The English NHS has seen its worst yearly results for four hour waits in accident and emergency since the target was introduced, as record levels of pressure on services mount.
Data released by NHS England* on Thursday showed 2015-16 performance against the target that 95% of patients should be treated within four hours dropped to 87.9%.
“Our focus needs to be on making sure that we are supporting frontline staff to respond to this unprecedented level of demand”
The total for attendances at type one full A&E units was lower than at any time since 2003-04, when performance was at 88.5%.
Attendances have grown by a quarter in that period, from 12 million to 15 million, while admissions grew by more than half, going from 2.5 million to 4.1 million, according to the latest monthly report on A&E performance from NHS England.
Nearly 23 million people visited A&E in the 12 months to March 2016 – a rise of more than 500,000 from the previous year.
Performance for all types of urgent care providers, including urgent care centres, was 91.9%. The service missed this target for the first time since 2004-05 last year.
The Health Foundation think-tank said that considering the financial pressure the NHS was under the performance was good.
Chief executive Jennifer Dixon said: “Considering the unprecedented squeeze in government funding of the NHS and adult social care, the figures could have been worse.
“Thanks to the dedication and hard work of NHS staff, the majority of patients have been seen within target times,” she said. “But if funding trajectories stay on the planned course set in the spending review, performance could deteriorate further. Is this what the public want?
The number of 12 hour trolley waits fell slightly in 2015-16, from 1,243 the previous year to 1,015. However, this was still the second highest number on record. Pennine Acute Hospitals Trust had the highest number in the country, with more than 70.
Six trusts took more than four hours to see a third or more of their attendances in the most recent quarter’s data:
- West Hertfordshire Hospitals NHS Trust
- University Hospitals of North Midlands NHS Trust
- Hillingdon Hospitals NHS Foundation Trust
- East and North Hertfordshire NHS Trust
- Blackpool Teaching Hospitals NHS Foundation Trust
- University Hospitals of Leicester NHS Trust
NHS Improvement chief executive Jim Mackey said: “March saw the NHS treat a record number of patients in A&E and the highest number of emergency admissions to hospitals ever. Despite this, the system still managed to see 1.8 million patients in four hours, which is the most since July 2015. This creates a big challenge and we should recognise the hard work of front line staff in delivering care to so many patients.
“We are being told that more patients with minor illnesses are visiting A&Es which is adding to the pressure,” he said. “We are working with the system to find out how we can best support work locally to treat patients in the right setting, in a more timely way and improve the way patients are discharged.
He added: “Our focus needs to be on making sure that we are supporting frontline staff to respond to this unprecedented level of demand and put in place real and rapid improvements for patients.”
Anna Crossley, professional lead for acute, emergency and critical care at Royal College of Nursing, said: “A&E departments are facing huge challenges in caring for so many patients, to the point that what used to be exceptional pressure is now becoming the norm.
“Emergency care is running on the goodwill and effort of dedicated staff, but that cannot sustain it forever,” she said. “If the exceptional is now the norm, we have to be concerned about any additional pressures which could cause the system to be completely overwhelmed.
“Working in these pressured environments is causing burnout, and having a serious impact on the ability to recruit and retain nurses and doctors. This cannot fail to have an effect on patients,” she added.
*Tableau representation by George Donald