London’s A&E departments struggled in the cold weather, with 13.6 per cent of attendances not dealt with in under four hours, but demand management strategies appear to be easing the strain on GPs and outpatient clinics. Air quality across the capital was better than this time last year, but still breached some legal limits.

Healthcare

These figures focus on the changing demand on London’s healthcare system by outpatients, individuals who do not stay overnight. From September 2017 to the end of the year, there were just over 570,000 referrals from GPs to outpatient clinics. When adjusted for working days and population, this figure was 2.7 per cent lower than the same period last year, its fifth successive quarter of falls.

First attendances – the initial appointment in a clinic – stood at over 800,000 for this period, 3 per cent lower than last year, while subsequent attendances topped 1.6 million during the three months, a 2.5 per cent fall. This possibly reflects a number of outpatient appointments which were cancelled during the height of the cold weather, but also the NHS’s continued demand management strategy.

New digital reforms, which are being pioneered and trialled in London, are set to allow GPs to receive advice from consultants on the next stage of treatment – this is intended to ensure referrals are correctly targeted, and to help reduce waiting times.

London’s emergency departments, like the rest of the country, felt the full force of the cold weather in March. 13.6 per cent of attendances to A&E were not dealt with in four hours, which was the second highest figure since 2011 (only January last year was worse). This was better than the performance of A&Es in the rest of England – by two percentage points – but still significantly above the five per cent target.

Emergency departments face the further problem of ambulance crews not being able to quickly transfer patients to A&E staff – NHS guidelines suggest more than 15 minutes is considered a threat to life – which has been particularly bad over this winter, and has stimulated the Health Secretary to take action.

The number of days of delayed discharge in the quarter to February was 18.6 per cent lower than the year before, with delays held to be social services’ responsibility again showing the largest proportional fall. While falling days are a sign of progress, they are not falling as fast as the rest of England. The Chancellor’s £2bn Better Care Fund announcement in March 2017 has helped reduce delayed transfers across the country. The figures suggest welcome progress, but there is still a way to go – and a recently announced £1.4m investment from NHS Digital should help local authorities (one of the seven successful bids was Hackney) with their assessment, withdrawal and discharge notices, which are a major stumbling block currently.

Air pollution

The first three months showed continuing progress in cleaning up London’s air, probably a combination of new policies taking effect, the gradual shift to cleaner cars, and favourable weather conditions. However, comparing these figures to last year’s unusually polluted winter period means declines may be exaggerated. New research, however, suggests it is not just pollution above ground we should be worried about, but that travelling on the underground tube network significantly increases your exposure to damaging particles.

Concentrations of larger particulates showed declines compared to last year of 15 per cent (roadside) and 18 per cent (background). While both levels are well under EU limits, background levels in March were above the more stringent WHO guidelines for the first time in a year.

Roadside concentrations of small particulate matter averaged 12.4 micrograms per cubic metre in the three months to March 2018, which was a third lower than the same period in 2017. Background levels of this pollution – which can be the most harmful on human health – also fell by a quarter, but both concentrations were still higher than the EU and WHO limit.

Nitrogen dioxide levels show a large difference between roadside and background levels – with the difference averaging 22 micrograms per cubic metre across 2016-17 – given their main source is from vehicle exhaust fumes in the capital. Levels have risen since the stabilised since the end of last year, with roadside levels still significantly above EU/WHO limits.