Combined Performance Summary: July–August 2019

Our monthly round-up of the latest NHS performance data.


Latest data

Published: 12/09/2019

Today, NHS England published its Combined Performance Summary, which provides data on key performance measures for July and August of this year. Here we show some of these statistics and how they compare with previous years.

In March, the Clinically-Led Review of NHS Access Standards Interim Report was released. It proposed some significant changes to many of the targets reported on here.

For urgent and emergency care, field testing of the proposed new standards began in 14 hospital trusts on 22nd May. The first stage of testing has focused on measuring the “mean time in A&E”, when compared to the existing four-hour target. The field test sites have not been submitting four-hour performance data since May, so the national time series omits these sites’ A&E performance. The time series data presented here excludes the field testing sites and so is comparable across months and years.

For interactive charts showing the quality of health and social care over time, please refer to our 200+ indicators.


  • In August 2019, 13.7% of people attending A&E spent more than four hours from arrival to admission, transfer or discharge – the worst performance for any August on record. There has been a sustained worsening of about 3 percentage points over the last five months compared to the same time last year.
  • The total number of A&E attendances exceeded 2.1 million in August 2019, which is 6.4% higher than August of last year. There was an average of almost 69,000 A&E attendances per day.
  • For major A&E departments (type 1), there were over 1.3 million attendances in August 2019 – the highest for any August since records began. This equates to an average of over 42,000 type 1 A&E attendances per day – an increase of 5.7% compared to August 2018.
  • Emergency admissions via A&E have been increasing year-on-year, reaching almost 400,000 in August 2019. The average number of emergency admissions via A&E per day reached 12,900, which is 2.8% higher than August of last year. The increase could be related to the rise in same-day emergency care, where patients are treated and discharged on the same day as admission.
  • 56,499 patients spent more than four hours waiting on a trolley from decision to admit to admission in August 2019. This is 40% higher than August of last year. 372 patients had a trolley wait of over 12 hours, which is more than two-fold higher than August of last year.
  • Only three out of 119 major A&E departments that submitted performance data met the four-hour A&E waiting time target in August 2019.

Per cent spending >4 hours in A&E, Monthly data,NHS EnglandPer cent spending >4 hours in A&E, Monthly data,NHS EnglandAverage Type 1 A&E attendances per day, Monthly data, NHS EnglandAverage emergency admissions via A&E per day, Monthly data, NHS EnglandTrolley waits: Patients spending >4 hours from decision to admit to admission, NHS EnglandTrolley waits: Patients spending >12 hours from decision to admit to admission, NHS England117 out of 119* major A&E departments (Type 1) missed the 4 hour target in June 2019

Treatment and diagnostic test waiting times

  • The total number of people waiting to start consultant-led elective treatment exceeded 4.5 million in July 2019 (reported waiting list plus the estimate of missing data).
  • The proportion of people waiting over 18 weeks to start elective treatment reached 14.2% in July 2019 – the highest level since January 2009.
  • In July 2019, 3.5% of patients had been waiting over 6 weeks for a diagnostic test. The diagnostic waiting time target has not been met since November 2013.

Patients waiting to start consultant-led elective treatment, NHS England

Delayed transfers of care

  • The average number of people delayed per day remained at around 4,500 in July 2019, which is almost the same as it was in August 2015.

Cancer waiting times

  • In July 2019, over one in five patients (22.4%) waited longer than two months to start their first treatment for cancer following an urgent GP referral. This is almost 5 percentage points higher than it was three years ago.
  • The 62-day cancer target has only been met once in the last five years.

Per cent waiting >62 days from urgent GP referral to first treatment for cancer, NHS England

© Nuffield Trust & The Health Foundation