New analysis confirms government target missed as A&E waiting times hit nine-year high

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New analysis of data for the final quarter of 2012/13 shows that nearly 6 per cent of patients waited four hours or longer in A&E departments, the highest level since 2004.

The latest quarterly monitoring report from The King’s Fund shows that 313,000 patients (5.9 per cent) spent four hours or more in A&E in the period January to March 2013, an increase of more than a third on the previous three months and nearly 40 per cent on the same quarter in 2011/12. This means that, across the quarter as a whole, the government’s target that no more than 5 per cent of patients should wait longer than four hours in A&E was missed for the first time since the Prime Minister pledged to keep A&E waiting times low in June 2011.

Nearly 40 per cent of trusts (98) reported breaches in the target, an increase of 50 per cent on the previous quarter. Data also shows that the proportion of patients waiting longer than four hours before being admitted from A&E to hospital – so-called trolley waits – rose to almost 7 per cent, also the highest level since 2004. While more recent data shows that A&E and trolley waits have since fallen back to pre-winter levels, this analysis confirms the severe strain on emergency care in early 2013 and the risk that performance could deteriorate again next winter.

The growing pressure on hospitals is also reflected in a survey of NHS finance directors carried out for the report. This suggests that, although the NHS will end 2012/13 in a healthy financial position, the outlook for the next two years is bleak, with the majority expecting the NHS to fail to meet its target to deliver £20 billion in productivity improvements by 2015. The main findings from the survey of 51 finance directors were:

  • 90 per cent (46) expect to end the 2012/13 financial year in surplus with only 4 per cent (2) expecting a deficit
  • more than 40 per cent (21) said that the quality of patient care in their area had got worse over the previous 12 months
  • more than two-thirds (35) indicated that the government’s reforms had a negative impact on performance
  • while nearly half (24) met their productivity target in 2012/13, less than 40 per cent (19) are confident of doing so in 2013/14, a reduction in confidence compared to previous surveys
  • more than 90 per cent (49) estimate the risk of the NHS failing to meet its £20 billion productivity target as 50/50 or worse.

The pessimistic outlook reflects growing financial pressure on the NHS. So far, a large proportion of savings have been the result of an ongoing pay freeze for staff, reductions in prices paid to hospitals and cuts in management costs. With these savings increasingly difficult to sustain, further productivity improvements will become harder to deliver without changes to services. The pressure will be exacerbated by cuts in funding for social care - more than two-thirds of finance directors (34) identified reductions in local authority funding as affecting their trust last year.

Despite the pressures in emergency care, other NHS performance measures are continuing to hold up well. Waiting times for referral to treatment in hospital, the number of health care-acquired infections and delays in transferring patients out of hospital all remain stable.

Commenting on the report, John Appleby, Chief Economist at The King’s Fund, said: ‘Emergency care acts as a barometer for the NHS. The worryingly high number of patients waiting longer than four hours in the last quarter of 2012/13 is a clear warning sign that the health system is under severe strain. The pressures in emergency care will not be relieved by focusing on a single aspect of the problem in isolation – it requires a co-ordinated response across the whole health system.

‘While the NHS is in a healthy financial position overall, efficiencies are becoming harder to deliver as one-off savings such as cuts in management costs start to slow. This is compounded by the need to maintain staffing levels following the shocking failures of care highlighted by the Francis report. With staff costs making up the bulk of the NHS budget, this will leave little room for manoeuvre - significant changes to services will be required if the NHS is to meet its target of delivering £20 billion in efficiency savings.’

More on quarterly monitoring

Notes to editors

How is the health and social care system performing? is the eighth of The King’s Fund’s regular quarterly monitoring reports and was published on 4 June 2013. For further information or to request an interview with John Appleby, please contact the Press and Public Affairs team on 020 7307 2585 (if calling out of hours, please ring 07584 146035).

The survey of finance directors was carried out online between 16 April 2013 and 29 April 2013. Of 136 finance directors contacted, 51 responded to the survey, 26 of whom worked in acute or combined acute and community trusts, with the remainder from mental health, ambulance and specialist trusts. The survey aims to provide a snapshot of opinion and is not intended to be a representative sample.

The King's Fund is an independent charity working to improve health and health care in England. We help to shape policy and practice through research and analysis; develop individuals, teams and organisations; promote understanding of the health and social care system; and bring people together to learn, share knowledge and debate. Our vision is that the best possible care is available to all.