London’s emergency departments felt the benefits of warm weather between April and June, with a drop in the number of patients not dealt with in under four hours, but London’s A&E’s have now fallen behind those in the rest of England. Both PM10 and PM2.5 pollution fluctuated around WHO levels, while roadside nitrogen dioxide fell below the WHO limit for the first time.

Outpatients

Outpatient demand pressures on London’s hospitals have eased off in recent quarters, when adjusted for population, with GPs being discouraged from referring patients over the winter period. Outpatient levels remain slightly higher than the rest of England.

GP referrals fell nearly 2 per cent in the first quarter of this year, compared to 2017, to under 590,000. Outpatient (non-overnight) visits to hospital remained broadly the same as last year – initial attendances fell nearly half a percent to 812,000 for the three months, while subsequent attendances rose a single percentage point to over 1.67 million.

A&E performance

As the weather warmed between April and June, the proportion of A&E attendances not dealt with within four hours dropped. Across April, May and June, 11.2, 10 and 9.3 per cent of patients were not dealt with inside four hours. All these figures were worse than 2017. And for the first time since April last year, they also performed worse than the rest of England on this measure.

As part of the digitalisation and technology drive in the NHS, artificial intelligence trials are being undertaken to determine why waiting time targets are not being met, and to prioritise the most at-risk patients.

While overall visits to A&E have been growing, the number of Londoners going to major departments has plateaued in recent years, with an increasing proportion of attendances (now over 80 per cent, up from around 65 per cent a year ago) occurring in other A&E departments, such as at walk-in centres. This trend is much more pronounced in the capital than the rest of the country.

Delayed discharge

Overall delayed transfers of care (DTOC) for the quarter to May fell by over 17 per cent (compared to 2017) to a little over 40,000 days – a ninth consecutive month of annual falls. This total figure masks a much smaller annual fall in delays the NHS is responsible for – which jumped during the cold weather, whereas delays social care is responsible for continued to fall significantly. And while the overall delays – which cost the NHS millions of pounds – have fallen in the capital, progress is slower than the country as a whole.

Air pollution

Air pollution levels are dependent on London’s emissions, as well as weather systems.

Concentrations of larger particles (PM10) in London’s atmosphere showed a slight increase compared to last year. The three-month average in the second quarter was 17 and 18 per cent higher for roadside and background readings respectively, and both readings are around WHO limits.

Background concentrations of smaller particulate matter (PM2.5) increased annually by 23 per cent, averaging at 13.2 micrograms per cubic metre in the three months to June 2018. Roadside concentrations were also up (by 25 per cent), averaging at 15.4 micrograms per cubic metre in the three months to June 2018.

Concentrations of roadside nitrogen dioxide fell below the WHO and EU limit in June this year for the first time since data collection started (in January 2008). The quarterly average to June fell six per cent and 1.6 per cent respectively for roadside and background levels.

A fall in nitrogen dioxide roadside levels – the main source of which is from vehicle exhaust fumes in the capital – shows positive signs that efforts to clean up London’s air are making progress. The Mayor of London announced a new fund to protect school pupils from pollution, alongside other measures to tackle poor air quality across the London, which remains one of the most polluted cities in Europe.

There was also a welcome recognition in the Government’s new ‘Road to Zero’ strategy on reducing non-tailpipe particulate emissions, but more decisive action is still required to reduce their concentration.