Access and waiting times

With a review of access targets forming part of the long-term plan for the NHS, we take a longer-term look at some of the best known indicators, including the totemic four-hour A&E target.

Indicator update

Published: 17/08/2018

The Government’s mandate to NHS England for 2018-19 put the flagship waiting time targets for planned and emergency care on hold. The four-hour A&E target, 18-week referral-to-treatment target, six-week diagnostic test target, ambulance response time targets, and the target to reduce delayed transfers of care have all been pushed back to overall 2020 goals.

More recently, the Prime Minister announced that as part of the long-term plan for the NHS there would be a review of waiting time targets. The new Health Secretary, Matt Hancock, followed this up by saying that we need to ensure that the targets are “clinically appropriate” and are focussed on improving patient outcomes. NHS England will advise on changes to the targets in due course.

Since our last blog on the growing problem of treatment waiting times, we have updated some of our key access and waiting times indicators for the NHS in England. Please find a summary below, and click on the links for the individual indicator pages where you will find interactive charts and more information.

A&E waiting times

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  • In Q4 2017/18, only 77% of patients attending A&E were admitted, transferred or discharged within four hours – the worst level of performance since the introduction of the four-hour target.
  • By Q1 2018/19 performance had recovered slightly to 84% but was still significantly below the 95% target.
  • A&E attendances have been increasing over time, reaching over 6.2 million in Q1 2018/19.
  • The median A&E waiting time remained at around 130 minutes until the second half of 2014 when it began to increase. Since 2016, the median wait for patients has fluctuated at around 150 minutes.
  • On average, admitted patients wait 1½ times as long as non-admitted patients.
  • Trolley waits have been increasing over time, peaking in the winter months. In January 2018, 1,054 patients waited over 12 hours between decision to admit and admission.

Ambulance response times NEW

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  • In July 2017, NHS England announced a new set of performance targets for the ambulance service. All 11 Ambulance Services have been providing data on the new standards since April of this year.
  • The national standard sets out that ambulance trusts must respond to Category 1 (life-threatening) calls in 7 minutes on average, and respond to 90% of Category 1 calls in 15 minutes. In July 2018, the mean Category 1 response time was 7 minutes 37 seconds and the 90th centile response time was 13 minutes 15 seconds.
  • Ambulance response times for Category 2 (emergency), Category 3 (urgent) and Category 4 (non-urgent) calls increased between April and July 2018, and the national standards are not being met.

Treatment waiting times

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  • The proportion of people starting consultant-led elective treatment within 18 weeks of a GP referral has been decreasing over time, and has not been met since February 2016. In June 2018, 12% of people waited longer than 18 weeks to start treatment.
  • The number of people on the waiting list for treatment has been increasing since 2009. As of June 2018, there were 4.3 million people waiting for consultant-led treatment (reported waiting list plus the estimate for missing data). This is the highest number since referral-to-treatment data was first collected in August 2007.
  • The number of people waiting over 52 weeks to start treatment has increased over the past three years, reaching 3,517 patients in June 2018.
  • Over the last five years the median referral-to-treatment waiting time has increased by 1.4 weeks.

Diagnostic test waiting times

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  • The target that less than 1% of patients should have to wait longer than six weeks for a diagnostic test has not been met since November 2013. In June 2018, 2.9% of patients had been waiting longer than six weeks for a diagnostic test.
  • The number of people on the waiting list for a diagnostic test has been steadily increasing over time. In June 2018, over one million people were waiting for a diagnostic test.
  • The number of diagnostic tests being undertaken each month doubled between June 2006 and June 2018.

Cancelled operations

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  • The number of elective operations that were cancelled at the last minute for non-clinical reasons has increased over the last seven years. There were 12,780 cancelled operations in Q1 2011/12 compared to 18,806 in Q1 2018/19 – a 47% increase.
  • The number of patients who were not operated on within 28 days of cancellation has gradually increased since 2014. In Q4 2017/18, 2,948 patients were not operated on within 28 days of cancellation - an 85% increase on the previous quarter. By Q1 2018/19 the number had decreased slightly to 2,022 patients.

Delayed transfers of care

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  • The average number of patients that were delayed per day fluctuated at around 3,800 between 2010 and 2013. After this, the number increased rapidly to reach a peak of 6,660 patients that were delayed on average per day in February 2017. Since then the number has decreased, falling to an average of 4,478 patients delayed per day in June 2018.
  • In June, two thirds of delayed transfer of care patients were receiving acute care and one-third were receiving non-acute care.
  • The NHS is responsible for the majority of delayed transfers of care. In June 2018, the NHS was responsible for 63% of patients delayed, social care was responsible for 30% of patients delayed, and both the NHS and social care were responsible for 7% of patients delayed.
  • Since July 2016, the most common reason behind delayed transfers of care is people awaiting a care package in their own home.