NHS in Crisis? On average probably, but we all know the problem with averages.

Scratch the surface of the latest headlines however, and it’s clear that the pressure on A&E is being felt differently in different parts of the country, with around three quarters of Trusts coping with the pressure far better than the rest. We’ve analysed the latest data with our interactive tool VVSS Online to take a closer look.

In this blog, we take a look at two significant metrics that indicate the pressure on acute hospitals and A&E departments at a provider and geographical level rather than simply nationwide:

 1. How long after a decision to admit a patient does that patient move from A&E to the hospital (these were known as trolley waits but now seem to be waiting in corridors?)

In the first chart below we count the number of waits over over 4 hours (blue) and over 12 hours (orange) from a decision being made to admit a patient and their admission. This is taken from data published for December 2017 by NHS England. You can click here to go to the data source.

Each bar represents an NHS Trust and the height of the bars are the numbers of waiting patients.

A&ERatioPareto

This first graph shows us two things:

  • The number of NHS Trusts experiencing ‘trolley waits’ is 37 of around 150 NHS Trusts with A&E departments. So about a quarter, by no means a whole NHS issue.
  • The 10 NHS Trusts with the most ‘trolley waits’ account for more than half of the total.

So we can conclude that while its a given that excessive waits on trolleys or in corridors are not acceptable, painting the whole NHS as being broken is doing it a major disservice.

The second chart on this subject shows us how the monthly number of ‘trolley waits’ has changed over time and seasonally.

TrendinAdmission4hrAnd12HourWaits

Whilst December 2017 was worse than the preceding 2 Decembers, October and November were both better, perhaps suggesting a better prepared NHS leading up to winter? January will be a real barometer of this! Has the flu pandemic passed its peak or is there worse to come?

 2.  How many hospitals diverted patients to other local hospitals to relieve pressure. This is only done in absolute extremis and could be viewed as a proxy for true ‘crisis’

This chart shows the number of Trusts that diverted patients by day between 20/11/17 and 07/01/2018. The data comes from the NHS England weekly Winter SitRep publication, and is available here.

DivertsDailyTrend

Again, in terms of context, this represents very few of our hospitals. The knock on effects of diverts on neighbouring Trusts are likely to have been significant given the pressures over the period.

So in the final chart in the blog we show the number of days of A&E diverts by geographic area (STP). The different colours identify where multiple Trusts in an STP are contributing to the total number of ‘divert’ occurrences.

DivertsBySTPProvider

While we have not shown here whether these multiple providers in an STP had simultaneous ‘divert’ days, should this occur it would be evidence of a much more serious problem for a local healthcare system.

Our analysis tools confirmed this occurred on 6 days in total and affected 2 STP areas over the period.

We are not saying that conditions are acceptable and if our loved ones were attending A&E we would be as concerned as everyone else. But the severity and spread of the problem is far from homogeneous.

The problems within emergency care are myriad and complex but with proper, detailed analysis of the full health system we can pick out the things we can affect and where we should got to work first. Being able to see the uncomfortable truths can only help this process.

Equally if the few trusts that have the biggest issues had ‘the kitchen sink’ thrown at them in terms of money and operational support the impact overall would be massive. If you can’t fix it all fix these.