As autumn sets in and winter looms there are already worrying signs of another year’s winter pressures on the NHS, and a reminder of the extent of the decline that has taken place since 2010. JOHN LISTER reports.

NHS England figures show a staggering increase of 1,400% in the numbers of so-called “trolley waits” from August 2010 to August 2019.

Other NHS figures show 12 hour waits for a bed after a decision to admit a patient have increased 372-fold from just 1 in August 2010 to 372 in April 2019

Perhaps even more alarming is the big increase in pressure on emergency services across the summer months which used to be relatively quiet.

In July 2019 there were 57,694 patients waiting more than 4 hours from decision to admit to admission, 34.7% higher than July 2018. Of these, 436 patients waited more than 12 hours (192.6% higher than in July last year).

More shocking perhaps is that the increased delays flow from a combination of rising use of A&E with a hefty reduction in front-line beds and services outside hospital. Numbers of the most serious “Type 1” emergency patients attending A&E in August have increased by just 21% since 2010, while the population is estimated to have increased by around 5.6%.

More seriously ill

However the patients who arrive are more likely to be seriously ill and require a bed: numbers of Type 1 being admitted have increased by more than a third (34%) over the same period, with the proportion of patients being admitted increased from 25% to 30%.

Total emergency admissions to hospital, which include urgent referrals by GPs, have risen by 28%, and by a significantly higher rate than general attendances at A&E.

But while the numbers have been rising on all fronts, the numbers of front-line beds available to admit them to has been falling overall: there were 8,779 fewer “general and acute” beds available in quarter 1 of 2019-20 than there were in quarter 1 of 2010-11. The reduction of almost 8% has come from a system that for years has had fewer hospital beds per head of population that almost any comparable country.

But there has been an even sharper reduction in mental health bed numbers: back in April 2010 there were 23,515 mental health beds: by April 2019 there were just 18,271 – a reduction of over 5,000 beds, or 22%. The targets for mental health are all much less demanding than those for acute hospital care, but NHS Improvement notes that at the end of June 2019 there were 805 Out of Area Placements for mental health patients, of which 770 (96%) were “inappropriate” (resulting from a lack of local NHS beds available).

The squeeze on acute hospital beds has run alongside a chronic failure to hit performance targets for emergency care and elective treatment.

NHS Providers last month noted that while the government’s target is to admit 95% of patients within four hours, A&E performance had been “sitting around the current 86.5% for the last 3 months:” the 95% target has not been achieved for four years.

4.5 million on waiting lists

The BMA notes that there are now 4.52 million people in England now waiting for treatment, with 14.2% waiting over 18 weeks.

NHS Providers also pointed out that the NHS is “missing the three key cancer targets – the 2 week wait, 31 day and 62 day.”

The decline in performance in cancer care has been especially notable, since figures were first collected in 2016. Then 94.8% of suspected cancer patients were seeing a consultant within 2 weeks of an urgent referral by a GP: now just 90.9% are doing so, bringing anxious delays to 180,000 people last year.

The performance on urgent referrals for patients with breast symptoms but not initially suspected as cancer has plummeted from 96.1% seen within 2 weeks to 82.4% in July.

In June the Public Accounts Committee heard that one in five cancer patients is having to wait up to two months to begin hospital treatment.

July was the 43rd consecutive month that the government target – to treat 85% within two months – has been missed. More than two thirds (69.9%) of providers missed the target.

As the BMA has warned, these figures indicate more trouble looming as the temperatures drop:

“Given the lack of a recovery from winter, it looks likely that the upcoming winter will see unprecedented pressure on the NHS.

“This will result in longer waits, with staff and patients suffering the consequences unless the Government takes action.”

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