Analysis: roundup of winter performance
This article looks at the key metrics from the urgent and emergency care sitrep released weekly between 9 December 2021 and 7 April 2022. We look at the situation as the winter progressed, how this compares with previous years and where the data is now at the start of April.
At a glance
- Over the winter of 2021/22, as the Omicron variant surged, the NHS saw unprecedented demand for its emergency care services and severe challenges in maintaining patient flow through hospitals.
- This has resulted in issues at the front doors of hospitals, with ambulances delayed in handing over patients and high numbers of people remaining in acute care despite being medically fit. As we approach spring, the picture does not appear to be improving.
- Increasing ambulance handover delays have been a whole system concern this winter, a trend that has not improved over recent weeks, hitting new records for the volume of delays. In the last week, 21,432 (26.9 per cent of arrivals) were delayed over 30 minutes, prior to 2021/22, the worst performance on record in the winter sitreps was just over 18 per cent of handovers being delayed over 30 minutes in week ending 6 Jan 2019.
- Although demand remains high, handover delays can result from challenges across the system - particularly hospital capacity, occupancy and patient flow, including delayed discharges to social care and other services. These areas have also been under sustained and increasing pressure all winter.
- Despite the best efforts of NHS organisations, interventions from the centre and the wider system, the number of people remaining in acute care despite no longer meeting the criteria to reside rose to almost 13,000 last week, the highest of the winter so far.
- The number of beds available is once again approaching pre-pandemic levels. However, the percentage of beds occupied has also started to rebound, allowing the NHS less extra capacity to deal with the pressures described above.
Ambulance handover delays
Handover delays have been at record levels this winter. Our deep dive looked at the impact of delays, how our members have been trying to tackle them and the variation across regions and trusts. It found that trusts across the country were struggling.
In January 2022, there were over 15,000 delays of over two hours, which is nearly four times higher than the same time in 2021. This has continued into the early spring, with this week, South Central Ambulance Service declaring a critical incident as extreme pressures forced it to prioritise patients with life-threatening illnesses, citing increased challenges in releasing ambulances from busy acute hospitals.
Although unprecedented demand is a strong predictor of ambulance delays, we know that it is not the only factor. The graph below shows this - delays this winter have not directly correlated to numbers of ambulance arrivals nationally. These services work as part of the whole system, all of which is under pressure.
The NHS standard contract was recently updated for 2022/23 with zero tolerance for delays in handovers over 60 minutes. 95 per cent should take place within 30 minutes and 65 per cent within 15 minutes; zero tolerance was previously set at 30 minutes. The clock begins when an ambulance arrives outside an A&E department and stops when a clinical handover has been fully completed to A&E staff.
The amended targets reflect the current pressures, which are most clearly demonstrated when 2021/22 is compared to previous years. Looking at the delays over 30 minutes as a percentage of ambulance arrivals to A&E, delays are well above 2020/21 as well as pre-pandemic levels. Not only is this year’s performance below previous years, but the trend is for delays to decrease as winter becomes spring (week 11 below). Rather, delays in 2021/22 have increased up to the latest week.
Discharging patients
The discharge of patients has been a problem throughout the winter and into spring (read our detailed analysis of some of the challenges). This is despite the best efforts from NHS organisations and the wider system including interventions from the centre to improve patient flow and reduce delayed discharges.
The chart below shows the number of patients who no longer meet the criteria to reside on an average day each week has fluctuated between just below 10,000 and nearly 13,000. The number of patients discharged has fallen slightly in recent weeks, both in absolute terms and as a proportion of patients medically fit to be discharged.
Regional trends show many areas struggling to discharge and seeing lower percentages of patients discharged in several regions compared to the January 2022 peak of COVID-19. The south west and south east have been particularly hit with high COVID-19 hospital bed occupancy compared to the January 2022 figures.
Bed occupancy
The percentage of general and acute beds occupied (adult and paediatric combined) has been lower throughout winter 2021/22 than pre-pandemic, although above 2020/21 as the graph below shows. The challenges in treating COVID-19 and non-COVID-19 patients separately and enhanced infection prevention control affect this, and in general hospitals have experienced capacity pressures at lower occupancy rates than previously as per the NHS England notes on bed data.
Consider the number of beds available too. The chart below shows that as we enter spring, the numbers of beds open have been relatively close to 2019/20 levels (in December 2020, 13 acute trusts without A&E departments were also added to the dataset) but much higher again than 2020/21.
Staff absence
The latest data shows that on an average day week ending 6 April, approximately 71,088 staff in acute trusts in England were absent from work through sickness, with 40.6 per cent due to COVID-19-related reasons. Seven-day averages have been applied where organisations have not submitted data or have submitted erroneous figures. The chart below shows the rise in absences throughout March having initially fallen following the January peak.
In the south west, approximately 52.1 per cent of absences were due to COVID-19 week ending 3 April, the highest in the country.
Member feedback
A number of organisations have reported to us that as we continue through spring, they feel a disconnect between the current pressures they are facing and government and public narratives about the state of the service and COVID-19. The latest ONS numbers estimated 1 in 13 people in England have COVID-19, and there are over 16,500 patients in hospital in England with COVID-19 (just shy of the January 2022 peak of over 17,000) although more positively, the rate of admissions is starting to slow. In regions including the south west, south east and east of England, the current patients in hospital comfortably eclipses January 2022 though (and some of our members have told us it eclipses any point during the pandemic). We covered some of the regional disparities and COVID-19 challenges last month, and the pressures of absence.
COVID-19 is therefore driving added pressures on capacity including having a negative impact on the elective recovery. The proportion of beds with patients with COVID-19 has risen, and reports of challenging absence figures are laid bare by the latest figures accompanied by rising demand, which some of our members have called a ‘perfect storm’.
This all has an impact on patient flow; one ambulance service this week reported the second highest level of lost hours due to handover delays ever in February 2022 and the statistics above show the ongoing record volumes of ambulances queuing outside emergency departments.
Winter pressures are not over, and in a number of areas these pressures are getting worse.
The Health Foundation also produced a piece looking at other performance metrics and how they compare against the winter of 2019/20.
How is the NHS performing?
View our analysis of the latest NHS performance figures for a rounded view of how healthcare services are coping under immense pressure.
