As NHS England publishes A&E Department performance data for January 2023, policy institute Curia asks what can be done to improve performance. Using data published by population health data platform, Vuit, Curia will work with the commissioners of the NHS Innovation and Life Sciences Commission to outline recommendations for improvements to services.
This data, which has been published today and circulated to all Members of Parliament by Chamber will help to highlight where examples of best practice can be found and where improvements need to be found within the system.
Waiting lists this winter
This winter, A&E waiting times have deteriorated so much that at some hospitals in England, more than 50% of patients were waiting more than four hours to be seen.
While NHS England are providing support for trust performance improvement, the data published today exposes the significant challenges affecting NHS trusts during the worst winter crisis in 20 years.
With significant delays across the emergency care system, both ambulance systems and A&Es have been under pressure with high levels of flu and covid patients.
Some commentators have not highlighted the impact of ongoing industrial disputes to patient care on the data, but this release should provide a wake-up call to political leaders to end the strikes.
A&E 4-hour wait data
NHS England data assessed by Vuit, Curia’s population health data partners, ranks all NHS trusts on all A&E patients treated within four hours.
Ranking each trust on their performance highlights that the top 5 trusts include Northumbria, Sheffield, Birmingham, Maidstone and Tunbridge Wells and Alder Hey.
The worst performers include Wye Valley, East Cheshire, Airedale, Queen Elizbeth Kings Lynn, Princess Alexandra Harlow and Mid Cheshire.
Find out the performance of your local A&E (Source: Vuit)
Data published by the BBC may not include the attributable type 3 data (including departments that treat minor injuries and illnesses) and includes December, whereas Vuit data provides monthly analysis.
Waiting lists fall
In January, the data reported was better than predicted as waiting lists fell for the first time since the start of the pandemic.
According to figures published by NHS England, elective care was delivered for 70,000 more patients in November compared to the same month before the pandemic. Waiting lists dropped by almost 30,000 compared to last month (27,012 patients).
Commenting on the figures earlier this year, NHS National Medical Director, Professor Sir Stephen Powis, said “The NHS will keep its foot on the accelerator to continue to make progress on the Covid backlog and hospitals have today been asked to ensure anyone waiting longer than 18 months has their treatment booked in before March.”
The Northumbria example
Northumbria is consistently profiled as an example of best practice. Their success is often attributed to their integrated status, in that it provides both acute and community care. The figures published today confirm their status as a high achiever.
Northumbria’s Chief Medical Officer, Professor Makani Purva told the BBC that the trust was working hard with its community and local authority partners to co-ordinate care.
But she emphasised that this winter there had been the equivalent of eight hospital wards full of patients who were unable to be discharged until community support was in place.
“Our emergency department has been under intense pressure. We apologise to patients waiting too long to be seen and those facing delays in admission,” she said.
Given Northumbria’s example, the Government’s plan to integrate services is being heralded as a possible solution to overcome problems next winter. The big question is how the Government will prepare a system ready solution six months ahead of a General Election.
Whilst this sounds simple, it is almost impossible for hospital trusts to begin running community services as in most places, they are independent bodies with separate governance. This would require substantial powers offered to acute trusts when the Government’s strategy is designed to devolve powers to Integrated Care Systems. Unless there is significant direction provided by NHS England, it is unlikely that much progress will be made.
New money and a new plan
The Government made extra funds available earlier this year, allocated to support hospitals to speed up discharge of patients into the community and purchase extra beds. The NHS also agreed to buy extra capacity from independent providers to help increase capacity as well as publish a two-year strategy to improve A&E performance.
An NHS England spokeswoman said: “Hospitals have experienced significant demand for emergency care this winter.”
But reinforced the points made by the Chief Medical Officer, outlining that performance had begun to improve, which NHS leaders would now build upon.
National Director of Healthwatch England, Louise Ansari agreed there had progress since Christmas, but warned there was “still a long way to go”.
She said the Government and NHS England needed to go further and be more ambitious to help hospitals get back to seeing 95% of patients within four hours.
Today’s data shows there has certainly been progress on improving A&E performance in the last few weeks.
However, the worst performing trusts look to be the same trusts that were poorly performing before the pandemic and not much has changed. Long queues of ambulances outside these hospitals are routine. CQC ratings have often demonstrated the need for improvement.
How many reports do we need to read to come to the same conclusion, A&E performance needs to improve. The question must now be about how this can be achieved.
Curia’s NHS Innovation and Life Sciences Commission will hold an inquiry session on improving performance within the acute setting ahead of the next winter crisis. It will identify ways in which technology can improve performance and ultimately patient outcomes.
To find out more about the Commission, or to share your organisation’s case studies, please visit www.curiauk.com or contact Policy and Research Analyst, Harry.Blacklock@chamberuk.com