admitted patients spent on average more than three times longer in an Emergency Department than those who were discharged home, who spent on average 4 hours 32 minutes in ED.

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.

Please find the team’s analysis of Sit Rep data for Week 20 2024 (25 – 31 March).

Flourish slides can be found here.

Summary for week 20:

  • The average occupancy at Type 1 acute trusts was 93.3%, only 0.9 percentage points less than last week and week 20 in 2022/23
  • A daily average of 18,466 patients occupied a bed for 21 or more days
  • This week, a total of 18,628 hours were lost to ambulance delays over 30 minutes, which is equivalent to more than two years. So far this year, a total of 294,971 hours has been lost to delays over 30 minutes, equivalent to more than 33 years
  • The number of patients who no longer met the criteria to reside that remained in hospital in week 20 was 84,104 (53% of all patients in hospital)
  • The daily average number of G&A beds occupied by flu patients for week 20 was 801, a decrease of 197 patients compared with last week but an increase of 564 compared with the same week last year.

Beds

  • On average there were 100,943 G&A beds open at Type 1 acute trusts, 1,294 more than week 20 in 2022/23 but 358 less than last week. There was an average of 102,669 beds open across all acute trusts
  • The average occupancy at Type 1 acute trusts was 93.3%, only 0.9 percentage points less than last week and week 20 in 2022/23
  • Bed occupancy reached a high of 94.9% on 27th March in week 20
  • Based on this week’s available Type 1 beds, an additional 9,920 beds would have been required to bring bed occupancy down to 85%.

Ambulance Offloads

  • There was a daily average of 13,237 ambulance handovers (arrivals), a weekly total of 92,662
  • National guidance states that patients arriving at an ED by ambulance must be handed over to the ED within 15 minutes. In week 20, only 33% of handovers met this guidance
  • On average, 26% of handovers involved a delay over 30 minutes, the same proportion as last week
  • On average, 2,661 hours were lost each day due to ambulance handover delays, a 2.8% decrease on the previous week
  • A total of 18,628 hours were lost to delays over 30 minutes, which is equivalent to more than two years.

Beds Occupied by Long-Stay Patients

  • In Type 1 acute trusts, a daily average of 47,497 patients occupied a bed for more than seven days. This represents a decrease of 622 patients when compared to last week and a decrease of 474 patients compared to week 20 last year
  • A daily average of 18,466 patients occupied a bed for 21 or more days. This was an increase of 26 patients compared to last week and a decrease of 469 compared to week 20 last year.

Criteria to Reside

  • In week 20, a daily average number of 12,015 patients remained in hospital while no longer meeting the criteria to reside. This is a decrease of 1,116 patients when compared with last week (13,131)
  • More than half of patients who no longer met the criteria to reside remained in hospital (53%). This is a decrease of 1 percentage point from last week.

Flu

  • The daily average number of G&A beds occupied by flu patients for week 20 was 801, a decrease of 197 patients compared with last week but an increase of 564 compared with the same week last year.

Diverts

  • The daily average number of diverts in week 20 was three, which is one more than week 20 last year and one less than last week
  • There was a weekly total of 21 instances during the week where patients were redirected from their intended healthcare facilities to alternative hospitals due to capacity issues, resource constraints, or other operational challenges.

Absences

  • The average daily number of absences in acute trusts was 43,603. This is 2,423 less than week 20 in 2022/23. Daily Covid absences averaged 700, this is 4,304 less than week 20 in 2022/23.



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