The number of people waiting for routine hospital treatment has surged to another all-time high, NHS figures revealed today amid warnings that upcoming strikes will cause even more chaos on the crippled service.
More than 7.2million patients in England were stuck in the backlog in October — or one in eight people. More than 400,000 have queued, often in pain, for at least one year.
A&E pressures have also worsened, with a third of emergency department attendees not seen within four hours — the NHS’s worst ever performance. Thousands weren’t even seen after waiting in casualty for 12 hours.
Ambulance response times improved slightly. But a third of patients taken to A&E by 999 teams still spent at least 30 minutes stuck in the vehicles outside of hospitals.
Health bosses fear a wave of strike action, which kicks off next week, will devastate hospital performances further. More than 100,000 nurses, paramedics and 999 call handlers will walk-out in a row over pay.
Bed blockers, a flu surge and growing demand from parents worried about the Strep A outbreak has already left the NHS ‘bursting at the seams’.
More than 7.2million patients in England were stuck in the backlog in October (red line)— or one in eight people. More than 400,000 have queued for at least one year (yellow bars)
A&E performance worsened in November, with a third of emergency department attendees not seen within four hours (red line) — the NHS’s worst ever performance. Thousands weren’t even seen after waiting in casualty for 12 hours (yellow bars)
Ambulances took an average of 48 minutes and eight seconds to respond to372,326 category two calls, such as heart attacks, strokes burns and epilepsy (red bars). This is nearly three times as long as the 18 minute target but around 13 minutes speedier than one month earlier
Cancer performance data shows that just six in 10 cancer patients started treatment in October within two months of an urgent referral from their GP (red line). The figure is the second-lowest logged since records began in 2009. NHS targets set out that the figure should be at least 85 per cent. It means 5,728 people waited more than eight weeks to start cancer treatment (blue bars)
Why IS the NHS struggling this winter?
Some 13,000 hospital beds across the country — or one in seven — are currently filled with patients declared fit for discharge.
The figure is triple the pre-pandemic average.
And there is huge variation across the country. In London, half of patients were discharged on time but the figure was as low as 28 per cent in the North West.
Experts say the numbers are being driven by a separate crisis in social care, leaving patients left to languish on wards for up to nine months because there is no suitable nursing accommodation or care available for them in the community.
The lack of beds has seen ambulances stuck in queues for 20 hours outside of hospitals this summer, as emergency medics scramble to find beds for patients. This is had a knock-on effect on response times.
The NHS, which employs over a million people, has around 130,000 vacancies across its entire workforce.
This reduces productivity, with too fewer staff to carry out appointments and procedures.
Health chiefs also warn that it stops staff from delivering high-quality care and can lead to safety concerns if too few staff are working.
In turn, medics are at a higher risk of burnout, illness and early retirement due to these factors.
Surge in seasonal viruses
More than 1,000 beds per day are taken up by patients severely unwell with seasonal viruses.
NHS data shows Britons sickened with influenza occupied 712 beds, on average, each day last week. Flu levels are much higher than this time last year.
Meanwhile, norovirus accounted for 318 taken beds per day and RSV saw 132 occupied.
Strep A fears
Nine children in the UK have died in recent weeks due to an outbreak of Strep A.
The bacterial infection is harmless for the vast majority. But it can cause life-threatening illness if the bacteria invade the blood, muscles or lungs.
Doctors have warned that A&E, GPs and ambulances are in meltdown due to a surge in demand from parents worried that their child is infected.
Patients have faced longer emergency department waits, while some hospitals have postponed routine procedures to cope with demand.
Around 4,700 beds per day were occupied by a patient infected with Covid in the week to November 30.
Two-thirds were primarily admitted for another ailment, such as a broken leg, but happened to test positive.
However, infected patients still pile pressure on the health service as they have to be isolated from others.
The virus also contributes to higher rates of staff sickness.
GP appointment crisis
Campaign groups, MPs and senior medics say desperate patients are turning to emergency and walk-in services because they can’t get a face-to-face appointment with their GP.
The average GP in England is responsible for 2,200 patients now – up from 1,900 in 2016.
In the areas with poorest access, up to 2,600 patients are fighting over one family doctor.
The Royal College of Emergency Medicine (RCEM) has previously warned difficulties in seeing a GP was leading to a crisis in emergency departments.
An extra 70,000 people joined the backlog in October, taking the queue for treatment to its highest level since records began in 2007.
The data shows 410,983 people had been waiting a year — the equivalent of one in 18 people on the waiting list. The figure is up 1.5 per cent compared to last month.
Ministers have told the NHS to abolish all one-year waits by March 2025.
The number of patients waiting at least 18 months fell by 656 in October. However, 50,124 people were still for one-and-a-half years — a backlog that is supposed to be cleared by April 2023.
Meanwhile, 1,907 people had been waiting more than two years. The NHS had the target of eliminating these long-waiters by the summer.
It says those who are still waiting are either complex cases or have turned down the chance to undergo their procedure sooner at a different hospital.
The NHS says it faces pressure from record demand in emergency care and a surge in influenza cases — with 712 beds taken up by flu patients per day, on average, last week. The figure has doubled since mid-November.
On top of this, 95 per cent of general and acute adult beds were occupied last week, with 13,000 spaces taken up by bed-blockers.
Danielle Jefferies, from the King’s Fund, said the figures show the NHS is ‘bursting at the seams as services head into winter struggling to meet sharply rising demand while keeping patients safe’.
Meanwhile, NHS data shows A&E performance plummeted in November.
Nearly a third of emergency department attendees (31.1 per cent, 143,949 people) had to wait more than the NHS four-hour target to be seen.
It is the worst rate since records began in 2010.
And 37,837 people spent at least 12 hours in A&E — the second-highest ever recorded.
While the figure is down 13.6 per cent on last month, it still equates to 1,261 patients per day in November facing the lengthy wait.
The NHS rule book states that at least 95 per cent of patients attending A&E should be admitted, transferred or discharged within four hours. But this has not been met nationally since 2015.
Rachel Harrison, national secretary of GMB which is one of the three unions coordinating ambulance strikes this month, said: ‘Our ambulance staff have been saying for years there is a crisis in emergency healthcare.
‘This tin-eared government need to talk to us about how to fix these issues.
‘There are 130,000 vacancies across our NHS. Without talking about pay you cannot fix the workforce shortage. Steve Barclay needs to talk to us about pay now.’
Professor Julian Redhead, NHS England’s clinical director for urgent and emergency care, said medics have ‘powered through to bring down some of our longest waits for care’.
He said: ‘We have already said we are dealing with a perfect storm of pressures this winter, including increased demand for emergency care.’
But plans are in place for new hubs to treat respiratory infections and falls to free-up ambulance capacity, Professor Redhead said.
He added: ‘The public can also play its part by using the best services for their care – using 111 services for urgent medical advice and 999 in an emergency – and to come forward for vaccinations, if eligible, to protect you and others around you against serious illness.’
Separate data on ambulance performance shows response times to each category of emergency improved in November. However, they still fell short of targets.
It took paramedics nine minutes and 26 seconds, on average, to reach category one patients — calls from people with life-threatening illnesses or injuries. This was 30 seconds faster than October.
Ambulances took an average of 48 minutes and eight seconds to respond to category two calls, such as heart attacks, strokes burns and epilepsy. This is nearly three times as long as the 18 minute target but around 13 minutes speedier than one month earlier.
Response times for category three calls — such as late stages of labour, non-severe burns and diabetes — averaged two hours, 43 minutes and five seconds.
This is around 50 minutes faster than October. But ambulances are supposed to arrive within two hours.
These figures do not include data for London.
Separate ambulance statistics show that 31 per cent of ambulance patients (23,894) spent at least 30 minutes stuck in the vehicles outside of hospitals in the week to December 4.
For comparison, the rate stood at just 23 per cent in December 2021 and 11 per cent in December 2020.
It means 3,400 hours of paramedics’ time per day, on average, was wasted last week due to the delays, which are usually caused by a lack of beds.
The data also shows that one in seven ambulance patients (11,296) waited more than an hour to be handed to A&E teams at hospitals.
Paramedics are supposed to complete handovers within 15 minutes, with none taking longer than 30 minutes.
Health experts said the delays show the NHS is facing ‘the toughest pressures since modern records began’ and is struggling to create space for new arrivals.
The ambulance strike will affect emergency services across England and Wales on two days
This graph shows the Royal College of Nursing’s demands for a 5 per cent above inflation pay rise for the bands covered by its membership which includes healthcare assistants and nurses. Estimates based on NHS Employers data
Industrial action is expected to begin before Christmas, with reports it will take place over two dates, potentially a Tuesday and a Thursday
Sarah Scobie, deputy director of researcher at the Nuffield Trust, said the figures show the NHS is ‘desperately struggling to get patients in and patients out fast enough’.
‘The situation continues to deteriorate as the temperature drops and we head into the most challenging winter months,’ she said.
She said: ‘Patients in desperate need are having to brace themselves for very long waits in ambulance bays and corridors, and now it would appear more and more are choosing alternative ways to reach hospital.
‘Ambulances are one of the most visible and vital cogs of the emergency care machine, and it is becoming more painfully visible that they are under severe strain.
‘The Government has confirmed additional funding to tackle the delayed discharges behind some of these problems, but it is far too late in the day to have a meaningful impact this winter.
‘On top of confirmed ambulance and nurse strikes, unfortunately winter will keep getting harder for patients and NHS staff.’
Tim Gardner, senior policy fellow at the Health Foundation, said the figures show a ‘gridlocked health and social care system struggling to meet the needs of patients — even before the full force of winter and the planned industrial action kicks in’.
He said: ‘NHS staff are working hard under intense pressure to provide the best care they can for patients.
‘But these delays risk the safety and quality of care, as well as leaving patients in pain and struggling to manage debilitating health conditions.’
Dr Susan Crossland, former president of the Society for Acute Medicine, said: ‘We are in deeply troubling times and the fact that such shocking levels of performance are now commonplace is reflective of just how far the NHS has fallen.
‘Standards are at all time lows for both patients and staff and it is demoralising for colleagues across the country and the UK as a whole who are working tirelessly against the tide to deliver a reasonable quality of care.’
Additional data on cancer performance shows that just six in 10 cancer patients started treatment in October within two months of an urgent referral from their GP.
The figure (60.3 per cent) is the second-lowest logged since records began in 2009. NHS targets set out that the figure should be at least 85 per cent.
It means 5,728 people waited more than eight weeks to start cancer treatment.
Each four-weeks delay to starting cancer treatment can reduce survival by 10 per cent, experts say.
There were some improvements on cancer. Nearly 240,000 urgent cancer referrals were made by GPs in England, the highest number for that month in records going back to 2009.
However, the figure is more than 10,000 fewer than September.
A Freedom of Information request, submitted by the Liberal Democrats, reveals the postcode lottery patients face when calling 999. The figures cover the year to March 2022 and local areas in England. Category one callers — those from people with life-threatening illnesses or injuries — faced a wait of nearly three-times longer in some towns and cities compared to others. In Mid Devon, where paramedics were slowest to arrive on the scene, patients waited 15 minutes and 20 seconds, on average. Meanwhile, people calling 999 due to burns, epilepsy and strokes — classed as category two callers — experienced a six-fold difference in waiting times nation-wide. Patients in Cornwall were forced to wait one hour and 41 minutes, on average
NHS data shows 539 people with influenza were taking up beds on November 27. The figure is 3.9-times higher than the peak logged across the entire season last winter, when a maximum of 138 flu patients were in hospital. This is despite winter pressures just starting to kick-off and cases expected to rise further
Meanwhile, the proportion of cancer patients in England who saw a specialist within two weeks of being referred urgently by their GP increased from a record low of 72.6 per cent in September to 77.8 per cent in October.
This figure is still well below the 93 per cent target.
Professor Pat Price, an oncologist and co-founder of the #CatchUpWithCancer campaign, said the ‘record-breaking’ cancer waiting time figures are ‘heartbreaking’.
She said: ‘We are plummeting further into a national cancer crisis, and it feels like the Government is continuing to ignore the growing evidence.
‘It beggars belief that there is no practical or effective plan to deal with this.
‘Patients diagnosed with cancer are waiting longer than ever for lifesaving treatment. The frontline is at breaking point, now is the time for an urgent investment boost into treatment capacity.’
She added: ‘Without a radical plan, I’m desperately concerned about the future of the cancer service in this country.’
Wes Streeting, Labour’s Shadow Health and Social Care Secretary, said the NHS is heading into winter ‘with more people waiting for treatment than at any time in history, and they are waiting longer than ever before’.
He said: ‘Behind the statistics are people suffering, sometimes for months or even years, putting their lives on hold because of their pain and discomfort.’
Daisy Cooper, Liberal Democrat Health spokesperson, said the figures show that the NHS is ‘on its knees and the blame lies entirely with this Conservative Government’.
She said: ‘Every day we hear horror stories of patients dying whilst they wait for help to arrive or to be admitted into a hospital.
‘The public is left asking: how has it come to this?
‘From the NHS waiting lists to record delays at A&E, the Conservative Government’s mismanagement of the health service is failing patients and staff alike.
‘The Government were woefully unprepared for winter, they now need to adopt a pandemic-style urgency to tackle this crisis before it’s too late.’
Health chiefs have warned that the state of the NHS will only worsen with strikes set to further cripple the health service in the coming weeks.
Unite, Unison and GMB — three unions representing ambulance workers — this week confirmed that they had coordinated strike action across England and Wales for December 21, accusing the Government of ignoring their pleas for a decent pay rise.
The NHS’s bedblocking crisis has exploded since the pandemic with the levels of delayed discharge around triple the comparable figures before the pandemic. Graph shows the number of beds occupied by patients that are medically fit for discharge over time
Nearly one hundred hospitals are dealing with fewer Covid patients than so-called ‘bed-blockers’, according to ‘worrying’ official figures. Map shows: The 10 hospitals with the most patients medically fit for discharge that were still in beds in the week ending October 31
Nurses, porters, healthcare assistants, cleaners and other NHS workers at Liverpool Heart and Chest Hospital and Liverpool University Hospital will also take industrial action on the same day, Unison has announced.
The Health Secretary warned heart attack and stroke calls, along with those from elderly people who have fallen, may not be attended.
Department of Health and Ministry of Defence officials have met to discuss making a formal request for the military to work as paramedics during the strikes.
However, army insiders have hit back at plans — saying soldiers, who are often paid less than striking NHS staff, should not be forced to work over the festive period.
Senior military figures told The Telegraph that it is ‘not right’ for soldiers, who are not legally permitted to strike, to replace public sector staff taking industrial action.
They told the newspaper: ‘You’ve only got to look at a private soldier on £22,000 a year and whose pay scales have not kept up with inflation for the last decade having to give up Christmas, or come straight off operations, to cover for people who want 19 per cent and are already paid in excess of what he or she would be, and it’s just not right.
‘We’ve got to the stage now where the Government’s first lever it reaches for every time there is any difficulty, whether it’s floods, strikes, all the rest of it, is the Armed Forces, as opposed to it being the last resort.’
Nurses across the country are also set to strike on December 15 and 20, with just a ‘Christmas Day’ level of service being provided on these dates.
However, chemotherapy, dialysis, critical care units and child care services are exempt and will operate as normal.
Chris Hopson, chief strategy officer at NHS England, told BBC Radio 4’s Today programme that staff were working hard to deliver care.
He said there ‘are so many instances that we have at the moment where, despite best efforts at the frontline, NHS staff aren’t able to provide the quality of care they would want see, but there is a clear plan to address that.’
He added: ‘As we come out of the peak of the Covid pandemic, just like every other advanced western health system, the NHS is under significant pressure, but we do have a very clear three-point plan.
‘The first is we know we need to recover and stabilise our core services like accident and emergency, ambulances, recover those planned care waiting lists.
‘Then as we recover, we need to get back to delivering the key ambitions we put out in the long-term plan to improve health outcomes long term.
‘And third, we know we need to transform the NHS for the future. So there is a clear plan but, yes, we are under very significant pressure.’
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