Long waits in A&E rise as NHS braces for winter

Performance against key targets fell short in emergency departments and ambulance response times, according to figures from the health service in England.

Experts warned that a “corridor care disaster” is unfolding as the figures revealed the number of people waiting more than 12 hours in A&E departments in England from a decision to admit to actually being admitted stood at 49,592 in October – up from 38,880 in September.

This is the third highest monthly figure since comparable records began in 2010.

The number waiting at least four hours from the decision to admit to admission also rose, standing at 148,789 in October, up from 130,632 in September.

Some 73.0% of patients in England were seen within four hours in A&Es last month, down from 74.2% in September.

Patricia Marquis, executive director for the Royal College of Nursing in England, said: “Today’s figures show a corridor care disaster is unfolding in front of our eyes – near record numbers are languishing on trolleys after being deemed sick enough to be admitted, whilst thousands cannot be discharged due to a lack of community care.

“The cold weather hasn’t properly arrived, and this situation threatens only to worsen.”

Meanwhile, the average response time in October for ambulances in England dealing with the most urgent incidents, defined as calls from people with life-threatening illnesses or injuries, was eight minutes and 38 seconds.

This is up from eight minutes and 25 seconds in September and is above the target standard response time of seven minutes.

Ambulances took an average of 42 minutes and 15 seconds last month to respond to emergency calls such as heart attacks, strokes and sepsis.

The target is 18 minutes.

NHS England said there were 2.36 million A&E attendances last month, 6% more than October 2023.

Concerns have also been raised that the target to eliminate all waits of more than 65 weeks for pre-planned care has been missed.

Meanwhile, ambulance teams responded to more incidents than any other October with more than three quarters of a million (759,019) incidents including 84,108 of the most serious Category 1 incidents.

Rory Deighton, acute director at the NHS Confederation, which represents NHS organisations, said: “These figures show that the NHS continues to be facing record demand, with A&Es and ambulances having their busiest October ever.

“This comes after the busiest summer and September on record, so it is very concerning that the health service is running so hot ahead of what is expected to be another very difficult winter.”

He added: “With record numbers of patients who often have multiple or more complex conditions there is a real risk services could become overwhelmed and fall into crisis.”

Professor Sir Stephen Powis, NHS national medical director, said: “The NHS is going into winter under more pressure and busier than ever before, with another record month for A&E and ambulance services before we even start to see a further spike of pressure caused by colder weather and the spread of winter viruses.

“While we saw 10% more A&E patients within four hours than last year despite the record demand, it is vital that people help us out by only going to A&E or calling 999 in a life-threatening emergency, using 111 for other conditions, and getting their Covid, flu and RSV vaccinations if eligible.”

The latest monthly performance figures also show:

– The waiting list for routine hospital treatment in England has fallen to its lowest level for five months – an estimated 7.57 million treatments were waiting to be carried out at the end of September, relating to 6.34 million patients.

– There were 22,903 patients who had been waiting more than 65 weeks to start treatment at the end of September, down from 45,527 in August – the target to eliminate all waits of more than 65 weeks was September of this year.

– A total of 249,343 people in England had been waiting more than 52 weeks to start routine hospital treatment at the end of September. While the numbers are down from those reported at the end of August, health commentators will be looking at the ambition set by the previous government and NHS England of eliminating all waits of more than a year by March 2025.

– In cancer care, some 74.8% of patients in England urgently referred for suspected cancer in September were diagnosed or had cancer ruled out within 28 days, below the target of 75%.

– And the proportion of patients in England who had waited no longer than 62 days in September from an urgent suspected cancer referral or consultant upgrade to their first definitive treatment for cancer was 67.3%, down from 69.2% in August. The target is 85%.

Professor Peter Friend, vice president of the Royal College of Surgeons of England, said: “Staff are working tirelessly to get the NHS back to delivering timely care. However, with the 65-week ambition missed and a very difficult winter ahead, progress will be slow.

“That means more people living in pain and unable to work, and in some cases needing emergency treatment, putting yet more strain on the NHS.”

Health experts warned that NHS performance issues are “endemic” across the country.

It comes after Health Secretary Wes Streeting said failing hospitals will be named and shamed in league tables and NHS managers sacked if they cannot improve patient care and take control of finances.

Commenting on the latest performance figures, Siva Anandaciva, chief analyst at The King’s Fund, said: “The figures show that NHS performance issues are endemic across the country and deep-rooted, with many key targets having been missed for years.

“Only 73% of people are seen within four hours in A&E compared to the NHS standard of 95% – a target not met in over eight years – and a target missed by every hospital trust running a major A&E department in England.

“People are waiting 42 minutes for an ambulance for urgent cases such as strokes when the target is 18 minutes – a target not met in over four years.

“Ministers rightly want to improve the poor standard of care many patients receive. Transparency is a good aim, but league tables alone will not lead to better and faster care this winter and could result in the unintended consequence of health leaders becoming too focused on reporting upwards to national bodies, instead of outwards to what their local communities need.”

Dr Vicky Price, president-elect of the Society for Acute Medicine, added: “This data shows there is a desperate need for the government to turn its attention to the threat of winter and the actions it needs to take to reduce the impact of the inevitable crisis we will face in hospitals over the coming months.

“We have grave concerns that focus is being placed in the wrong areas, with talk about the introduction of league tables, penalties and consultations distracting from the pressing need to deliver meaningful solutions on the ground right now.

Meanwhile, health leaders have also issued a warning about a rise in superbugs in England.

The UK Health Security Agency said there were an estimated 66,730 serious antibiotic resistant infections in 2023 – up from 62,314 in 2019.

People who get a bacterial infection that is resistant to one or more antibiotics are more likely to die within 30 days compared with those who respond to treatment.

Professor Dame Jenny Harries, chief executive of UKHSA, said: “Increasingly, the first antibiotics that patients receive aren’t effective at tackling their infections. That’s not just an inconvenience – it means they are at greater risk of developing a severe infection and sepsis.”