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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 January’s NHS England performance figures can be found below.

Flourish slides can be found here.

January 2024 summary:

  • January was the second worst month for 12-hour performance since records began, with more than one in eight patients waiting this long
  • Four-hour performance was the worst for any January on record, with 45.6% of patients spending four hours or more in an Emergency Department
  • Despite there being a significant increase in the number of beds available to 103,114, bed occupancy increased since last month to 94%. 10,927 more beds were required to bring occupancy down to 85%.

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

  • In January 2024, 177,805 patients waited 12 hours or more from their time of arrival. The most amount for any January since records began and the second most for any month
  • 13.2% of all Type 1 Emergency Department attendances waited 12 hours or more in January, the second largest proportion of patients since records began
  • This is an increase of 1.9% from the previous month and a 1.9% increase from January 2023 (11.3%).

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

  • There were 1,397,645 Type 1 attendances, a 1% increase on last month
  • There were 403,210 emergency admissions via Type 1 Emergency Departments
  • The percentage of patients seen within four hours in Type 1 Emergency Departments stood at 55.4%, 3.6% less than January last year and 0.7% more than last month
  • The aggregate four-hour target stood at 70.3%. This is 5.7% lower than the Government’s intermediary threshold target of 76% to be hit by March 2024
  • There is a 14.9% 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 54,308, a 23% increase on last month and a 27% increase on January 2023.

Beds data for January 2024 show:

  • There were 103,114 Type 1 G&A beds available. This is 3,923 more beds than December 2023, and 3,068 more than January 2023
  • Bed occupancy stood at 94%, representing an increase of 1% compared to December 2023, and a 0.3% decrease compared to January 2023
  • Based on the data for this month, there are 10,927 more beds required to bring bed occupancy down to 85%.
+ Scotland

Scotland

Emergency Department performance data for Scotland, January 2024:

Flourish slides: https://public.flourish.studio/story/1848443/

Summary:

  • January was the worst month on record for four, eight, and twelve-hour performance
  • 41,161 (38%) patients waited over four hours in major Emergency Departments, a 21% increase compared to last January (33,962)
  • 17,077 (16%) of patients waited eight hours or more in Emergency Departments, almost 13 times higher than in January 2016 (1,338)
  • 8,402 (8%) of patients waited twelve hours or more in Emergency Departments, the largest amount for any January since records began and 36 times higher than in January 2016 (232)
  • There were 1,866 beds occupied due to delayed discharges, an increase of 53 compared to December 2023.
  • In January 2024, there were 108,427 attendances at major Emergency Departments in Scotland. This is marginal decrease of 0.25% compared to the previous month
    • 62% of patients were seen within four hours at major (Type 1) Emergency Departments. This is the worst four-hour performance for any January since records began
    • This is a decrease of 0.5 percentage points decrease compared to December last year and a decrease of 3.2 percentage points compared to January 2023
    • 41,161 (38%) patients waited over four hours in major Emergency Departments. This is a 1% increase compared to December last year (40,763) and a 21% increase compared to January 2023 (33,962)
    • The number of patients waiting more than four hours has increased by more than three times compared to January 2016 (9,808)
  • 17,077 (16%) of patients waited eight hours or more in Emergency Departments
    • The proportion waiting this long has increased by 2% compared to the previous month, December 2023 and has increased by 2.3% compared to the previous year, January 2023
    • The numbers waiting more than eight hours is almost 13 times those in January 2016 (1,338).
  • 8,402 (8%) of patients waited twelve hours or more in Emergency Departments
    • This is the largest amount for any January since records began.
    • The proportion waiting this long has increased by almost 1% compared to December last year and has increased by more than 1% compared to January 2023
    • The numbers waiting more than 12 hours is 36 times those in January 2016 (232).
  • There were 1,866 beds occupied due to delayed discharges, an increase of 53 compared to December 2023.
+ Wales

Wales

Wales NHS Emergency Department Performance Data – January 2024

Flourish slides can be found here.

Summary:

We welcome the slight improvement in four and eight-hour performance figures for January. However, we are still well below pre-2017 performance.

Nearly half of patients waited four hours or longer in an Emergency Department, nearly one in four waited eight hours or longer, and more than one in seven people waited 12 hours or longer.

Between 2007 and 2016, performance levels were moderately consistent, four-hour performance rarely dropped below 80%. However, since January 2017, the numbers waiting four hours or more increased by 64%, the numbers waiting more than eight hours by 100%, and the numbers waiting more than 12 hours by 143%. This is despite attendance increasing by only 0.9% in the same period.

  • 63,586 people attended major emergency care facilities in January
  • Overall, 58% of patients in major EDs were admitted, transferred, or discharged within four hours from arrival
    • This is a 1.5 percentage-point increase from last month, and a 2.5 percentage-point decrease since January 2023
    • 42% of patients in major EDs waited longer than four hours (26,684 patients). The number of patients waiting more than four hours has decreased by 2.6% compared with last month (27,388)
    • The number of people waiting more than four hours has increased by 63.5% compared with January 2017 (16,318)
  • 24% of major ED attendances waited more than eight hours (15,228 patients)
    • This means that nearly one in four patients were delayed eight hours or more at a major emergency department. It is a 0.7 percentage-point decrease on last month
    • The number of people waiting more than eight hours has increased by 100% compared with January 2017 (7,465)
  • 15.5% of major ED attendances waited more than 12 hours (9,838 patients)
    • This means more than one in seven patients were delayed by 12 hours or more. It is a 0.3 percentage-point increase on last month
    • The number of people waiting more than 12 hours has increased by 143% compared with January 2017 (4,048).
+ Northern Ireland

Northern Ireland

Northern Ireland Quarter three 2023/24 (Oct-Dec 2023) performance data:

Flourish slides can be found here.

Summary:

October to December 2023 was the worst quarter on record for four-hour and the second worst for 12-hour Emergency Department performance in Northern Ireland. On average, more than half of patients waited for four hours or more (59.8%) and over one in six patients waited for 12 hours or more (17.7%).

In December, the percentage who waited less than four hours in an Emergency Department dropped below 40% for the first time ever. The number of patients who waited 12 hours or longer has increased by 16 times compared to quarter three 2016.

The median time that admitted patients waited in an Emergency Department was 14 hours, three times longer than the time spent by discharged patients.

  • The average number of monthly attendances for Quarter three was 48,238. 15% less than last Quarter and 8.7% less than October to December last year.
  • On average, 40.2% of patients were seen and resulted in a subsequent admission, transfer, or discharge within four hours for each month.
    • This is 4.3% less than last quarter and 3% less than Quarter three last year.
    • This is the worst four-hour performance for any quarter on record.
    • December was the worst on record for four-hour performance (only 38.4% seen in four hours).
  • 17.7% of patients waited more than 12 hours in an Emergency Department.
    • In December, 18.7% of patients waited this long. This is the worst 12-hour performance for any month on record.
    • More than one in six patients had to wait longer than 12 hours.
    • 25,524 people waited longer than 12 hours. This is 16 times more than quarter three 2016.
  • The average for the median time that admitted patients spent in an Emergency Department was 14 hours. 40 minutes more than the previous quarter.
    • This is 8 hours and 18 minutes more than the average for Quarter three 2016.
    • Admitted patients spent on average more than three times longer in an Emergency Department than those who were discharged home (9 hours 46 minutes more).

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 17 (4th – 10th March).

(NB. Over the past few years, the winter sitreps have commenced at different points in the winter season. To keep things consistent across calendar weeks, we have called this week’s analysis week 17 in our records, even though it is technically week 16 of publication. This helps us to sync our reporting to get a clearer picture of how winter is playing out, making it easier to spend trends over time.)

Flourish slides can be found here.

Summary for week 17:

  • The average occupancy at Type 1 acute trusts was 94.3%
  • On average 2,609 hours were lost each day due to ambulance handover delays, a 31.5% increase since the previous week.
  • The daily average number of diverts in week 17 was 3, which is one more than week 17 last year.
  • A daily average of 18,741 patients occupied a bed for 21 or more days.
  • The daily average number of G&A beds occupied by flu patients was 1,190, an increase of 238% on week 17 last year.

Beds

  • On average there were 101,292 G&A beds open at Type 1 acute trusts, 1,819 more than week 17 in 2022/23 and 163 more than last week. There was an average of 103,054 beds open across all acute trusts.
  • The average occupancy at Type 1 acute trusts was 94.3%
  • Bed occupancy reached a high of 95% on 6th March.
  • Based on this week’s available Type 1 beds, an additional 11,040 beds would have been required to bring bed occupancy down to 85%.

Ambulance Offloads

  • There was a daily average of 13,044 ambulance handovers (arrivals) by ambulance, a weekly total of 91,306.
  • National guidance states that patients arriving at an ED by ambulance must be handed over to the ED within 15 minutes. In week 17, only 37% of handovers met this guidance.
  • On average, 26.6% of handovers involved a delay over 30 minutes, a decrease of 2.9 percentage points from last week.
  • On average, 2,609 hours were lost each day due to ambulance handover delays, a 31.5% increase since the previous week.
  • A total of 18,262 hours were lost to delays over 30 minutes, equivalent to nearly 2 years’ worth of time in just one week.

Beds Occupied by Long-Stay Patients

  • In Type 1 acute trusts, a daily average of 47,861 patients occupied a bed for more than seven days. This represents an increase of 72 patients when compared to last week and a decrease of 240 patients compared to week 17 last year.
  • A daily average of 18,741 patients occupied a bed for 21 or more days. This was a decrease of 113 patients compared to last week and a decrease of 187 compared to week 17 last year.

Criteria to Reside

  • In week 17, a daily average number of 13,204 patients remained in hospital while no longer meeting the criteria to reside. This is a decrease of 171 patients when compared with last week.
  • More than half of patients who no longer met the criteria to reside remained in hospital (55%). This is a decrease of 1.4 percentage point compared with last week.

Flu

  • The daily average number of G&A beds occupied by flu patients was 1,190, a decrease of 64 patients compared with last week (1254) but an increase of 838 compared with the same week last year (352). This is an increase of 238% on week 17 last year.

Diverts

  • The daily average number of diverts in week 17 was 3, which is one more than week 17 last year and the same as last week. There was a weekly total of 24 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 45,566. This is 2,929 less than week 17 in 2022/23. Daily Covid absences averaged 860, this is 4,446 less than week 17 in 2022/23.



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