Latest performance figures show further decline
The latest NHS performance figures are a stark reminder of the scale of the task Keir Starmer’s government faces if it is to implement its manifesto commitment to “Build an NHS fit for the future”.
To sum up: there are too few hospital beds, too many patients staying too long in hospital, and far too many long delays in emergency departments, community services and mental health – and this is only looking at July, once a relatively easy month, not looking ahead to the looming winter pressures.
Average bed occupancy for England’s acute hospitals was 92.6% in July: the Royal College of Emergency Medicine (RCEM) stressed that this is well above the 85% occupancy considered “safe”. To get back to that would need an impossible extra 8,800 beds.
But the average figure, as always, conceals some very worrying higher figures. The sitrep figures for July show 32 trusts with 95 percent of more of their beds occupied, and therefore running on the edge of crisis levels in the middle of summer.
One of the unresolved reasons for these very high occupancy levels is the lack of adequate community health and social care to support patients discharged from hospital, leaving 55 trusts with more than 30 percent of their beds filled by patients who had been there for over 14 days. For seven trusts (Epsom & St Helier, North Middlesex, Mid Cheshire, Liverpool University Hospitals, Clatterbridge Cancer centre, University Hospitals Sussex, and the Robert Jones and Agnes Hunt Orthopaedic Hospital) that figure was 40 percent or more.
Perhaps even more worrying is the fact that a third of Integrated Care Boards (and 51 trusts) averaged 20 percent (one in five) or more of their beds occupied for over 21 days.
The RCEM notes that despite efforts over many years to get the system moving, a daily average of 22,310 patients who no longer met the criteria to reside in hospital could not be discharged in July due to a lack of appropriate social care option. The figure has hardly changed despite many attempts to reduce it. In fact the latest figure is 613 patients higher than the same time last year.
Busiest A&E for 15 years
The lack of services to allow easy discharge of patients results in a blocked system, making it much harder to get the most seriously ill patients admitted to beds from A&E. This problem has grown, and been worsened by the busiest July in A&E for 15 years.
NHS Providers report that the first six months of 2024 has been “the busiest year ever,” with record highs for each month in terms of A&E attendances.
And while 74.6 percent of people attending A&E were seen or discharged within four hours, the July total of 129,000 patients waiting more than 4 hours in A&E was more than double the level in the same month five years ago in 2019.
Almost 37,000 patients waited 12 hours or more on trolleys in A&E, waiting for a bed: this was 57 percent higher than the same figure a year ago July 2023 … and 81 times higher than the July 2019 figure (of 452)!
During the election campaign Labour promised to return the NHS to meeting the constitutional standard that 95% of people who attend A&E will be seen within four hours – by the end of their five year term. On current levels of performance this will be a major challenge.
And even though the number of patients who have already waited over a year has fallen, the waiting list for routine hospital treatment actually rose again in June to 7.6 million, up 4.7% compared to last year, and up by 56.5% compared to May 2019.
Over 2.4 million diagnostic tests were carried out in May 2024 – 91,000 more than the month before, and the highest number of tests ever recorded. This is nearly 11% higher than a year ago and 21% higher than pre-pandemic levels in May 2019.
But more than a fifth (22%) of patients waited six weeks or more for a test, an improvement from 23% last month, but a long way away from the 5% target maximum set out in NHS England’s 2024/25 planning guidance.
Community and mental health
But it’s not just hospitals under pressure. NHS Providers point out that April 2024 saw the highest number of community services referrals on record – 1.68 million. That’s 52% more than the 1.1 million referrals a month in the year prior to the Covid-19 pandemic (February 2019-February 2020).
Community referrals, which dropped back during the early months of the pandemic, have been rising consistently since the autumn of 2020. In April 2024, referrals were 24% higher than a year ago. However community services too have problems discharging patients once their treatment is complete: in June, only 11% of patients who no longer met the criteria to reside could be discharged from community providers each day.
The logjammed system has therefore developed a separate waiting list for community services, which in May increased for the fourth month running, to 1.09 million, with numbers of adults (799,900) and children and young people (287,300) waiting for community health services both at record highs.
A shocking 11,500 adults and almost 40,000 children had been waiting over 52 weeks, up by 16% and 10% respectively compared to April 2024.
Children and young people are also among the main victims of the soaring caseload facing mental health services: NHS Providers point out that in April 2024 there were 1.91 million people in contact with mental health services, up by 11.3% compared to a year ago.
Demand for mental health care remains considerably higher than pre-pandemic levels, with 41% more people in contact with mental health services since April 2019. But over 327,000 children and young people are now waiting for community mental health support.
The demand has continued to grow since the pandemic: 21.8 million people were in contact with mental health services in 2023/24, an increase of 9.4%, compared to 2022/23.
Reforms
None of this suggests that even the most imaginative ‘reforms’ from Health Secretary Wes Streeting will be enough to enable the NHS to cope with high and growing levels of demand right across the board.
As Health Foundation policy chief Hugh Alderwick argued last summer, responding to Labour’s Mission Statement on the NHS:
“The elephant in the room is money. Labour’s narrative is that reform will need to do “the heavy lifting” to improve the NHS – and Starmer dodged questions from journalists about how Labour would fund the plans. […] No amount of reform will avoid the need for substantial investment for Starmer’s Labour to make real progress.”
The NHS lacks both revenue and capital funding needed for expansion – indeed it lacks the capital even to maintain and repair the clapped-out buildings and equipment many trusts have been reduced to in 14 years of austerity.
But the situation is still getting worse. New polling conducted by Ipsos for the Health Foundation just before the election, published as this article is written, shows only 28% of the public agreed the NHS is providing a good service nationally – the lowest since the question was first asked in 2021.
A worrying 46% disagreed that the NHS was providing a ‘good service’ nationally.
Promises made
Labour came to office promising to put things right, and the patience of patients and public won’t last long, especially if no real change is accomplished, or services deteriorate further going in to another tough winter.
Chancellor Rachel Reeves has made sure we’ve all heard about the £22bn shortfall she now says she has found in the public accounts, the cash gap that everyone but Labour leaders already knew would greet the new government.
In mid June the Nuffield Trust’s Sally Gainsbury warned that:
“… if any of the three parties’ pledges were implemented, the period 2022/23 to 2028/29 would see the tightest and most sustained NHS funding squeeze in recorded history (going back to 1979/80) […] tighter even than the coalition government’s “austerity” period, which saw funding grow by just 1.4% real terms a year between 2010/11 and 2014/15.””
Before the July 4 general election the Institute for Fiscal Studies warned of a “conspiracy of silence” between the main political parties over the dire state of the public finances. Whoever won the election, tax rises, public spending cuts or more borrowing would be needed.
Ms Reeves has now announced moves to scale back spending on new hospitals as well as road and rail projects, and limited winter fuel payments to pensioners on benefits. She has warned more “difficult decisions” on tax and spending will be needed, and made clear her intention to continue the austerity for an indefinite period.
So Wes Streeting has his work cut out if he’s going to make the case for the spending needed to start now on repairing the NHS he has described as “broken,” and make it fit for the future. At the end of last year Labour was posting on social media claiming:
“The longer the Tories are in power, the longer patients will wait. Only Labour has a plan to cut NHS waiting lists and get patients treated on time again.”
Labour made the promises, and now have to find ways (and the funding) to deliver. They have both a huge majority and a clear mandate: the voting in the general election was very substantially for parties that promised to invest in and repair the NHS.
Fixing the NHS is also part of fixing the wider economy. As Tim Gardner, Assistant Director of Policy at the Health Foundation has said, the restoration of the NHS is vital if the government is serious about wanting to encourage more people back to work:
“While the government has made economic growth its primary mission, a thriving economy requires a healthy population and a strong health service.”
In February the BMJ Commission on the future of the NHS suggested the best way to push through swift and decisive investment to reverse its decline would be to declare a “national health and care emergency” and begin an “urgent reset for the NHS”.
Ms Reeves is perhaps lucky that there are plenty of objectionable billionaires and brazen tax-avoiding companies that have got away with it for years, and can be taxed to raise enough for a significant cash injection to the NHS, social care and other struggling public services, without the need to raise tax on ordinary families.
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