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1000 more NHS emergency patients admitted daily than same time last year

Widespread workforce vacancies and looming deficit don’t bode well for winter, warn healthcare leaders as latest provider performance figures published

Caroline White

Friday, 30 November 2018

NHS hospitals admitted nearly 1000 more emergency patients every day than in the same period last year, reveal the latest second quarter performance figures* for the provider sector in 2018-19 from NHS Improvement.

Some 5.52 million patients were dealt with within the four-hour target and hospitals were able to discharge more patients from their services sooner, including reducing the number of beds occupied by those who had been there for more than three weeks, freeing up the equivalent of 2470 beds in time for winter, the figures show.

But waiting times for planned treatment, such as routine non-urgent operations, increased; vacancies for doctors and nurses remained at over 100,000; and a deficit of £558 million is forecast by the end of March.

The NHS Long-Term Plan, due to be unveiled next month, will outline how the £20.5 billion of additional government funding will be spent over the next five years from April 2019.

It will include a focus on preventing ill health and a commitment to invest £3.5 billion a year in primary and community healthcare services to cut avoidable hospital admissions and help patients return home sooner. It will also seek to eliminate provider deficits.

Ian Dalton, chief executive of NHS Improvement, said: “The NHS is working flat out to ensure record numbers of patients get the care they need. Frontline staff and managers deserve tremendous praise for their heroism.

“But this achievement continues to come at a cost with performance targets not being met nationally and hospitals being unable to balance their books to cover the increased demand on their services.”

Dr Jennifer Dixon, chief executive of think tank, the Health Foundation, commented: “As the NHS comes under greater and more sustained pressure, figures released from NHS Improvement reflect the extraordinary efforts of NHS staff to provide care in challenging circumstances. But as pressure on services continues to build, we are seeing falling performance against targets.

“Emergency departments continue to see rising demand, but the even steeper rise in patients requiring admission also places significant pressure on hospitals. These patients are likely to have more complex needs than ever before. Recent Health Foundation analysis showed that in 2015/16 one in three emergency patients admitted for an overnight stay had five or more health conditions, up from one in 10 in 2006/7.”

She added: “Reductions in the number of delayed discharges from hospital are encouraging, particularly ahead of what is certain to be a challenging winter for the NHS. But on its own, this will not offset pressures elsewhere in the system – this includes the impact of more seriously unwell patients who need hospital admission. It underlines the urgent need for additional investment in services outside hospital, including general practice, community nursing, and social care. Without thriving services in the community, patients cannot be supported after discharge, and it is much harder to prevent admissions.”

Siva Anandaciva, chief analyst at health think tank The King’s Fund said the figures were “a warning that the NHS is heading for another very tough winter, with rising demand for services and staff shortages taking an increasingly heavy toll on patient care.”

She continued: “We have become used to key targets being missed but the increase in the number of patients forced to experience long waits for care is a significant concern. The number of people stuck on hospital waiting lists for more than a year or spending more than 12 hours in A&E is worryingly high, and far worse than this time last year. Tackling long waits for hospital treatment must be a top priority for NHS England’s clinical review of waiting times.”

And she warned: “As we get closer to the publication of the Long-Term Plan, it is becoming increasingly clear that the new funding will not be enough to address all the pressures facing the service – ‘resetting’ performance back to desirable levels is highly ambitious. It is therefore vital that sufficient funding is dedicated in the plan for developing new models of care, building on the work currently taking place in integrated care systems up and down the country.”

Niall Dickson, chief executive of the NHS Confederation, said: "If it is bad now, and it is, it will almost certainly be worse over the next few months. Flu, norovirus and severe cold are our enemies and we must hope they stay away this winter. A & E departments had to cope with record numbers of patients this summer, this next period will be an even more severe test.

"The challenge is all the greater with more than 100,000 vacancies across the NHS in England. The service simply does not have the staff to do the job.”

The Long-Term Plan wouldn’t be a panacea, he suggested. “But it must set the right direction of travel that will in time make the health service sustainable – as these figures show we cannot go on as we are."


*Quarterly performance of the NHS provider sector: quarter 2 2018/19. NHS Improvement, November 2018.

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