Healthcare and environment

The London Intelligence – Issue 3

Healthcare and environment

The most recent air pollution data suggests that recent months have seen some dramatic improvements along London’s roads and in its background environment. Meanwhile, The London Intelligence paints a mixed picture for London’s healthcare performance and delivery.


Data from the Ipsos MORI Issues Index in the Society chapter, shows that 36 per cent of Londoners spontaneously mention the NHS as an issue, and it retains its political significance. This has intensified in recent weeks amidst widespread reports of a ‘winter crisis’, though it should be noted that the data recorded here refer to late 2017, before the crisis peaked.

1 – GP Referrals

Source: NHS England

In the third quarter of 2017, GP referrals to hospitals fell compared to the same period last year, by 4.4 per cent, suggesting the recently implemented demand management strategy is beginning to have an impact on the number of patients GPs are passing on to outpatient clinics. The 58,000 appointments from July to September equates to over 65 per 1,000 people in London.

2 – A&E performance

Source: NHS England

There has been recent media attention on A&E performance data, due to a change in recording practices in some trusts which changes the headline figure, as highlighted by the UK Statistics Authority (see here). The statistics reported here are (and have been in previous reports) for attendances to Major A&E departments (Type 1), Single Specialty A&E departments (Type 2) and other A&E and Minor Injury Units (Type 3).

The performance of London’s hospital trusts in relation to emergency attendances was a little better than the rest of England in November and December 2017, but is still significantly below the target level of seeing/treating 95 per cent of patients within 4 hours. Figures for the last three months are also slightly improved on compared to the previous year, but this could have been helped by a relatively mild autumn/early winter. The true extent of the NHS’s ‘winter crisis’ in the capital will be seen in the next release.

3 – Delayed discharge

Source: NHS England

Not having the ability to discharge patients when they are ready causes a serious problem for hospitals – but recent data suggests London’s hospitals have improved a little in recent months, with the total number of delayed transfers standing at 25,000 (quarter to November), compared to nearly 29,000 last year. The delays attributable to social care institutions have seen a particularly stark drop.

For November, the two main reasons for the delay were for patients awaiting nursing home availability (in 20 per cent of cases), or awaiting further non-acute NHS care (18 per cent).

The devolution deal to give the Mayor, London’s Councils, and health leaders more control over health and social care in the capital should bring health and social care services closer together, improving patient experience – but it will take many months for material changes to be felt on outcomes, and become observable in the data.

Air pollution

The most recent air pollution data, captured by the King’s College Air Quality Network, suggests that recent months have seen some dramatic improvements along London’s roads and in its background environment. Indeed, this has been picked up on by the Mayor, who is championing a series of measures he has recently introduced (including the new T-Charge on the most polluting vehicles entering central London).

Source: KCL Air Quality Network

Small particulates are some of the most damaging to human health – especially in terms of child respiratory and cognitive development, and the majority come from car transport, including non-tailpipe sources. After the unusually high peak during the early months of 2017, more recent figures suggest levels have dropped to around the WHO and EU limit, although the WHO argues there is no level at which they do not cause harm to human health.

Source: KCL Air Quality Network

Larger particulates show a similar picture, and background and roadside level have sat around the WHO limit over the last few months (which is much stricter than the EU limit). The last breach of the EU limit was March 2012.

Source: KCL Air Quality Network

Nitrogen dioxide levels have a large disparity between roadside and background levels, given their main source is from vehicle tailpipes. Levels have risen since the summer, but are down compared to the same point last year, in some cases by nearly a quarter.

Pollution is not equally spread across the capital, with many main roads historically faring badly, but new data suggests the Mayor’s low emission bus zones are improving the local air quality around main roads. However, as always, there are many factors out of the Mayor’s control – in particular the weather, which has not allowed recent pollution to settle above the city. Research, for example, suggests that three quarters of particulate matter in the city can come from outside its boundaries (the figure is under 20 per cent for NO2).