Combined Performance Summary: November–December 2019

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


Latest data

Published: 09/01/2020

Today, NHS England published its Combined Performance Summary, which provides data on key performance measures for November and December of last year. SitRep data for the first week of 2020 was also released, giving a more up-to-date analysis of how the NHS is coping this winter. Here we show some of these statistics and how they compare with previous years.

In March 2019, the Clinically-Led Review of NHS Access Standards Interim Report was released, proposing some significant changes to many of the targets reported on here. A six-month Progress Report from the NHS Medical Director was published in October.

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 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 elective care, field testing of the proposed new standards began in 12 hospital trusts in early August. These trusts are testing the use of an average (mean) wait measure for people on the waiting list as a potential alternative to the current 18-week threshold target. Performance of the field test sites will continue to be included in the national time series, so the data is fully comparable over time.

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


  • In December 2019, 20.2% of people attending A&E spent more than 4 hours from arrival to admission, transfer or discharge – the worst performance for any month since records began.
  • Only one out of 118 major A&E departments (type 1) that submitted performance data met the four-hour A&E waiting time target in December 2019.
  • The total number of A&E attendances exceeded 2.1 million in December 2019, which is 7% higher than December 2018. There was an average of 70,356 A&E attendances per day.
  • There were over 1.37 million type 1 A&E attendances in December 2019 – the highest for any December since records began. This equates to an average of 44,338 type 1 A&E attendances per day – an increase of 5% compared to December 2018.
  • Emergency admissions via A&E have been increasing year-on-year, reaching over 424,000 in December 2019. There were on average 13,698 emergency admissions via A&E per day, which is 3% higher than December 2018. 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.
  • 98,452 patients spent more than 4 hours waiting on a trolley from a decision to admit to admission in December 2019; this is the highest since records began. 2,347 patients had a trolley wait of over 12 hours, which is more than eight times higher than December 2018.

Ambulance handover delays

  • In Week 1 of 2020 (commencing 30th December 2019), 100,569 people arrived by ambulance and 18,251 of them experienced a handover delay of over 30 minutes. This is almost 6,000 more delayed ambulances in Week 1 of 2020 compared to Week 1 of 2019.

Treatment and diagnostic test waiting times

  • The total number of people waiting to start consultant-led elective treatment remained above 4.5 million in November 2019 (reported waiting list plus the estimate of missing data).
  • The proportion of people waiting over 18 weeks to start elective treatment reached 15.6% in November 2019 – the highest level since September 2008.
  • In November 2019, 2.9% of patients had been waiting over 6 weeks for a diagnostic test. The diagnostic waiting time target has not been met for six years.

Delayed transfers of care

  • There was an average of 4,863 people delayed per day in November 2019. This is 24% lower than it was in November 2016, but 25% higher than it was in November 2013.

Cancer waiting times

  • In November 2019, over one in five patients (22.6%) waited longer than two months to start their first treatment for cancer following an urgent GP referral.
  • The 62-day cancer target has not been met since December 2015.

Beds occupied by long stay patients

  • In Week 1 of 2020, there was an average of 16,413 hospital beds occupied by long-stay patients (>21 days). This is 5% higher than Week 1 of 2019 but 7% lower than Week 1 of 2018.

© Nuffield Trust & The Health Foundation