The secondary care acute sector consists of acute, specialist acute and combined trusts delivering urgent and emergency care, planned care and specialised care for different conditions such as rare cancers, genetic disorders or complex medical or surgical conditions. It isn't possible to cover the data associated with all acute pathways here. For this summary, we explore trends across A&E services, diagnostics, the elective care waiting list and cancer services. We also look at data relating to current levels of NHS capacity such as general and acute beds and metrics of patient flow.
Demand and activity
Demand for urgent and emergency care has been extremely high – at the end of July it looked like it could be the busiest summer on record for activity across the pathway. In July there were 2.32 million A&E attendances, 5.8% higher than July last year and 2.4% greater than five years ago, before the pandemic.
There were 552,468 emergency admissions in July, 15,500 more than in June. But emergency admissions were slightly lower than five years ago in July 2019, with 1,600 fewer patients admitted to hospital via A&E. Despite a 2.4% increase in attendance, there’s a lower conversion into admissions, meaning these people may have accessed the care they needed in A&E, received treatment through a SDEC service or been referred elsewhere. Despite lower numbers of admissions through A&E attendances, hospitals are also admitting patients via ambulance, where sustained high levels of demand for category 1, the most seriously ill patients, is seen.
For planned care, demand continues to outstrip supply and activity levels were lower than the high levels recorded last month. This might be partly because of industrial action, which led to 91,000 cancelled operations.
The latest data for June 2024 shows more than 2.33 million diagnostic tests were carried out - nearly 92,000 fewer than the month before, when the highest number of tests was recorded. But activity levels are 4% higher than a year ago and 21% higher than pre-pandemic levels, once again demonstrating how the NHS is doing more across many services.
Looking at specific diagnostic tests such as MRI, CT and colonoscopy scans, activity is slightly lower compared to last month. Activity is greater year-on-year for MRI and CT scans, increasing by 7.7% and 5.3% respectively, while colonoscopies fell by 1.1%.
Total diagnostic tests
Demand for elective care outstripped activity in June. There were 1.69 million new RTT pathways in June, 100,000 fewer than May, but the waiting list still grew in size. Admitted and non-admitted activity decreased month-on-month in June. This is nearly 14,000 fewer treatments, with a total of 299,200 inpatient pathways and nearly 49,000 fewer non-admitted pathways in June.
Lastly, in June cancer services saw fewer patients after May’s swell in activity. Patients completing the 28-day faster diagnosis pathway decreased by 12,600 to 261,200, while 51,700 patients completed the 31-day pathway, a decrease of 3,700, and 25,800 patients completed the 62-day pathway, a decrease of 1,560 from May’s figures.
Waiting times
During the election campaign the Labour party promised that by the end of its term the NHS will return to meeting the constitutional standard that 95% of people who attend A&E will be seen within four hours. There is currently a significant gap between this ambition and current levels of performance.
A recovery target was set out in the planning guidance for 2024/25, requiring trusts to see 78% of patients in four hours by March 2025. In July 2024, performance against this target improved to 75.2%, a positive development in the face of more A&E attendances.
The performance across type 1 A&E only (excluding other types of A&E delivered by these trusts) also improved slightly to 61.4% in July. Of the 122 trusts with a type 1 A&E department, six currently meet the 78% recovery target. To get a sense of the broad variation, only one trust currently delivers at 90% or above; 59 trusts are below 60%.
The number of patients waiting more than 12 hours for admission after the decision to admit decreased by 1,300 from the previous month, reaching 36,800. This is a third lower than the record high figure of 54,000 in January 2024, but 53% greater than July 2023. Five years ago, before the pandemic, only 436 people waited more than 12 hours.
A&E 12 hour waits from decision to admit to admission
The diagnostic waiting list decreased slightly this month, reaching 1.64 million in June 2024. Compared to last year, the waiting list is 2.4% larger; it's more than 50% up on June 2019. 22.9% of patients waited six weeks or more for a test, slipping slightly from 22.1% last month, but missing the 5% target.
161 trusts reported diagnostic waiting lists this month. No trusts met or exceeded the target of 95% of patients seen within six weeks or less. There's significant variation across diagnostic waiting lists. The longest waits from 37 of the 161 trusts contributed to half of the total waiting list.
The waiting list increased for the third month in a row, reaching 7.62 million in June (19,000 more treatments/0.3% increase). The waiting list size is only slightly larger than it was a year ago but 69% greater than five years ago in May 2019, before the pandemic. In June, 83.8% of patients on the waiting list were unique patients. This is an estimated 6.39 million people, similar to the previous month.
There was a slight improvement in the numbers of treatments waiting more than 78 weeks and more than 104 weeks compared to last month, falling to 2,621 and 120 treatments, respectively. The target in the 2024/25 operational planning guidance is for no patients to be waiting longer than 65 weeks by September 2024. Treatments waiting over 65 weeks increased by around 2,000 reaching over 58,000, an increase of nearly 4%. Despite this increase in waits over 65 weeks, treatments waiting over 52 weeks decreased by 4,800. The constitutional standards state 92% of treatments should be carried out within 18 weeks. At the end of June, 3.1 million treatments, 59% of the waiting list, had waited more than 18 weeks.
There is, of course, trust variation and speciality variation across the waiting list. Size of trust also plays a role. The 13 trusts with the most incomplete treatments all have more than 100,000 treatments on their waiting list, with the highest nearly 190,000. In relation to long waiters, of the 135 trusts that currently have incomplete pathways of over 65 weeks, the top 10 trusts account for nearly 35% of waits.
The cancer standards were streamlined recently into three new targets: Faster Diagnosis Standard (FDS) 28-day referral, 75%; 31-day treatment standard, 96%; 62-day treatment standard, 70%.
Performance against the 28-day faster diagnosis standard (FDS), which was met, remained similar to last month with 76.3% of people told if they had cancer, or if cancer was definitively excluded, within four weeks. The fact trusts are consistently meeting the 75% 28-day FDS, a positive sign with the new target of 77% set out in the planning guidance for 2024/25, clearly in the minds of those leading cancer services in trusts and across cancer alliances. 72 out of 132 acute trusts reporting this month would meet the target of 77%.
Performance for the 31-day also slipped by one percentage point, not meeting the standard (90.9%). Contrastingly, there were improvements on the 62-day pathway, with 67.4% of people treated beginning first definitive treatment of cancer within 62 days of an urgent suspected cancer referral, breast symptomatic referral, urgent screening referral or a consultant upgrade. This is a positive step towards the new target, introduced in April 2024, for performance against the 62-day standard to reach 70% by March 2025.
Capacity
As part of the delivery plan for recovering urgent and emergency care services, NHSE promised additional beds to help deal with increasing pressures on hospitals. In the plan it acknowledges the well-established link between high bed occupancy rates in hospitals and worse A&E performance and sets out an objective to return bed occupancy to 92%. In July 2024, there were 100,900 general and acute beds available across all acute beds and the bed occupancy rate was 92.4%, down from 92.8% in June.
Patient flow around the health and care system remains a systemic issue across the country with average time in A&E (including waits over 12 hours from time of arrival), handover delays and delayed discharges important metrics for all systems to monitor. For hospitals, delayed discharge is a daily focus and challenge. On 31 July (a Wednesday), 23,600 patients no longer met the criteria to reside in hospital. Of these, 52.1% remained in hospital that day. On average in July, 22,300 patients who no longer met the criteria to reside and 55.2% remained in hospital each day. This remains at a similar level to the previous month.