A&E performance has remained outside targets but in line with national levels, while delays in discharging patients have continued to improve. There has been a slight improvement in air quality and the hope is that the forthcoming Ultra Low Emission Zone (ULEZ) will lead to more significant reductions in pollutant concentrations.

A & E performance

In December 2018, 54,000 patients attending London A&E departments were not attended to within 4 hours. Though these figures show slight improvement on the previous year – falling 0.05 per cent – performance has remained outside of the 5 per cent target for the third consecutive year. Senior NHS officials have recently questioned whether the target is still appropriate.

As the graph shows, performance in London mirrors that elsewhere in the rest of England, showing the increasing pressure that NHS staff and services are under across the country.

Outpatients

When adjusted for population, GP referrals fell 3 per cent in the third quarter of 2018 when compared with the previous year, to 572,000. Subsequent attendances also declined over the same period, albeit more marginally, falling 0.4 per cent over the same period. First attendances were slightly up on the previous year, with a 1 per cent increase in the third quarter of 2018, to 811,000 patients.

Digital demand management strategies are increasing across London’s healthcare system, and the recent reduction in referral rates signal that they may be having a positive impact.

Delayed discharge

Delayed transfers of care in London’s health system prevents new patients being seen, placing increased pressure on NHS staff and finances. They occur when a patient is ready to depart from their place of care and is still occupying a bed.

Recent data suggests continuing improvement, with a 10 per cent reduction in the total number of days delayed in the year to November 2018.

The new NHS long-term plan was announced earlier in the month, with GP’s mental health and community care receiving the biggest funding increase. The plan promises a sea-change in the delivery of health care, yet some remain sceptical.

Air pollution

Air quality in the capital continues to be a live issue, though these data indicate that concentrations of particulate matter and in particular Nitrogen Dioxide are showing some signs of gradual improvement, while remaining above European Union and World Health Organisation targets.

Despite common assumptions, research carried out by the University of Leeds found cyclists in London are exposed to the least air pollution on their morning commute, when compared with drivers and pedestrians. A report by the Committee on the Medical Effects of Air Pollutants (COMEAP) also sparked concerns over air quality on the Underground, though any negative effects are yet to be unearthed.

Private hire vehicles will pay the Congestion Charge from April this year, alongside tighter restrictions on green vehicle exemptions in an effort to clean up London’s air. April will also see the introduction of the ULEZ, which will charge the most polluting vehicles £12.50 per day. This month also saw the launch of a new air quality monitoring network to identify the most toxic areas of the capital.