How is the NHS performing this winter? 10 to 16 January in review

At a glance

• Although Omicron is still having different effects on different regions, the number of patients in hospital with COVID-19 has encouragingly followed other indicators such as new admissions and cases, showing a downturn in all regions.
• Staff absences across acute trusts in England were also down by 13 per cent, falling in all regions. Allowing for some discrepancies in the data, the biggest reduction remained in London where absence fell 17 per cent.
• On an average day in week ending 16 January, 12,438 inpatients (59.4 per cent) no longer meeting the criteria to reside in hospital were not able to be discharged on the day out of an average 21,042 patients who were medically fit to leave. This was a minor improvement on last week, but a continued cause of concern with pressures on the care sector and other NHS services delaying discharge.
• There was a 2.9 per cent in ambulance arrivals week on week after they had reduced week ending 9 January, but ambulance handover metrics were more positive. While still at record levels for this time of the year, the proportion of handovers delayed over 30 minutes dropped from 22.6 per cent to 17.9 per cent, while handovers taking over 60 minutes dropped from 9.8 per cent to 6.7 per cent.

COVID-19

The seven-day average of COVID-19 patients in hospital has started to drop, falling to 16,355 after the release of data on 19 January, having been as high as 16,696 after data was released on 15 January.

This seven-day average is now declining in all regions, following the decrease in new hospital admissions. Fewer patients were in hospital with COVID-19 on the 19 January than the 12 January in all regions.

The below chart shows how the current figure of patients in hospital compares to the previous two peaks, now numbers have started to decrease across England:

The latest primary diagnosis supplement of data released on 20 January shows 52.1 per cent of these patients in acute trusts were primarily being treated for COVID-19 as opposed to being in hospital with COVID-19. This has decreased through the winter, having been as high as 76.2 per cent in October 2021. 

It is also encouraging that the steep decrease in cases (latest figures show a seven-day average of 79,670.7 cases by specimen date in England, when this had been over 157,000 and 200,000+ cases were reported on one day on 4 January) is supported by the latest ONS prevalence stats which showed around 1 in 20 people testing positive for COVID-19, down from 1 in 15 the previous week.

This indicator typically lags behind the government’s case data, as prevalence lags incidence (people will still test positive after being first recorded as a case).

Absence

The total number of COVID-19 absences in acute trusts is encouragingly down by 22.3 per cent in week ending 16 January compared to the previous week. When trusts for whom figures are not available this week are removed entirely, this is adjusted down to a 21.1 per cent decrease. Note that data in the SitRep is collected on a rapid-turn around basis and with minimal validation.

A comparison with available absence data for last winter also shows a significant drop in COVID-19 absences from record levels last week:

With COVID-19 driving the overall absence pattern, it’s not surprising to see the national absence figure down 12.7 per cent, with over 77,000 staff off on an average day compared to 88,500 in the previous week. Adjusted for trusts that didn’t submit data, this is down 11.7 per cent.

One concern is that the jump in cases in children could be having some impact on staff shortages. Data from the government’s COVID-19 dashboard shows that one demographic where cases are increasing is children, with case rates in under 5s more than three times last winter’s peak (as reported in the Financial Times).

Bed occupancy

General and acute

General and acute bed occupancy for adults and paediatric was 91.6 per cent for week ending 16 January. The highest it has been this winter is 93.3 per cent week ending 12 December, and it was 91.4 per cent in the previous week, having dropped over the Christmas period. This continues to trend above last year (87.5 per cent in the second week of January) but below the previous three years where it averaged between 94.3 and 94.8 per cent.
 

In previous years adult and paediatric beds were not split in the dataset, the figures for these this week are 93.2 per cent on an average day for adults, and 67.2 per cent for paediatric.

As per the dataset, caution should be exercised in bed occupancy rates with challenges such as infection prevention control meaning beds are being deployed differently in hospitals. Capacity pressures are generally experienced at lower overall occupancy rates than would previously have been the case, and staffing pressures as described later in this article contribute to this.

Critical care

In the equivalent week last year, adult critical care bed occupancy was 86.3 per cent; considerably higher than the 76.16 record this week. That figure was with an average 5,820 beds open (2020/21) compared to 4,110 this year. One potential reason for this may be the reported reduction in omicron patients ending up in critical care compared to previous strains of the virus, which also seems apparent when considering London, which peaked with omicron earlier, had the highest percentage of adult critical care beds occupied up to week commencing 16 January at 84.35 per cent.

Discharge

On an average day in the week ending 16 January, 12,438 inpatients (59.4 per cent) no longer meeting the criteria to reside in hospital were not able to be discharged on the day out of an average 21,042 patients who were medically fit to leave. This is down from the previous week’s average, in which 11,795 patients out of 19,460 (60.6 per cent) could not be discharged.

89.9 per cent of patients who had been in hospital for more than three weeks and no longer met the criteria to reside in hospital could not be discharged, further emphasising pressure in other NHS services and the care sector. This was slightly down from 90.6 per cent in the previous week

Ambulance handover delays

Last week’s performance stats highlighted high activity in the ambulance service in December 2021 and in particular, a record number of calls (82,361) for category 1 ambulances (where an immediate response is required to a life threatening condition, such as cardiac or respiratory arrest). The high levels of activity alongside challenges in discharging patients have added to issues with ambulance handover delays, however there were signs of improvement in today’s SitRep.

For week ending 16 January, there were over 2,300 more ambulance arrivals than the previous week (up 2.9 per cent to 83,492). Although this shows added pressure, the significance can be overstated as arrivals had been over 83,000 in every SitRep so far this winter bar the previous week.

And despite the increase in arrivals compared to the previous week, the number of arrivals delayed over 30 minutes dropped from 22.6 per cent to 17.9 per cent, while over 60 minutes dropped from 9.8 per cent to 6.7 per cent.

The below chart showing delays over 60 minutes shows there are still issues compared to previous winters, but a downturn in raw numbers of delays having risen back up after Christmas and New Year.