Combined Performance Summary: September–October 2019

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

Latest data

Published: 14/11/2019

Today, NHS England published its Combined Performance Summary, which provides data on key performance measures for September and October of this year. 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 was released, proposing significant changes to many of the targets reported on here. A six-month Progress Report from the NHS Medical Director was also recently published.

For urgent and emergency care, field testing of the proposed new standards began in 14 hospital trusts on 22 May 2019. The first stage of testing focused on measuring the ‘mean time in A&E’ as 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 (or planned) care, field testing of the proposed new standards began in 12 hospital trusts in early August 2019. 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 October 2019, 16.4% 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.
  • For major A&E departments (type 1), 25.5% of people attending waited for longer than 4 hours in October – also the worst on record.
  • The total number of A&E attendances exceeded 2.1 million in October 2019, which is 4% higher than October of last year. There was an average of 70,000 A&E attendances per day.
  • There were over 1.3 million type 1 A&E attendances in October 2019 – the highest for any October since records began. This equates to an average of over 44,000 type 1 A&E attendances per day – an increase of 4% compared to October 2018.
  • Emergency admissions via A&E have been increasing year-on-year, reaching over 420,000 in October 2019. On average, there were 13,582 emergency admissions via A&E per day, which is 4% higher than October 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.
  • 80,092 patients spent more than 4 hours waiting on a trolley from a decision to admit to admission in October 2019; this is almost as high as January last year. 726 patients had a trolley wait of over 12 hours, which is more than three times higher than October of last year.
  • Only two out of 118 major A&E departments that submitted performance data met the four-hour A&E waiting time target in October 2019.

Per cent spending >4 hours in A&E, Monthly data,NHS EnglandPer cent spending >4hoiurs in A&E, Monthly Data, NHS EnglandTotal A&E attendances, Mothly 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 England116 out of 118* major A&E departments (Type 1) missed the 4 hour target in October 2019

Treatment and diagnostic test waiting times

  • The total number of people waiting to start consultant-led elective treatment exceeded 4.5 million in September 2019 (reported waiting list plus the estimate of missing data).
  • The proportion of people waiting over 18 weeks to start elective treatment reached 15.2% in September 2019 – the highest level since September 2008.
  • In September 2019, 3.8% 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 increased slightly to 4,979 in September 2019. This is 24% lower than it was in September 2016, but 26% higher than it was in September 2013.


Cancer waiting times

  • In September 2019, nearly a quarter of patients (23.1%) waited longer than two months to start their first treatment for cancer following an urgent GP referral.
  • 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