NHS Activity Tracker 2023

Introduction

Today, NHS England published the latest figures for performance and activity across physical and mental health services. Below we detail the trends across specific services.

This month's data highlight the considerable effort from trusts to make activity gains in some areas despite working against the backdrop of ongoing industrial action, including the first ever joint strike by consultants and junior doctors. As we approach the winter period, additional challenges arise for the NHS. The latest figures for September show that more beds are being occupied by Covid-19 patients; the average number of patients in hospital with Covid-19 each day is up by over a third from August. This will add to the existing pressures facing the provider sector.

This month's performance figures

Each month, NHS England publishes statistics looking at activity and performance across a range of services including urgent and emergency care (UEC), routine care, cancer, and mental health. Below we set out the latest trend for each clinical area.

NHS 111: Over 57,000 calls a day were received in August, with 14% more calls answered.

In August 2023, 1.63 million calls were received by NHS 111 and of these 1.43 million calls were answered. This equated to 57,482 calls answered a day in August.
NHS 111 answered 14% more calls compared to four years ago, before the pandemic (August 2019).

Ambulance activity: Busiest month this year for ambulance services, with record numbers of most serious callouts. Average response times deteriorated for both call categories.

September saw a 5% increase in ambulance category 1 incidents to 77,553 (3,727 more incidents). There were 12% more incidents compared to a year ago, and incidents were also 39% higher than four years ago, before the pandemic in September 2019. Ambulance category 2 incidents remained roughly the same as the previous month (19 more incidents). Compared to four years ago, they were down by about 1%.
National targets were not met yet again in September, and the average response time across England for category 1 and category 2 calls increased.

A&E and emergency care:  Busiest September on record for A&E attendances, with over 2 million people attending A&E services.

September saw over 2,165,000 million A&E attendances, a number nearly 3% higher compared to the month before and also 8% higher than last year. Compared to four years ago before the pandemic (September 2019), this figure is slightly higher (+1%).
Performance against targets for all A&E types decreased.
The number of patients waiting more than 12 hours from the decision to admit to admission has increased by 15% to 33,107 since the month before. This figure is nearly 100 times higher than the same month four years ago before the pandemic (September 2019), when this number was 333.

Diagnostics: Third highest month recorded for diagnostic tests carried out, and the waiting list decreased again, even if it remains much higher than before the pandemic.

In August 2023, 2.22 million diagnostic tests were carried out, a slight increase of 0.2% from the month before. This is the third highest month recorded. Activity for the latest month is 8.9% higher than one year ago (182,142 more tests) and is 16% higher than pre-pandemic levels, with 310,357 more tests carried out compared to August 2019.
The number of CT scans and colonoscopies remained at a similar level to last month, both slightly up by 0.1%, but the number of MRI scans decreased this month by 1.1%.
The diagnostic waiting list decreased this month by 2% but remains over 1.5m (1,563,422) 3% higher than August last year, and 57% higher than August 2019 before the pandemic.
The number of patients waiting six weeks or more for a test is at 27.5%; this is up from the month before (25.5%) and is still missing the 1% target.

Elective care: Activity has decreased in August for all pathways except admitted pathways. The waiting list increased again, now at an all-time high of 7.74m.

In August 2023, the size of the waiting list increased slightly by 0.8% and is now at a new record high of 7,745,030 (7.74m, 65,179 more people than the previous month). The size of the waiting list is still 70% greater than four years ago just before the pandemic.
The number of those waiting more than 18 weeks has increased compared to the previous month (2%), as did the number of those waiting more than 52 weeks, which is now at 396,643 (+2%).
However, the number of those waiting more than 104 weeks has decreased again by 4% to 265.
Inpatient elective care activity, with the exception of admitted inpatient pathways, has decreased in August 2023 from the previous month.
The number of non-admitted pathways decreased slightly (-0.9)% from the previous month, and the NHS delivered over 1.1m (1,136,378) elective non-admitted pathways. The number of new RTT pathways in August decreased on the previous month from 1.75m to 1.73m.

Cancer: Activity is at an all-time high, but performance against the waiting time standard has deteriorated for all pathways apart from the 62-day pathway, and all targets are still being missed.

In August, there were 264,533 patients who completed the 28-day faster diagnosis pathway which aims to diagnose or rule out cancer within 28 days of an urgent GP referral for suspected cancer. This is the highest month on record for this pathway and up by 8% from last year.
There were 267,555 patients who were seen within two weeks of an urgent referral for a suspected cancer pathway, also the highest month on record. This is up by 2% from the previous month, above levels seen one year ago (5% higher) and above pre-pandemic levels also (34% higher).
Activity for the 31-day and 62-day pathways registered the highest August on record, with increases of 11% and 18% from before the pandemic, respectively.
However, performance against the waiting time standard has improved slightly for the 62-day pathway but deteriorated across all other pathways. The NHS is still missing all key national targets.

Delayed discharges: A high proportion of patients continue to remain in hospital despite no longer meeting the criteria to reside, highlighting issues with patient flow and the challenges of supporting patients to recover closer to or at home.

On 30 September (a Saturday), there were 22,068 patients who no longer met the criteria to reside in hospital. Of these, 57% remained in hospital that day.
For the month of September, there were an average of 22,472 patients who no longer met the criteria to reside. Of these, an average of 55.1% remained in hospital. This is higher than the previous month (54.1%).

Urgent community response: 

As of July, 85.3% of urgent community response (UCR) referrals met the two-hour standard for delivering UCR services, up from last month.

Mental health: Referrals and people in contact with mental health services remained high in July, with over 400,000 mental health referrals, 23% more than before the pandemic.

There were 1.75 million people in contact with mental health services, a similar number to last month. However, this is up by 8% compared to a year ago but up considerably by 26% compared to July 2019. 
In July 2023, there were over 417,000 mental health referrals, a figure down by 2% compared from the previous month but up by 10% compared to a year ago, and 23% above pre-pandemic levels.
There were 1.98m care contacts attended in the latest month, nearly 3% more than before the pandemic in July 2019.
There were 150,292 referrals to talking therapies in July 2023, an increase of 5% compared to the previous month. Compared to a year ago, referrals are up by 14% and up by 3% compared to July 2019.
In July 2023, there were 845 out of area placements (OAPs), an increase of 9% since the previous month (70 more) and the highest number of OAPs observed since March 2019. Compared to a year ago, OAPs are up by 23% (160 more).

Our view

This month's data once again highlights how hard NHS staff are working to increase activity. Cancer activity was at an all-time high in August. Similarly, the waiting list for diagnostic tests shrunk showing activity was outstripping demand, a testament to the hard work of staff delivering more than before the pandemic. UCR services also met the two-hour service standard this month. At the same time, activity across elective care slipped slightly and the waiting list has reached a high of 7.8m.

Pressure across UEC stepped up again this month with a sharp rise in the number of category 1 calls, the most serious ambulance callouts. Demand for category 2 cases remained stable showing that the demand rises are across the most acutely unwell patients. Greater numbers of high acuity patients have a knock-on impact on hospitals as they usually require more complex care and treatment, often staying longer in hospital. The increase in demand was reflected in A&E which experienced the busiest September ever.

Demand for mental health services is greater than the same time last year and up by a quarter from before the pandemic. Capacity for mental health beds remains under pressure with another increase in the number of OAPs, reaching its highest level since March 2019.

As winter approaches, flu, as well as increasing Covid-19 prevalence, continue to apply additional pressure on NHS services. In addition, staff sickness remains high and workforce shortages continue. Further to staffing challenges, trusts had to manage six days of industrial action in August and four in September, including the first co-ordinated action by consultants and junior doctors. Industrial action continues to add operational pressure, with the NHS having to reschedule over 1.3m appointments so far this year. With challenging seasonal pressures on the horizon, NHS Providers continues to call for the government and unions to resolve the dispute quickly.

Putting our patients first: improving patient experience

Jayne Black, chief executive at Medway NHS Foundation Trust talks about how a major ward refurbishment embodied the trust's vision of putting patients first.

Our trust's vision is to continually improve its service and provide the best of care through the best of people. With one of our wards, Harvey Ward, becoming available for refurbishment earlier this year, it was an ideal opportunity to achieve this.

The trust's aim was to create an ultra-clean and modern ward which once opened would significantly enhance the patient environment and address all necessary infection, prevention and control standards. The ward's refitting also made sure other estate compliance standards such as fire safety would be enhanced and fit for purpose. The £1.74m project involved colleagues across a variety of areas including procurement, clinical divisions, finance, estates and facilities, infection, prevention and control and IT.

In addition, the trust's capital projects programme manager Simon Goodwin liaised with a wide range of external contractors and specialist technical services over the course of the five-month project.

The work included a new multidisciplinary team room, new staff room with dining table and chairs, new staff lockers, easy chairs, fridge and microwave, a dedicated relative's room and a day room with dining table and chairs, TV and easy chairs. Additionally, a dedicated room for dementia patients – the Butterfly Room – was also created. Patients staying on the ward will benefit from therapy equipment to support their mobility with a special red area for patients with a broken hip.

We were very pleased to unveil our new look Harvey Ward, with thanks to the hard work and collaboration of colleagues across the trust, patients were transferred to the newly refurbished ward on Tuesday 22 August. The refurbishment has resulted in a 25-bed ward for our trauma and orthopaedic patients in a clinically suitable and comfortable environment to receive inpatient care and treatment.

In turn the staff working on the ward benefit from a modern, clean and organised workspace to deliver the best of care, to our patients. Plus there is a well-equipped staff area to use during breaks.

Penny Horton, matron for orthopaedics said: "It was a great team effort in moving our patients to their new ward on Harvey. We have all worked towards this day to provide the best of care to our patients. We are all looking forward to working on a modern bright ward."

The refurbishment of Harvey Ward has allowed further internal moves to take place which ultimately has resulted in returning the trust's day case centre back to its original purpose.