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The proportion of patients spending more than four hours in A&E has increased by more than a quarter over the last year, reaching its highest level since 2004, according to the latest quarterly monitoring report on NHS performance published by The King’s Fund.

A&E waiting times increased sharply in the last two quarters of 2011/12, despite the Prime Minister’s pledge in June last year that they would remain low. Although at a national level, A&E waits still remain within the government’s target range that no more than 5 per cent of patients should wait more than four hours, 48 NHS providers breached this threshold, compared to 18 in the second quarter. This reflects growing pressures on the hospital sector and coincides with emerging evidence of increases in ‘trolley waits’ as some hospitals struggle to find beds for patients.

The report also found that 40 per cent of NHS organisations failed to meet productivity targets in 2011/12, based on the findings of an expanded survey of 60 NHS finance directors. This will be a significant concern as last year was the first in a four-year spending squeeze, during which the NHS needs to find £20 billion in productivity improvements.

This quarter’s report looks back at how the NHS performed during the first year of the spending squeeze. It shows that it is performing well against a number of key indicators.

• Waiting times for hospital treatment are stable, with the proportion of inpatients waiting more than 18 weeks falling over the last 12 months, while outpatient waits remain static.
• C difficile and MRSA infections in hospitals fell by 33 cent and 14 per cent respectively during 2011/12, continuing the downward trend of recent years.
• The proportion of patients waiting more than six weeks for diagnostic tests fell to its lowest level since the last General Election.

Our survey of NHS finance directors indicates that the NHS has ended 2011/12 in a healthy financial position, with just four forecasting a deficit in their organisation – in line with national figures estimating a surplus of £1.5 billion across the NHS as a whole. However, this masks significant financial challenges in some areas, with recent figures showing that 31 hospitals received ‘bail out’ funding of £414 million in 2011/12, an increase on previous years.

The main findings from our survey of finance directors were:

• nearly half (28) said their organisations met their cost improvement targets in 2011/12, with two-fifths (23) failing to meet their targets and one-tenth (7) exceeding them
• more than half (32) were pessimistic about the financial prospects for their health economy over the next year, with less than a quarter (14) optimistic about this.
• 35 said their organisations plan to reduce staff numbers, with the 28 able to quantify their plans identifying nearly 4,200 job losses – if replicated across the NHS, this would add up to the biggest fall in staff numbers in more than a decade.

John Appleby, Chief Economist at The King’s Fund said: ‘Overall, the NHS continues to perform well, despite the spending squeeze. However, this masks growing pressures in hospitals and significant performance issues in some NHS organisations. Given the strength of the political commitment to keep waiting times low, the steep rise in A&E waits will be a concern for the government. The productivity challenge will only get harder, so evidence that large numbers of  NHS organisations failed to meet their productivity targets last year does not bode well.’

Read the May 2012 quarterly monitoring report

Notes to editors

How is the NHS performing? was published by The King’s Fund on 31 May 2012. For further information, or to request an interview with John Appleby, please contact the Press and Public Affairs team on 020 7307 2585 (if calling out of hours, please ring 07584 146 035).

226,021 patients (4.2 per cent) waited for more than four hours in A&E in the last quarter of 2011/12, compared to 177,815 (3 per cent) in the same quarter in 2010/11. This is an increase from 144,843 patients (2.7 per cent) at the end of the second quarter in 2010/11, although it should be noted that seasonal factors mean that the four-hour target is breached more often in the last two quarters of the year. The Department of Health no longer publish A&E data on a quarterly basis so the figures are based on aggregating weekly data.

In June 2011, the Prime Minister announced five key pledges on the NHS, including a pledge to keep waiting times low – this incorporated a commitment on A&E waiting times. He also announced that the previous government’s target that 98 per cent of patients should wait no more than four hours would be relaxed to 95 per cent, and that additional A&E performance measures also monitored.

Our survey of NHS finance directors has been expanded. 136 were invited to take part in this quarter’s survey, of whom 60 responded. Responses were collected via an internet survey between 17 April and 1 May.

The King’s Fund is a charity that seeks to understand how the health system in England can be improved. Using that insight, we help shape policy, transform services and bring about behaviour change. Our work includes research, analysis, leadership development and service improvement. We also offer a wide range of resources to help everyone working in health to share knowledge, learning and ideas.