9th January 2015

Contents

• A&E waiting times and cancelled operations rise
• Welsh waiting time targets missed again but cardiothoracic lists improve
• Circle to pull out of managing Hitchingbrooke, first privately run NHS hospital
• Lib Dems commit to match level of spending outlined in NHS Five Year Forward View
• Training proposals criticised by surgical and medical trainees
• Population ageing is only responsible for a third of the rise in emergency admissions of older people

A&E waiting times and cancelled operations rise

A demanding period for the NHS has seen the total proportion of people treated within the four hour A&E target for the week ending 4th January fall to 86.7%, the lowest ever recorded figure since records began in 2010. For type 1 attendances the percentage treated within 4 hours is even less, at 79.8%. Government targets specify that 95% of all attendances should be treated within 4 hours.

The pressures also extend to elective and urgent operating lists. Between 3rd November and 4th January 12,669 operations were cancelled, an increase of 32.5% on the corresponding period last year.

Other figures demonstrate the extraordinary winter pressures experienced by A&Es over the winter period. For example, the number of trolley waits over 12 hours between 3rd November and 4th January was 336. This is fourteen times higher than the same period in 2012/13 and five times higher than the figure last year.

Welsh waiting time targets missed again but cardiothoracic lists improve

The latest statistics on referral to treatment waiting times in Wales were published this week. The figures show that both the Welsh Government’s 26 week and 36 week referral to treatment targets have been missed across Wales between October 2013 and November 2014.

The data does show a slight improvement in the number of patients waiting less than 26 weeks from referral to treatment, increasing from 86.2% in October 2014 to 86.3% in November 2014. In addition, 19,679 people waited longer than 36 weeks to begin treatment, down from the previous month’s total of 19,785.

The Welsh Government have set a target of 95% of patients waiting less than 26 weeks from referral to treatment and 100% of patients not treated within 26 weeks to be seen within a maximum of 36 weeks. By the end of November 2014, a total of 423,711 patients were waiting to start treatment in Wales. Of those patients, 86.3 per cent had been waiting less than 26 weeks and 95.4 per cent had been waiting less than 36 weeks.

The College has been active in raising concerns about waiting times for cardiothoracic surgery in Wales. The latest figures show an improvement in waiting times, with 95 patients waiting over 36 weeks to start treatment (down from 109 in October 2014) and 64 waiting over 26 weeks (down from 66). There are now a total of 534 patients waiting to start treatment (down from 552). Diagnostic waiting times also showed an improvement with the number of people waiting over 8 weeks for diagnostic tests below 20,000 for the first time since April 2013

Circle to pull out of managing Hitchingbrooke hospital, first privately run NHS hospital

Circle, the private healthcare partnership that runs a number of independent hospitals in England, has announced that it is to pull out of managing Hitchingbrooke hospital.

In 2011 the company was awarded a contract to run the hospital as an NHS franchise, becoming the first private firm to run a hospital for the NHS. However, Circle has announced this week that it is to withdraw from the contract, citing that the arrangement is “no longer viable under current terms”.

Circle took over Hitchingbrooke as the hospital was experiencing long standing financial problems and initially seemed to have turned things around as the hospital won a number of awards, including being named “best trust in England for quality of care”. However, in a statement explaining the firm’s decision to pull out of the contract Circle chief executive, Steve Melton, said that the “playing field has changed” since the contract was initially put out to procurement. Mr Melton explained that unprecedented pressures in A&E and other parts of the system meant that the franchise was no longer sustainable.

The hospital had also been one of the first to be inspected under the CQC’s new inspection regime and the results are expected to be published soon. Circle have criticised the process, saying the report will likely be “unbalanced” and they expect to “disagree with many of its conclusions”.

Lib Dems commit to match level of spending outlined in NHS Five Year Forward View

The Liberal Democrats have announced that they would increase NHS funding by £8bn per year in real terms by 2020 if they were to gain power following the General Election. This matches the level of investment NHS England said would be required in the health services as outlined in the Five Year Forward View.

Previous Lib Dem funding commitments to increase the base level of healthcare spending and changes to pensions and tax would be made to pay for the additional expenditure. The party says that from 2017/18, on the assumption that there is no longer a Government deficit, spending increases would be made in line with growth in the economy.

The Lib Dems also announced that they would commission an independent review of NHS and social care spending in 2015 in order to fully evaluate pressures on health budgets.

Training proposals criticised by surgical and medical trainees

Fifteen organisations representing junior doctors, including the Association of Surgeons in Training (ASiT) and the British Orthopaedic Trainees Association (BOTA), have expressed their concern with proposed reforms to postgraduate medical training.

In a joint statement to health minister Dr Dan Poulter MP, the organisations are critical of the proposals set out in the Shape of Training review, which recommends changes to medical training in order to equip the medical workforce with the skills required in caring for an ageing population. Junior doctors have expressed particular concern with the review’s central theme of creating a more generalist workforce. They contend that, rather than finding a balance between the number of specialists and generalists in the workforce, it is possible for well-trained doctors to be both a good generalist and a good specialist.

The Royal College of Surgeons set out its views on Shape of Training.

Population ageing is only responsible for a third of the rise in emergency admissions of older people

The Centre for Health Service Economics & Organisation has published a report on a study looking at the drivers behind the rise in emergency hospital admissions for older people in England. Emergency admissions for over 65s have increased yearly since 2001, but only a third of this rise can be accounted for by the increasing numbers of older people due to population ageing. The study suggests that increased availability of services may be important in accounting for the remaining two thirds of the increase in admissions. In addition to increased staffing funded by rising NHS budgets, there has been a fall in the number of bed days following emergency admissions for over 65s, creating the necessary capacity to admit more patients. This fall in the number of bed days associated with the increase in admissions is thought to be linked to the introduction of the Payment by Results system.

The study also found that each subsequent cohort from those born in 1912 has experienced lower emergency admission rates, possibly reflecting improvements in health or primary care. This so-called ‘cohort effect’ offsets the impact of population ageing on the number of emergency hospital admissions, and is likely to continue to do so until, but not beyond, 2020/21, when numbers of older people are projected to rise more quickly.