As the NHS continues to plan for the winter flu season, new analysis reveals that the start to the financial year has seen frontline staff cope with record A&E attendances, high bed occupancy levels and improved discharge rates.
In its report on the Performance of the NHS provider sector for the quarter ended 30 June 2018 out today (Tuesday, 11 September), NHS Improvement has revealed that A&E attendances increased to 6.23 million over April, May and June 2018 – 220,574 more than the same period last year.
Staff succeeded in seeing 5,602,531 patients in under four hours in A&E compared with 5,427,860 in the same quarter last year.
Also, there were 1.14 million emergency admissions that quarter. This equates to 22,200 more admissions a month via A&E, compared to the same period last year.
The report reveals that staff vacancies are increasing and are forecast to rise more throughout the year. Staff vacancies across hospitals rose by 9,268 over the three-month period. At the end of June 2018, there were 107,743 vacancies, up from 98,475 at the end of March 2018.
Across trusts in England there are 41,722 nursing vacancies and 11,576 doctor vacancies. Trusts have had to turn to using more bank and agency staff to ensure patients get the care they need. London has the highest nursing vacancy rate at 14.80% and Midlands and the East has the highest doctor vacancy rate at 11.50%.
As part of the NHS’ plan for winter, hospitals have been reminded of the national ambition to free up 4,000 beds by the end of December, particularly by reducing the number of ‘long-stay’ patients.
Already, trusts have been successful in reducing delayed discharges by 74,863 bed days compared with the same period last year – equivalent to freeing up over 800 beds.
Also, more patients with minor illnesses and injuries will be referred to services other than A&E, including through primary care with 9m additional GP appointments to be available from October and community services being expected to free up their own capacity. This is so that A&Es and hospital beds can be prioritised for those most in need.
This publication comes after the government announced an extra £145 million of capital funding for trusts in England to help cope with increased demand over winter. This will be used to fund 81 schemes which will provide an additional 900 beds.
Ian Dalton, Chief Executive of NHS Improvement, said:
“Staff are working extremely hard to cope with a rise in A&E attendances and high occupancy levels.
“A&Es up and down the country have been successful in treating more patients than ever before within four hours. We are helping trusts ensure that no-one stays in hospital longer than they need to so that beds are free for other patients who urgently need them.”
The report reveals that at the end of the first quarter of 2018-19, trusts across England were £814 million in deficit, which is £22 million better than planned at the beginning of the year. At the end of the first quarter, trusts were projecting to end 2018/2019 £519 million in deficit. NHS Improvement and NHS England have been working together to identify actions which will result in a balanced plan for the NHS as a whole.
NHS Improvement and NHS England are leading the development of a long-term plan for the NHS, which is expected in November. Alongside that, the government has committed to an additional £20.5 billion for the NHS over the next five years from 2019-20 and the NHS is already making huge improvements in its efficiency and productivity for the benefit of patients.
The number of patients waiting longer than 52 weeks for elective treatment stood at 3,402 in June 2018, compared to 1,475 in June 2017. In May 2018 it stood at 2,972.
For the first time, the report contains mental health data. It reveals that mental health trusts have exceeded the standard for early intervention in psychosis. The standard is for 53% of people to be treated with a package of care within two weeks of referral, however trusts achieved 76.5% in June 2018.
The report also reveals that:
- Trusts had to turn to bank and agency staff to ensure vacancies were filled. Around 80% of nursing vacancies were filled by bank (64%) or agency (36%) staff. And 85% of doctor vacancies were filled by a combination of bank (45%) and agency (locum) (55%).
- Over the quarter trusts spent £805 million on bank staff and £599 on agency. Bank spend was £102 million more than planned and agency spend was £32 million overbudget.
- The national elective waiting list remained at almost record levels. At the end of June 2018 it was 3.90 million, a 7.2% increase compared to a year ago.
NHS Improvement is working with trusts to help them make every penny count by identifying unwarranted variation and opportunities to improve. NHS Improvement is doing this by sharing best practice and developing practical tools and solutions to help trusts buy cheaper medicines and to help them switch to cheaper bank staff as opposed to more expensive agency staff.
Over the quarter, hospitals have been successful in making £495 million worth of savings, however this was £64 million below the ambitious plan. The main areas of overspend was on temporary staffing costs to cover the high number of vacancies. At the end of the financial year, trusts predict to make savings of £3.4 billion.