Background levels of PM2.5, which have the most damaging health effects, were up 11 per cent from July to September. Meanwhile GP referrals fell substantially in the capital, compared to the same quarter last year, but other healthcare indicators show a system continuing to operate under stress.
While the issue of the NHS and social care continues to float around political discourse, data show a mixed picture of its performance in the capital.
GP referrals – when a patient is referred by their general practitioner to see a specialist in a hospital for an outpatient appointment – saw a year-on-year fall of 5.4 per cent. This contrasts with the upward trend (highlighted in the last edition), and is likely down due to a demand management strategy recently employed by the NHS, which prioritises resources on some aspects of NHS care and discourages GPs from referring to hospitals unnecessarily.
A&E waiting time performance continues to fall well below the expected level. In July, 9 per cent of patients were not admitted, transferred or discharged within four hours, which was slightly higher than the same month last year, but marginally better than England as a whole (9.7 per cent). Recent analysis shows this is symptomatic of a wider failure to hit wait times – only around 35 per cent were achieved.
Most hospitals perform reasonably well for patients not requiring admission after visiting an emergency department (ED), although increasingly many who should be admitted end up completing their entire hospital stay in an ED. A smooth-running system requires a bed occupancy rate of less than 85 per cent, but London’s hospitals are nearly full. This is driven partly by discharge issues but also by complexity of work load. Across the capital, generally the more complex work carried out by a Trust, the more likely they are to struggle to hit the Emergency Access target. With mental health provision, hospitals now report patients waiting days in ED for a mental health bed to become available. Most systems now recognise that length of time spent in ED is a whole system issue that cannot be resolved simply by throwing resource at the front doors of hospitals.
Dr Malik Ramadhan, Divisional Director of Emergency Care and Trauma at the Royal London Hospital
Delayed discharges are often caused by social circumstances meaning medically fit patients are not able to leave hospital, but can also occur as a result of delays within the hospital. In the capital, total delayed discharge days have been rising over recent years, but this rise appears to be slowing a little (only a 0.5 per cent increase in July compared to last year). The NHS is responsible for 55 per cent of total days, although the proportion attributable to the social care system has risen since late 2014.
The Mayor triggered the high pollution warning twice over the summer months, but data for three main pollutants are suggesting a relatively positive picture (in historic terms) for London.
Particulate matter levels show a mixed picture across London – these have been receiving more attention in recent months as the scale of the problem is beginning to be realised. The smaller particles (PM2.5), which have the most damaging health effects, averaged 10.4ug/m3 on the roadside and 8.9ug/m3 background levels from July-September; the former was down 15 per cent, the latter up 11 per cent. Both these have been over the WHO/EU limit for most of the time series.
Larger particle concentrations (PM10) have been falling a small amount over the last few years. They are well below the EU limits, which are considered very lax, but oscillate around the WHO guidelines. Nitrogen dioxide levels (both background and roadside) saw significant falls for the same period, but roadside figures were still above EU/WHO limits. Future data releases will show any discernible effect of the T-Charge’s introduction on the 23 October this year.