NHS England publishes Combined Performance Summary

NHS England has published its Combined Performance Summary, which provides data on key performance measures for January and February of this year. Here Jessica Morris of the Nuffield Trust shows some of these statistics and how they compare with previous years.

Commenting on the latest Combined Performance Summary, Prof John Appleby says the A&E slump and spike in cancer waits are of real concern and a reminder of the pressure that NHS staff face: A&E slump and spike in cancer waits mean stormy waters for new NHS targets

Full analysis: Combined Performance Summary: January – February 2019 | Nuffield Trust

The NHS England resource contains a summary of the performance statistics on:

Urgent and emergency care

Planned care


Mental Health

Full detail: Combined Performance Summary | NHS England

Waiting Times and Attendance Durations at English A&E Departments

The Strategy Unit & NHS Midlands and Lancashire Commissioning Support Unit | February 2019 | Waiting Times and Attendance Durations at English A&E Departments

A new report from The Strategy Unit presents a detailed view of presents a detailed review of the demand-side, supply-side, practice and emergent factors that lead to 4-hour breaches with a particular focus on changes that have taken place since 2010.


Waiting Times and Attendance Durations at English A&E Departments reviews both commonly cited causal factors and a range of more novel hypotheses.  It sets out the causal theories underpinning each factor and seeks statistical evidence in support of them.  Finally, the analysis scales the relative impact of each causal factor and aims to provide an explanation for the recent deterioration in A&E waiting times within the limits of national datasets.  New insights emerge which have the potential to reshape the received wisdom about the performance of A&E departments, carrying important implications for healthcare policy and system leadership (Source: The Strategy Unit).

Waiting Times and Attendance Durations at English Accident and Emergency Departments

Insight report: High intensity users of A&E departments

Dr Foster | January 2019 | Insight report: High intensity users of A&E departments

Analysis conducted by Dr Foster  examining data from A&E departments across England in the year to May 2018 shows that 10 patients attended A&E 2,000 times between them in one year while 31,492 people attended A&E more than 10 times a year. Findings indicate that 0.4 per cent of all patients, made more than half a million visits to A&E, equivalent to 4 per cent of all A&E attendances. The data suggests that the analysis suggests a relatively small cohort of people are receiving a significant allocation of NHS resources compared to the average population. This is increasing the pressure on the NHS and contributing to the rising cost of healthcare (Dr Foster


Dr Foster Insight report: High intensity users of A&E departments 

[press release]

Dr Foster High Intensity Users Report  

Dr Foster High Intensity users methodology 

A&E visits by young people with mental health problems have almost doubled in five years

There has been a steep rise in the number of young people aged 18 or under arriving at A&E departments in England with psychiatric conditions, according to new figures released this week | via YoungMinds


The Department of Health and Social Care has revealed that, in 2017-18, there were 27,487 attendances in A&E by young people aged 18 or under with a recorded diagnosis of a psychiatric condition. This figure has almost doubled since 2012-13, when there were 13,800 equivalent attendances, and almost tripled since 2010.

The findings coincide with a survey by mental health charity YoungMinds, which revealed that 61 per cent of parents said the care their child received in crisis was “bad” or “unacceptable.” In the survey of 1,531 parents whose children have experienced a mental health crisis:

  • 75% agreed that “it would have been helpful for my child to have a safe place to go to while they were in crisis within our local community”.
  • 65% agreed that “It would have been helpful for me or my child to have access to a mental health crisis telephone hotline”.
  • 86% agreed that “it would have been helpful for my child to have access to support before they reached crisis point.”

Full detail: A&E attendances by young people with psychiatric conditions almost doubled in five years – new figures | YoungMinds

Reducing emergency admissions

This Public Accounts Committee report states that the Government must improve preventive care outside hospitals , warning that hospitals, GPs, community services and social care need to work together more effectively | House of Commons Committee of Public Accounts

The Public Accounts Committee has published Reducing emergency admissions.  The Committee finds it lamentable that nearly 1.5 million people could have avoided emergency admissions in 2016–17 if hospitals, GPs, community services and social care had worked together more effectively.  They say it is frustrating that NHS England and partners are making some progress in reducing the impact of emergency admissions for patients and hospitals when they do happen, but no impact on reducing the numbers of admissions that could have been avoided.

The report make a number of recommendations, including:

  • NHS England should identify gaps in capacity in primary and community health care and set out how it intends to fill those gaps. 
  • NHS England’s and NHS Improvement’s regional teams should assess the capacity that hospitals need in terms of beds, staff and funding to deal with emergency admissions throughout the year.
  • The Department should encourage better sharing of best practice on how the voluntary sector supports health and social care efforts to reduce emergency admissions and understand the reliance the system has on the sector.
  • NHS England and NHS Improvement should improve data they collect and that hospitals record so that by the end of 2018 care can be tracked and publicly reported.

  • Read the report summary
  • Read the report conclusions and recommendations
  • Read the full report: Reducing emergency admissions

How is the NHS performing?

This report aims to take stock of what has happened within the NHS over the past quarter. 


The report finds that more patients are facing long waits for hospital treatment, with those experiencing the longest waits often most in need of treatment. With demand for services continuing to rise, the authors suggest it is very unlikely that meeting waiting time targets will become more achievable.

The report also finds that:

  • nearly two-thirds (63 per cent) of finance directors felt that patient care has worsened in their local area in the past year. Just 4 per cent said it had improved
  • more than half (52 per cent) of trust finance directors said they expected their organisation to end 2017/18 in deficit. A third (32 per cent) were fairly or very concerned about meeting financial targets agreed with national NHS bodies
  • demand for services continues to soar – admissions from A&E jumped by 6.8 per cent in January 2018 compared to January 2017, reaching 389,649
  • more positively, progress on reducing delayed discharges from hospitals has continued to improve, with 145,3180 total days delayed in December 2017, the lowest total since September 2015.

Full report: How is the NHS performing? March 2018 quarterly monitoring report

See also:

Waiting times in A&E departments

Waiting times in accident and emergency (A&E) departments are a key measure of how the NHS is performing. In recent years, patients have been waiting longer in A&E; this article from the Kings Fund explores the reasons behind this.

The article reports that not only are more people are attending A&E departments each year, but A&E waiting times have also increased substantially over recent years. The NHS has not met the standard at national level in any year since 2013/14, and the standard has been missed in every month since July 2015.

At the same time, longstanding staffing issues and continued reductions in the number of hospital beds have made it more difficult for A&E departments to admit patients.

Full article: What’s going on with A&E waiting times?