In March 2019, the Clinically-Led Review of NHS Access Standards Interim Report was released, proposing some significant changes to the flagship waiting time targets for planned and emergency care. Field testing of the proposed standards for urgent and emergency care, elective care, cancer and mental health began in 2019, however in light of the coronavirus (Covid-19) outbreak, the publication of the review’s recommendations has been delayed until later this year.
QualityWatch will continue to monitor the quality of health and social care as best it can, even during these unprecedented times. The latest data presented here for elective care, cancer and mental health are from February 2020, before the Covid-19 outbreak took place in the UK. Data for urgent and emergency care are from March 2020, and will reflect changes in access and service use as a result of the outbreak.
Please find a summary below of our key access and waiting times indicators for the NHS in England. Click on the links for more detailed content and analysis.
For further information and analysis of access and waiting times, see these Nuffield Trust blogs:
- The tipping point: considering the impact of the proposed changes to treatment waiting time targets
- What will the proposed A&E waiting time targets mean for patients?
Note that the latest data presented below is from March 2020, after the onset of the coronavirus (Covid-19) outbreak.
- The percentage of patients attending A&E that were admitted, transferred or discharged within four hours has fallen substantially since 2010. In December 2019, performance had dropped to an all-time low of 69%, recovering slightly to 76% in March 2020.
- The total number of A&E attendances has increased over time, reaching over 6.5 million attendances in Q2 2019/20 (July to September 2019). In Q4 2019/20 (January to March 2020), the total number of A&E attendances fell by 14% on the previous quarter to 5.6 million, which reflects changes in access and service use with the onset of the coronavirus (Covid-19) outbreak.
- Trolley waits – the time patients wait between a decision to admit and the patient arriving on a ward – have increased considerably since 2010. In January 2020, 18% of admitted patients waited over four hours between the decision to admit and admission – higher than the peaks of 15% in January 2019 and January 2018.
Note that due to a new set of performance targets for the ambulance service, performance can only be reliably compared from April 2018 onwards.
- The target that all ambulance trusts must respond to Category 1 (life-threatening) calls in 7 minutes on average has only been met three times since its introduction – in March, April and May 2019. The 90th centile target for Category 1 calls, set at 15 minutes, is consistently being met.
- The national standards for Category 2 (emergency) calls, Category 3 (urgent) calls and Category 4 (less urgent) calls are being missed. The response times for Category 2 calls are of particular concern, since they include people who may have had a heart attack or stroke, or are suffering from sepsis or major burns.
Note that the latest data presented below is from February 2020, before the onset of the coronavirus (Covid-19) outbreak.
- In February 2020, only 83% of patients had been waiting less than 18 weeks to start elective treatment – the lowest proportion since August 2010.
- The total number of people waiting for elective treatment exceeded 4.5 million in February 2020 (reported waiting list plus the estimate for missing data).
- Between February 2011 and February 2020, the median wait time for patients still waiting increased from 5.5 to 7.5 weeks.
- In February 2020, the median waiting time was 4.9 weeks longer for admitted patients (11.2 weeks) than non-admitted patients (6.4 weeks).
- The proportion of patients waiting six weeks or more for a diagnostic test increased from 0.7% in February 2010 to 2.8% in February 2020.
- The median waiting time for a diagnostic test increased from 1.9 weeks in February 2008 to 2.1 weeks in February 2020.
- The average number of patients 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 delayed per day in February 2017. Since then the number has decreased, falling to an average of 5,370 patients delayed per day in February 2020.
- In February 2020, around two-thirds of delayed transfer of care patients had been receiving acute care and one-third had been receiving non-acute care.
- The NHS is responsible for the majority of delayed transfers of care. In February 2020, the NHS was responsible for 60% of patients delayed, social care was responsible for 30% of patients delayed, and both the NHS and social care were responsible for 10% 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.
Note that the latest data presented below is from 2019, before the onset of the coronavirus (Covid-19) outbreak.
- Between Q3 2009/10 and Q3 2019/20, the percentage of people with suspected cancer having their first consultant appointment within two weeks of an urgent GP referral decreased from 96% to 92%. The two-week standard has been missed for the last seven quarters.
- The proportion of patients waiting less than 31 days for a first treatment for cancer following a decision to treat decreased from 98% in Q3 2009/10 to 96% in Q3 2019/20. The 96% threshold has not yet been breached.
- The proportion of patients waiting less than two months to start cancer treatment following an urgent GP referral has decreased considerably over time. In Q3 2009/10, 87% of patients started treatment within 62 days compared to 78% in Q3 2019/20.
- The number of elective operations cancelled for non-clinical reasons on the day of admission or later increased from 15,640 in Q3 2007/08 to 23,503 in Q3 2019/20 – a 50% increase.
- The number of patients not operated on within 28 days of cancellation increased from 521 in Q3 2009/10 to 2,138 in Q3 2019/20 – a four-fold increase.
- The most deprived decile had the lowest surgery rate, with 176 hip replacements per 100,000 population in 2018/19. The highest surgery rate was found in decile seven, with 229 hip replacements per 100,000 population.
- Between 2008/09 and 2018/19, the rate of hip replacement increased by 6 per 100,000 population in the most deprived decile and increased by 19.7 per 100,000 population in the least deprived decile.
- The percentage of children and young people with an eating disorder starting urgent treatment within one week of referral increased from 65% in Q1 2016/17 to 81% in Q2 2018/19, but has since decreased to 74% in Q3 2019/20.
- Between Q1 2016/17 and Q3 2019/20, the percentage of routine/non-urgent cases starting treatment within four weeks of referral increased from 65% to 87%.
- Despite this improvement, progress has stalled in recent quarters and waiting times need to be reduced further if the 95% target is to be met in 2020.
- The number of referrals to the IAPT programme starting treatment has more than doubled, from 533,550 in 2011/12 to 1,092,291 in 2018/19. But the number of people starting treatment must still increase considerably if the 2023/24 target of 1.88 million people is to be reached.
- The number of people successfully finishing a course of treatment increased between 2012/13 and 2016/17, but since then improvement has stalled. In Q3 2019/20, 147,359 people finished a course of IAPT treatment, which is only 8% more than it was three years ago.
- The recovery rate has increased gradually over time, from 46% in Q1 2012/13 to 51% in Q3 2019/20. The target recovery rate of 50% was first achieved in Q4 2016/17, and has been met consistently since then.