Only 77.1% of patients were dealt with within four hours in January, well short of 95% target

Hospitals recorded their worst performance against the four-hour A&E treatment target last month as the NHS came under unprecedented strain because of winter and the flu outbreak.



A&E units based at hospitals managed to treat and then admit, transfer or discharge just 77.1% of arrivals within the politically important four-hour target in January. That compared with 77.3% in December, which was also a new record low at that time.



The figures reveal just how far away the NHS is from meeting the requirement for hospital A&Es, walk-in centres and urgent care centres to deal with 95% of patients within four hours.

They are a setback for Jeremy Hunt, the health and social care secretary, who has ordered the NHS to improve its performance against the best-known of the various NHS-wide waiting time targets.



The latest set of performance data published by NHS England also shows that patients due to have planned surgery in hospital have been waiting longer and longer for their operations, and hospitals have been struggling to cope with the seasonal surge in illness.



Hospital emergency departments have now had to divert patients elsewhere 287 times since the NHS began recording winter performance data on 20 November. It happened 36 times last week, of which 17 were at the Worcestershire Royal Acute trust in the West Midlands.

The trust, which runs hospitals in Worcester and Redditch, has had to take that action a total of 65 times this winter, far more than any other trust, although it pointed out that it tended to divert patients from one of its two A&Es to the other, rather than to other nearby hospitals.

Q&A Why is the NHS winter crisis so bad in 2017-18? Show Hide A combination of factors are at play. Hospitals have fewer beds than last year, so they are less able to deal with the recent, ongoing surge in illness. Last week, for example, the bed occupancy rate at 17 of England’s 153 acute hospital trusts was 98% or more, with the fullest – Walsall healthcare trust – 99.9% occupied. NHS England admits that the service “has been under sustained pressure [recently because of] high levels of respiratory illness, bed occupancy levels giving limited capacity to deal with demand surges, early indications of increasing flu prevalence and some reports suggesting a rise in the severity of illness among patients arriving at A&Es”. Many NHS bosses and senior doctors say that the pressure the NHS is under now is the heaviest it has ever been. “We are seeing conditions that people have not experienced in their working lives,” says Dr Taj Hassan, the president of the Royal College of Emergency Medicine. The unprecedented nature of the measures that NHS bosses have told hospitals to take – including cancelling tens of thousands of operations and outpatient appointments until at least the end of January – underlines the seriousness of the situation facing NHS services, including ambulance crews and GP surgeries. Read a full Q&A on the NHS winter crisis

Dr Nick Scriven, the president of the Society for Acute Medicine, said: “The last six weeks have seen the acute services of the NHS under a sustained period of stress due to ‘normal’ winter pressures along with a surge in influenza. Neither of these were unpredictable, but both have combined to cause the issues that have been widely reported across the country.



“Last year we coined the phrase ‘eternal winter’, but the last month-and-a-half has shown an even steeper decline in performance as demonstrated by all the data available, particularly around ambulance delays, the four-hour emergency target and bed occupancy both in acute beds and critical care.”

Scriven said Theresa May and Hunt’s repeated insistence that the NHS was the best prepared it had ever been to deal with the rigours of winter was not being borne out by events, and many frontline NHS did not believe it.



Thursday’s new data also revealed that:

138,463 patients have waited at least 30 minutes in the back of an ambulance or a hospital corridor before being handed over to A&E staff this winter, despite NHS bosses telling hospitals that no patient should have to wait more than 15 minutes with an ambulance crew.

31,306 of those patients endured a wait of at least an hour.

81,003 patients had to wait on a trolley in an A&E unit in January for more than four hours, of whom a record 1,043 waited more than 12 hours – again an event which hospitals were told to ensure never happened this winter.

Bed occupancy levels in hospitals are running at 95%, far above the 85% limit that doctors and health experts should be the maximum, in order to prevent the spread of infections such as MRSA and C dificile and ensure patient safety.

NHS England stressed that the proportion of patients receiving A&E-type care at all types of settings, including walk-in and urgent care centres, rose slightly to 85.3% in January from 85.1% in December 2017. However, that was still the third worst-ever performance by that, their preferred measure of progress against the A&E target.

“Today’s figures provide hard evidence on just how bad a winter the NHS is having: over 80,000 patients waited on trolleys for more than four hours at A&E in January, of whom over 1,000 were waiting for over 12 hours. These are the highest numbers since records began,” said Prof John Appleby, chief economist at the Nuffield Trust health thinktank.



“A year ago we warned that corridors had become the new emergency wards. It is deeply concerning that 12 months on the position has worsened, with many harrowing reports of patients being treated in busy corridors by stressed and overworked staff.”

Patients awaiting non-urgent surgery such as cataract removal or a hip or knee replacement are facing lengthening delays and are now the longest for nine years. The NHS is meant to treat 92% of such patients within 18 weeks under the Referral to Treatment (RTT) scheme.

Yet that target is increasingly being breached as well. At the end of December 92% of people on the waiting list had waited an average of 21.3 weeks, up from 20.2 weeks just a month earlier.



Dr Rob Findlay, an expert in NHS performance, said: “The increase in waiting times from 20.2 weeks to 21.3 weeks is a shocking deterioration in performance and the worst monthly rise since December 2010.”



Of the 3.76 million people on the RTT waiting-list, in all 445,360 had been waiting for more than 18 weeks. Hospitals cancelled tens of thousands of operations in December and January, in part because NHS England told them to do so to free up beds to accommodate emergency arrivals over the winter.

