NHS Winter Pressures 2017/18, England

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1 BRIEFING PAPER Number 8210, 3rd April 2018 NHS Winter Pressures 2017/18, England By Carl Baker Contents: 1. Introduction & Context 2. Emergency Care 3. Ambulances and NHS Beds and capacity

2 2 NHS Winter Pressures 2017/18, England Contents 1. Introduction & Context 2 Summary Graphic 3 2. Emergency Care A&E attendances and waiting times Emergency Admissions and Trolley Waits 5 Map of A&E performance in England A&E Diverts 7 3. Ambulances and NHS Ambulance handover delays Ambulance response times NHS Beds and capacity Bed availability and occupancy Delayed discharges Beds closed due to norovirus Cancelled operations Introduction & Context Over the winter period, NHS England publishes daily situation reports on winter pressures facing acute hospital trusts and NHS 111 providers. NHS England states that the winter dataset is subject to only minimal validation because it is turned around quickly, but that it is nevertheless fit for purpose. Unless otherwise specified, data in this publication is sourced from these winter situation reports. This year, data on ambulance handover delays and the number of long stay patients was added to the publication. However, data on operational pressure escalation levels was removed from the publication. This system is still in use, but data on which trusts reported major pressures and/or problems delivering comprehensive care was not made public this winter. This briefing gives an overview of NHS data on demand, supply and performance in England. Other external data is also relevant to understanding winter pressures. For instance, Public Health England releases a weekly bulletin on levels of influenza. Flu outbreaks can cause severe pressure on the NHS. The data for this winter shows that the number of acute respiratory outbreaks and hospitalisations from January onwards was higher than in winter 2016/17, the rate of GP consultations for flu-like illnesses was higher than usual levels. Similar winter situation reports are not published in Scotland, Wales or Northern Ireland, although routine performance data can be accessed at the following links: ISD Scotland StatsWales Department of Health Northern Ireland Cover page image: George Hodan (public domain)

3 NHS winter pressures in England, 2017/18 Hospital accident & emergency attendances rose by 1.6% compared with last winter. 22.9% of patients spent longer than 4 hours in A&E, compared with 20.7% last winter and 6.2% in 2010/11. The number of A&E diverts for temporary respite was down on last year. Emergency admissions were up 6% on last year. The number of 12-hour waits for admission hit a new high. WINTER PATIENTS SPENDING OVER 4 HOURS IN HOSPITAL A&E 22.9% 20.7% 16.3% 13.7% 8.2% 6.2% 6.7% 7.5% 2010/ / / / NUMBER OF HOSPITAL TRUSTS OVER 99% BED OCCUPANCY EACH DAY Christmas period 3rd Jan 20-Nov 11-Dec 01-Jan 22-Jan 12-Feb General & acute bed occupancy was 94.4% and was over 90% for all but four days this winter. On average, 20 hospital trusts had occupancy over 99% each day. On average there were 1,100 fewer beds available each day than last winter. But there were also 1,500 fewer beds each day lost to delayed discharges than last winter. Norovirus bed closures were at their highest level for 3 years. 13,445 ambulances arrived at England's hospitals each day. One in eight ambulance handovers were delayed by more than 30 minutes over the winter, peaking at one in four on 2nd January. 3% of handovers were delayed by more than an hour over the winter, with a peak of 9% on 2nd January. 25% 20% 15% 10% AMBULANCE HANDOVERS DELAYED BY MORE THAN 30 MINUTES 2nd Jan NHS 111 received an average of 43,000 calls per day. 27% of calls weren't answered within 60 seconds, peaking at 60% on 24th December. 5% 0% 20-Nov 11-Dec 01-Jan 22-Jan 12-Feb

4 4 NHS Winter Pressures 2017/18, England 2. Emergency Care 2.1 A&E attendances and waiting times Between December 2017 and February 2018, 3.7 million people attended major hospital accident and emergency departments in England. 1 This is 1.6% higher than the same period last year an extra 637 attendances per day across England. A&E attendances don t peak in the winter there were around 41,000 attendances per day over this period, compared with over 43,000 attendances per day in June and July last year but the increased severity of cases can lead to greater pressure. The percentage of patients spending longer than 4 hours in A&E (measured from arrival to departure or admission) was higher than in recent years, at 22.9% over the winter period. The number of patients seen in under four hours was also the lowest it has been in recent years. The table and chart below show trends on these measures. 2 Winter pressures data for all acute hospital trusts in England is available to browse in our downloadable tables. WINTER A&E WAITING TIMES IN ENGLAND December to February each year. Type 1 departments only % Over 4 Number of Number over Number under Year hours attendances 4 hours 4 hours 2010/11 6.2% 3,347, ,000 3,140, /12 6.7% 3,400, ,000 3,171, /13 8.2% 3,437, ,000 3,155, /14 7.5% 3,399, ,000 3,145, / % 3,438, ,000 2,967, / % 3,701, ,000 3,099, / % 3,642, ,000 2,889, / % 3,700, ,000 2,853,000 Patients spending longer than 4 hours in A&E each winter: 2010/ / / / / / / /18 6.2% 6.7% 8.2% 7.5% 13.7% 16.3% 20.7% 22.9% 1 These departments are known as type 1 by NHS England, and are defined as those offering a 24-hour consultant-led service. Typical hospital A&E departments fall under this category. Data is also collected on attendances at walk-in-centres, minor injury units and other minor A&E facilities. That data isn t discussed here. 2 Data in this section is taken from NHS England, Accident and Emergency Attendances and Admissions.

5 5 Commons Library Briefing, 3rd April 2018 The tables below shows which NHS trusts had the highest and lowest percentage of patients spending over 4 hours in A&E. At 19 out of 137 trusts, four-hour waits accounted for more than one-third of attendances. At 13 trusts, less than 10% of attendees spent 4+ hours in A&E. The map on the following page shows data on each trust. Highest percentage of 4+ hour waits Lowest percentage of 4+ hour waits Blackpool Teaching Hospitals NHSFT 51.9% Luton & Dunstable University Hospital NHSFT 3.1% The Hillingdon Hospitals NHSFT 45.7% Sheffield Children's NHSFT 3.5% Royal Cornwall Hospitals NHST 42.6% Yeovil District Hospital NHSFT 5.3% University Hospitals Of North Midlands NHST 41.4% Homerton University Hospital NHSFT 5.7% Norfolk & Norwich University Hospitals NHSFT 39.5% Birmingham Women's & Children's NHSFT 5.9% Worcestershire Acute Hospitals NHST 38.9% Alder Hey Children's NHSFT 6.5% Lancashire Teaching Hospitals NHSFT 38.9% Royal Surrey County Hospital NHSFT 6.8% Shrewsbury & Telford Hospital NHST 38.7% Dorset County Hospital NHSFT 7.2% Imperial College Healthcare NHST 37.4% Chesterfield Royal Hospital NHSFT 8.1% Portsmouth Hospitals NHST 37.0% Chelsea & Westminster Hospital NHSFT 8.3% 2.2 Emergency Admissions and Trolley Waits The number of emergency admissions to hospital over the winter period was also at its highest level, at 1.52 million, up from 1.44 million in 2016/17. This is an average increase of 944 emergency admissions per day across England. WINTER EMERGENCY ADMISSIONS AND TROLLEY WAITS December to February each year % 4 hour Emergency 4 hour waits 12 hour waits waits for admissions for admission for admission Year admission 2010/11 2.7% 1,295,939 34, /12 3.1% 1,298,407 40, /13 4.3% 1,293,341 55, /14 4.0% 1,340,293 53, /15 9.1% 1,372, ,043 1, /16 9.4% 1,435, , / % 1,437, ,651 1, / % 1,522, ,694 1,914 Patients waiting longer than 4 hours for admission each winter: 2010/ / / / / / / /18 2.7% 3.1% 4.3% 4.0% 9.1% 9.4% 13.7% 14.5%

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7 7 Commons Library Briefing, 3rd April 2018 The number of cases where patients waited over 4 hours to be admitted to hospital after a decision to admit was made so-called trolley waits also rose, from 198,000 last winter to 221,000 this winter. There was also record number of 12-hour trolley waits, at 1,914 compared with 1,880 last winter. The percentage of all admissions which resulted in trolley waits of over 4 hours rose to its highest winter level, 14.5%. The left-hand table below shows the trusts with the highest number of 12-hour trolley waits between December 2017 and February Two trusts, University Hospital of North Midlands and North Bristol, accounted for almost one-third of all 12-hour trolley waits in England. The right-hand table below shows which trusts had the highest level of four-hour waits for admission, calculated as a percentage of total admissions. At eight trusts, more than one-third of those admitted waited longer than four hours after a decision to admit was made. At 35 of 137 trusts, however, less than 5% of those admitted had to wait over 4 hours. Highest number of 12-hour trolley waits Highest percentage of 4-hour trolley waits University Hospitals Of North Midlands NHST 332 Blackpool Teaching Hospitals NHSFT 48.6% North Bristol NHST 255 The Princess Alexandra Hospital NHST 38.9% Blackpool Teaching Hospitals NHSFT 181 West Hertfordshire Hospitals NHST 38.5% Portsmouth Hospitals NHST 146 Worcestershire Acute Hospitals NHST 37.9% Southport & Ormskirk Hospital NHST 131 George Eliot Hospital NHST 37.4% Brighton & Sussex University Hospitals NHST 96 Southport & Ormskirk Hospital NHST 35.7% Stockport NHSFT 85 Warrington & Halton Hospitals NHSFT 35.6% University Hospitals Of Morecambe Bay NHSFT 77 Kettering General Hospital NHSFT 34.0% Oxford University Hospitals NHSFT 74 Isle Of Wight NHST 33.1% Shrewsbury & Telford Hospital NHST 51 Portsmouth Hospitals NHST 33.0% 2.3 A&E Diverts Between 20 th November and 4 th March there were 386 accident and emergency diverts. These are cases where a temporary divert is agreed from one A&E to another to provide temporary respite. Only diverts with a specific agreement between trusts are counted. NHS England says that diversion of patients for respite should only happen in exceptional circumstances, where internal measures have not solved the underlying problem. 3 The level of diverts was below that seen last winter, and the bulk of diverts where concentrated in a handful of NHS trusts. The chart below shows data comparing recent winters for 1 Dec to 28 Feb only, since data for previous years was published over different time periods. 3 NHS England Daily SitRep Guidance

8 8 NHS Winter Pressures 2017/18, England THERE WERE FEWER A&E DIVERTS BETWEEN DEC AND FEB THAN LAST YEAR, BUT MORE THAN PREVIOUS YEARS / / / / / / /18 On 27 th January, eight separate trusts registered A&E diverts the highest number on any day this winter. The highest total number of total diverts was 14, on 1 st January largely because Gateshead trust registered 6 diverts on that day. The table below shows the ten trusts which registered the most A&E diverts between 20 th November and 4th March. Highest number of A&E diverts Worcestershire Acute Hospitals NHST 105 Gloucestershire Hospitals NHSFT 38 York Teaching Hospital NHSFT 26 Gateshead Health NHSFT 22 County Durham & Darlington NHSFT 19 Northumbria Healthcare NHSFT 14 West Hertfordshire Hospitals NHST 12 Brighton & Sussex University Hospitals NHST 12 Wrightington, Wigan & Leigh NHSFT 10 Portsmouth Hospitals NHST Ambulances and NHS Ambulance handover delays NHS England say that the handover of patients from an ambulance to a hospital emergency department should take no longer than 15 minutes. 4 On 186,000 occasions this winter, an ambulance arriving at hospital was delayed by more than 30 minutes in handing over its patient(s) to the hospital. This amounts to 13% of all ambulance arrivals at hospital between 20 th November and 4 th March, - just over one in 4 NHS England, Ambulance Handover Letter Nov 2017

9 9 Commons Library Briefing, 3rd April 2018 eight. Of these, 42,000 handovers were delayed for more than 60 minutes 3% of all arrivals, or one in every 34. Data on ambulance handover delays wasn t collected in 2015/16 or 2016/17, but we can compare with earlier years. The chart below shows delays over 30 minutes for a comparable period covering December 1 to February 28 for each year in question. 5 The number of delays in 2017/18 was substantially higher than previous years. 6 AMBULANCE HANDOVER DELAYS ROSE BY 72% COMPARED WITH 2014/15 163,298 58,001 76,087 54,463 94,953 No data No data 2011/ / / / / / /18 In 2017/18 delays peaked in the period after Christmas. On 2 nd January, one quarter of all ambulance arrivals were delayed for over 30 minutes and 9% were delayed for over 60 minutes. On 23 separate days, more than 15% of ambulances were delayed by over 30 minutes. 26 th November had the lowest percentage of delays, at 8.2%. At some NHS trusts the level of delays was substantially above average. The tables below show the trusts with the highest percentage of ambulance handovers delayed by 30+ minutes or 60+ minutes. At United Lincolnshire Hospitals trust, almost half of all ambulance arrivals were delayed by 30 minutes. Six trusts reported zero 30-minute ambulance handover delays over the winter: Homerton Hospital (Hackney), Royal Free London, Alder Hey, North Bristol, Royal United Hospitals Bath, and Yeovil District Hospital. A further four trusts reported that less than 1% of handovers were delayed by 30+ minutes. 5 This means that the 2017/18 total (163,298) for Dec-Feb does not match the figure for the entire winter quoted before (186,000, which covers 20 Nov to 4 Mar). 6 Note that for previous years the total number of ambulance arrivals was not published, so it s not possible to compare the percentage of arrivals delayed.

10 10 NHS Winter Pressures 2017/18, England Ambulance handovers delayed over 30 mins Ambulance handovers delayed over 60 mins United Lincolnshire Hospitals NHST 48% United Lincolnshire Hospitals NHST 20% Lancashire Teaching Hospitals NHSFT 39% Lancashire Teaching Hospitals NHSFT 17% The Queen Elizabeth Hospital, King's Lynn, NHSFT 34% The Queen Elizabeth Hospital, King's Lynn, NHSFT 14% Worcestershire Acute Hospitals NHST 31% Portsmouth Hospitals NHST 12% The Princess Alexandra Hospital NHST 30% Southport & Ormskirk Hospital NHST 11% Kettering General Hospital NHSFT 30% North West Anglia NHSFT 10% East Lancashire Hospitals NHST 28% Wrightington, Wigan & Leigh NHSFT 10% North West Anglia NHSFT 27% York Teaching Hospital NHSFT 9% Portsmouth Hospitals NHST 27% Kettering General Hospital NHSFT 8% Sherwood Forest Hospitals NHSFT 26% Worcestershire Acute Hospitals NHST 8% Note that there some reported discrepancies between the number of delays registered by trusts, and the number registered by corresponding ambulance trusts Ambulance response times The target that the most life-threatening Category calls should receive an emergency response at the scene in an average of seven minutes was not met in winter 2017/18. The table below shows monthly data covering the winter period. Only North East Ambulance Service met the seven minute target in each of these months. Values in this table are shaded, with darker shading indicating worse waiting time performance. AVERAGE RESPONSE TIME TO CATEGORY 1 AMBULANCE CALLS (Target: 7 mins) Ambulance Service Dec-17 Jan-18 Feb-18 England 08m 52s 08m 19s 08m 16s East Midlands 09m 38s 09m 19s 09m 27s East 09m 12s 08m 35s 08m 42s London 07m 24s 07m 10s 07m 26s North East 06m 57s 06m 32s 06m 34s North West 11m 17s 09m 51s 08m 51s South Central 07m 42s 07m 04s 07m 05s South East Coast 08m 31s 07m 51s 08m 18s South West 10m 20s 09m 11s 09m 19s West Midlands 07m 03s 06m 48s 07m 03s Yorkshire 08m 12s 08m 10s 08m 07s Because the classification of 999 calls and the waiting time targets for these services have recently changed, it s not possible to compare trends in call volume or waiting times to previous years. The 7-minute target is one of several target response times for ambulance services. See NHS England s Ambulance Quality Indicators 7 See BBC News, East of England Ambulance delay discrepancies 'worrying'', 8 Feb 2018

11 11 Commons Library Briefing, 3rd April 2018 for the full data, and our publication NHS Key Statistics for a discussion of the new targets. 3.3 NHS 111 NHS 111 is a non-emergency telephone line for healthcare advice. Throughout the winter, daily data is published on the activity and performance of these services, including the number of calls, the number that were answered within 60 seconds, and the number of callers that were advised to attend A&E. 8 Call volume Between 20 th November and 4 th March, NHS111 services answered an average of 43,000 calls per day. This compares to an average of 20,500 emergency ambulance responses per day over the winter. The highest number of calls answered was 86,400 on Saturday 23 rd December, followed by 82,700 on Saturday 30 th December. The number of calls on Saturday and Sundays was around double the number on weekdays. Calls answered within 60 seconds Over the winter period, 73% of calls were answered within 60 seconds, compared with around nine in ten in winter 2016/17. However there was substantial variation between different days and different providers. The chart below shows the percentage of calls not answered within 60 seconds for England as a whole, each day over the winter. 8 Data in this section is taken from the NHS 111 time series data published by NHS England.

12 12 NHS Winter Pressures 2017/18, England On Christmas Eve, 60% of calls were not answered within 60 seconds the highest percentage of any day this winter. This performance is substantially lower than the worst day in winter 2016/17, 27 th Dec, when 36% of calls were not answered within 60 seconds. Throughout the winter there was a weekly pattern, with 60-second answering times on Saturday tending to be worse than other days. As the chart shows, weekend response times became progressively worse throughout the winter, with the last Saturday of reporting (3 rd March) seeing the worst performance of any day outside the Christmas and New Year period. The table below shows which NHS 111 areas had the best and worst call answering timeliness over the winter period. South East Coast (excl. East Kent) had the lowest performance, answering only 52% of its calls within 60 seconds. By contrast, in East London & City, 91% of calls were answered within 60 seconds. Lowest % NHS 111 calls answered in 60 secs Highest % NHS 111 calls answered in 60 secs South East Coast exc East Kent NHS % East London & City NHS % Bath/NE Somerset & Wiltshire NHS % Isle Of Wight NHS % Gloucestershire & Swindon NHS % South East London NHS % Bristol, N Somerset & S Gloucestershire NHS % Dorset NHS % West Midlands NHS % Outer North East London NHS % East Kent NHS % Yorkshire And Humber NHS % Hillingdon London NHS % North East England NHS % North West London NHS % Cornwall NHS % Norfolk incl. Great Yarmouth & Waveney NHS % Thames Valley NHS % North West inc Blackpool NHS % Staffordshire NHS % Looking at daily data, there were several cases where an NHS 111 service answered 10% or less of its calls within 60 seconds. These are shown below. The lowest performance, of 4% within 60 seconds, was registered by Oxfordshire NHS 111 on 24 th December. 9 WORST DAILY NHS 111 PERFORMANCE, WINTER 2017/18 Service Within 60 secs Date Oxfordshire NHS 111 4% 24-Dec Berkshire NHS 111 5% 24-Dec South East Coast exc East Kent NHS 111 6% 24-Dec Mainland Ship NHS 111 8% 24-Dec Buckinghamshire NHS 111 9% 24-Dec East Kent NHS % 30-Dec 9 Note that Mainland Ship NHS 111 covers Southampton, Hampshire, Isle of Wight and Portsmouth.

13 13 Commons Library Briefing, 3rd April 2018 Callers recommended to attend A&E Over the winter period, an average of 3,000 callers to NHS 111 each day were advised to attend an accident and emergency department around 1 in every 14 callers. This varied in different parts of England in North Central London, 10.4% of callers were advised to attend A&E, while in Hertfordshire, 2.8% were advised to attend A&E. Over the winter, the daily average A&E attendance level was 65,000 (including minor departments). So if each person advised to attend A&E as a result of an NHS 111 had attended, they would have comprised around 5% of attendances. The proportion of NHS 111 callers advised to attend A&E was lower at weekends, suggesting that the average severity of a weekend call may be lower than a weekday call. Ambulance dispatches Each day an average of 5,000 ambulances were dispatched by NHS 111 call handlers, meaning that around one in nine NHS 111 calls answered resulted in an ambulance dispatch. Again, this varied across England. In Devon, 16.9% of NHS 111 calls resulted in an ambulance dispatch, while in Hertfordshire the figure was 6.4%. The proportion of NHS 111 calls resulting in an ambulance dispatch was lower at weekends, once again suggesting a lower average call severity at weekends. 4. Beds and capacity 4.1 Bed availability and occupancy Acute NHS trusts in England had fewer beds available on average this winter than in previous winters. Looking at the comparable period from December to February, there were around 1,100 fewer beds available than in 2016/17 (1.1%) and 2,300 fewer than in 2011/12 (2.3%). 10 The highest number of beds available was 99,298 on Monday 19 th February. Average occupancy (excluding weekends) was 95.2% - higher than in 2016/17, but lower than in 2015/16. The table below shows the average number of beds available, and the average occupancy, for each winter period since 2011/12. This data covers December to February only. 10 This calculation excludes weekend data, since in years prior to 2015/16, bed availability data was not published at weekends.

14 14 NHS Winter Pressures 2017/18, England AVERAGE GENERAL & ACUTE BEDS AVAILABLE/OCCUPIED December to February each year Year Beds Occupancy 2011/12 100, % 2012/13 100, % 2013/14 99, % 2014/15 100, % 2015/16 99, % 2016/17 98, % 2017/18 97, % Occupancy levels followed a largely consistent pattern throughout the winter, with rates highest at the beginning of the week and lowest on Saturdays. There was also a dip in occupancy over the Christmas period. The highest occupancy was 96.1% on Tuesday 20 th February, and the lowest was 84.2% on 24 th December. There were only four days where occupancy was below 90%. Occupancy was over 95% on just over half of all days in the winter. Occupancy varied substantially across the countries. Some NHS trusts were at or near full capacity on each day of the winter. The table below shows the trusts with the highest average occupancy between 20 th November and 4 th March.

15 15 Commons Library Briefing, 3rd April 2018 Highest average bed occupancy Walsall Healthcare NHST 99.7% North Middlesex University Hospital NHST 99.5% The Princess Alexandra Hospital NHST 99.3% The Hillingdon Hospitals NHSFT 99.3% Northampton General Hospital NHST 99.2% Basildon & Thurrock University Hospitals NHSFT 99.1% James Paget University Hospitals NHSFT 99.1% Kettering General Hospital NHSFT 99.0% King's College Hospital NHSFT 99.0% Worcestershire Acute Hospitals NHST 99.0% There was a daily average of 20 trusts (out of 137 reporting data) above 99% bed occupancy and 75% above 95% occupancy. The chart overleaf shows how these numbers changed through the winter. The number of trusts over 99% peaked just after New Year, at 36 on Wednesday 3 rd January. This number was almost matched on the last day of winter reporting, Sunday 4 th March, at 34. The number of trusts over 95% occupancy also peaked on 3 rd January at 98 more than 70% of all trusts. Even on the lowest day of occupancy, 24 th December, two trusts had occupancy over 99%: Walsall trust and Buckinghamshire trust. The tables below show the trusts which spent the most days over 99% occupancy (left) and 95% occupancy (right). There were 105 days in the winter data period, meaning that Basildon & Thurrock trust spent each day over 95%, and that Walsall trust spent all but 11 days over 99%.

16 16 NHS Winter Pressures 2017/18, England Most days over 99% bed occupancy Most days over 95% bed occupancy Walsall Healthcare NHST 94 Basildon & Thurrock University Hospitals NHSFT 105 North Middlesex University Hospital NHST 86 Northampton General Hospital NHST 104 The Princess Alexandra Hospital NHST 84 Worcestershire Acute Hospitals NHST 104 The Hillingdon Hospitals NHSFT 83 Walsall Healthcare NHST 103 James Paget University Hospitals NHSFT 76 North Middlesex University Hospital NHST 103 Basildon & Thurrock University Hospitals NHSFT 75 The Hillingdon Hospitals NHSFT 103 Kettering General Hospital NHSFT 73 Kettering General Hospital NHSFT 103 King's College Hospital NHSFT 72 King's College Hospital NHSFT 102 Northampton General Hospital NHST 69 Wirral University Teaching Hospital NHSFT 102 Croydon Health Services NHST 68 London North West Healthcare NHST 101 Escalation beds An escalation beds are temporary beds to provide extra capacity. They are usually closed as they are additional to the substantive, funded and staffed bed stock. So a higher number of escalated beds shows a high level of pressure on a trust. Before the Christmas period in 2017 the number of escalation beds open was around 2,500 per day in England. After Christmas this rose to around 4,500 per day. These levels are similar to winter 2016/17. However, in 2016/17 the number of escalation beds began to gradually fall in February, suggesting a decline in pressure. In 2017/18, the number of escalation beds remained constant until the end of the winter reporting period, suggesting that pressure did not abate. The table below shows the trusts where escalation beds made up the largest proportion of total available beds between 20 th November and 4 th March

17 17 Commons Library Briefing, 3rd April 2018 Highest reliance on escalation beds Barnsley Hospital NHSFT 18% The Whittington Hospital NHST 17% Walsall Healthcare NHST 13% Aintree University Hospital NHSFT 13% Great Western Hospitals NHSFT 11% Chelsea & Westminster Hospital NHSFT 10% Bedford Hospital NHST 10% Croydon Health Services NHST 9% Harrogate & District NHSFT 9% North Middlesex University Hospital NHST 9% Beds occupied by long stay patients This new measure for 2017/18 presents the number of beds on each day that were occupied by patients who had been in hospital for over 7 days and over 21 days. As NHS Providers note, this doesn t distinguish between those still needing care and those whose discharge has been delayed. It also may be influenced by norovirus, since patients with norovirus or on an infected ward can t be discharged back to anywhere with other vulnerable people, for example a care home, even if they no longer require hospital care. 11 On average over the winter period, 45.7% of available beds were occupied by long stay patients over 7 days, and 17.7% were occupied by long stay patients over 21 days. This fluctuated relatively little between 20 th November and 4 th March, but it is notable that the very highest levels of long stay patients 48.7% over 7 days and 18.8% over 21 days - was observed on the final day of winter reporting, Sunday 4 th March. The tables below show the trusts which had the highest percentage of their bed days occupied by long stay patients across the whole winter period. Beds occ'd by long stay patients (>7 days) Beds occ'd by long stay patients (>21 days) Homerton University Hospital NHSFT 83% Homerton University Hospital NHSFT 48% Northampton General Hospital NHST 65% Northampton General Hospital NHST 32% Leeds Teaching Hospitals NHST 61% Leeds Teaching Hospitals NHST 29% University Hospitals Birmingham NHSFT 61% Portsmouth Hospitals NHST 28% University Hospital Southampton NHSFT 60% Birmingham Women's & Children's NHSFT 28% Portsmouth Hospitals NHST 59% Kettering General Hospital NHSFT 28% Harrogate & District NHSFT 58% Barts Health NHST 27% The Whittington Hospital NHST 58% Manchester University NHSFT 26% Oxford University Hospitals NHSFT 58% Salford Royal NHSFT 25% Mid Cheshire Hospitals NHSFT 58% Oxford University Hospitals NHSFT 25% 11 NHS Providers, Winter Pressures: Getting Underneath the Data

18 18 NHS Winter Pressures 2017/18, England 4.2 Delayed discharges Delayed discharges, also known as delayed transfers of care, occur when a patient is ready to leave their current level of care but are delayed in doing so. This can lead to beds being unavailable for patients waiting to be admitted, so can cause issues with patient flow. In December and January, around 3.7% of possible bed days were lost to delayed discharges across England. 12 After reducing delayed discharges formed a key part of the NHS England Mandate for 2017/18, the number of delays fell by around a quarter compared with last winter, from 6,338 per day to 4,800 per day. Delays due to social care fell by 30% and delays due to the NHS fell by 21%. Nevertheless, the level of delays was higher than this winter than in or ON AVERAGE, 1,500 FEWER BEDS WERE LOST TO DELAYED DISCHARGES EACH DAY THAN LAST YEAR Year Total Responsible organisation Estimated NHS Social Care Both bed days ,821 2, % ,668 3,129 1, % ,056 3,083 1, % ,338 3,573 2, % ,800 2,833 1, % NHS Social Care Both 6,000 4,000 2, The tables below show the acute providers which lost the largest percentage of possible overnight bed days to delayed discharges in December and January. 12 This is calculated using data for all NHS providers where data on the number of beds available overnight is available. 13 Data in this section is taken from NHS England s Delayed Transfers of Care data.

19 19 Commons Library Briefing, 3rd April 2018 BED DAYS LOST TO DELAYED DISCHARGES Burton Hospitals NHSFT 8.9% North Cumbria University Hospitals NHST 8.1% University Hospital Southampton NHSFT 7.6% Cambridge University Hospitals NHSFT 7.6% South Warwickshire NHSFT 7.2% Oxford University Hospitals NHSFT 7.1% Lancashire Teaching Hospitals NHSFT 6.9% Milton Keynes University Hospital NHSFT 6.8% Hampshire Hospitals NHSFT 6.7% Bolton NHSFT 6.7% The tables below show delayed discharges in December and January apportioned to the local authority where the patient is resident, and calculated as a crude rate per 1,000 resident population. Plymouth, Cumbria and Hampshire had the highest rates of delayed transfers, with Sunderland, Sandwell and Barking having the lowest. HIGHEST RATES OF DELAYED DISCHARGES LOWEST RATES OF DELAYED DISCHARGES Plymouth 14.6 per 1,000 Sunderland 1.2 per 1,000 Cumbria 13.9 Sandwell 1.2 Hampshire 10.9 Barking & Dagenham 1.2 Cornwall 10.4 Merton 1.3 Oxfordshire 10.4 Sutton 1.4 Stoke-On-Trent 10.2 Waltham Forest 1.4 Dorset 10.0 Bradford 1.4 Bury 9.9 Luton 1.5 Sheffield 9.4 Barnsley 1.6 Bristol 9.2 County Durham Beds closed due to norovirus Norovirus, which causes diarrhoea and vomiting, often peaks in winter, and NHS trusts take measures to contain the infection. When a case is identified, it is often necessary to close not only the bed occupied by the infected patient, but other beds in the same ward. The level of norovirus bed closures was higher this winter than in 2015/16 and 2016/17, but lower than in previous years. The chart below shows the average daily number of bed closures across England This excludes weekends for 2016/17 and 2017/18 since data from previous years did not cover weekends.

20 20 NHS Winter Pressures 2017/18, England NOROVIRUS BED CLOSURES WERE HIGHER THAN THE LAST TWO WINTERS BUT DOWN ON PREVIOUS YEARS 2,186 Average daily closures 1,432 1, / / / / / / /18 As the chart below shows, there were three main peaks in norovirus closures this winter: around 10 th December; around 4 th January; and around 21 st February. Closures also spiked on the final day of reporting, 4 th March. 1,400 1,200 1, NOROVIRUS BED CLOSURES WERE HIGHEST IN EARLY DECEMBER 0 20 Nov 04 Dec 18 Dec 01 Jan 15 Jan 29 Jan 12 Feb 26 Feb The tables below show the trusts that had the highest levels of norovirus bed closures this winter. The left table shows the highest number of closures, while the right table shows the number of closures measured against daily bed availability.

21 21 Commons Library Briefing, 3rd April 2018 Highest bed days lost to norovirus closures Highest % bed days lost to norovirus St George's University Hospitals NHSFT 4,878 Weston Area Health NHST 12% Taunton & Somerset NHSFT 4,503 Kingston Hospital NHSFT 9% Kingston Hospital NHSFT 3,826 Taunton & Somerset NHSFT 7% King's College Hospital NHSFT 3,319 St George's University Hospitals NHSFT 5% Weston Area Health NHST 3,318 Yeovil District Hospital NHSFT 5% University Hospitals Of Leicester NHST 2,337 The Rotherham NHSFT 5% The Rotherham NHSFT 2,247 The Princess Alexandra Hospital NHST 4% Northumbria Healthcare NHSFT 2,161 Northern Lincolnshire & Goole NHSFT 3% Northern Lincolnshire & Goole NHSFT 2,050 Milton Keynes University Hospital NHSFT 2% Yeovil District Hospital NHSFT 1,959 King's College Hospital NHSFT 2% 4.4 Cancelled operations As was widely reported, NHS England asked trusts to cancel non-urgent operations for part of the winter. 15 These will be unlikely to appear in NHS England s routine publications on cancelled operations, because these measure only operations which were cancelled at the last minute (i.e. on the day of the operation). NHS England recently published an assessment of cancelled non-urgent operations in January 2018, concluding that there were 22,800 fewer elective admissions compared with the previous January. This amounts to a fall in activity of 3%. 16 Note, however, that these cancellations were reported in some parts of the country to have recurred during later parts of the winter, up to the end of March. 15 See e.g. NHS England, Operational update from the NHS National Emergency Pressures Panel, 2 Jan NHS England, Deferred Elective Activity in January 2018

22 About the Library The House of Commons Library research service provides MPs and their staff with the impartial briefing and evidence base they need to do their work in scrutinising Government, proposing legislation, and supporting constituents. As well as providing MPs with a confidential service we publish open briefing papers, which are available on the Parliament website. Every effort is made to ensure that the information contained in these publicly available research briefings is correct at the time of publication. Readers should be aware however that briefings are not necessarily updated or otherwise amended to reflect subsequent changes. If you have any comments on our briefings please papers@parliament.uk. Authors are available to discuss the content of this briefing only with Members and their staff. If you have any general questions about the work of the House of Commons you can hcenquiries@parliament.uk. Disclaimer This information is provided to Members of Parliament in support of their parliamentary duties. It is a general briefing only and should not be relied on as a substitute for specific advice. The House of Commons or the author(s) shall not be liable for any errors or omissions, or for any loss or damage of any kind arising from its use, and may remove, vary or amend any information at any time without prior notice. BRIEFING PAPER Number rd April 2018 The House of Commons accepts no responsibility for any references or links to, or the content of, information maintained by third parties. This information is provided subject to the conditions of the Open Parliament Licence.

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