Healthcare and Environment

The London Intelligence – Issue 8

Healthcare and Environment

Colder winter weather placed London’s emergency departments under increased strain, while outpatient demand pressures have begun to ease. Although all roadside pollutant concentrations previously dropped below legal limits, levels peaked again in the last few months.

A & E performance

London’s emergency departments were placed under increased strain during the colder winter months, with a continuing decline in performance against the NHS waiting standard.

The percentage of patients not seen within 4 hours of arrival increased from 12.7 to 14 per cent between February 2017 and February 2018. A recent report in the British Medical Journal suggests that the continuing failure to hit such a publicised target, despite targets’ ability to distort priorities in the normal course of events, indicates a significant inadequacy of resources.

A review of the four-hour waiting target is currently underway to ensure the measure keeps pace with the changing climate. Centre for London will review what data and targets to publish for future editions of The London Intelligence.


Outpatient demand pressures on London’s hospitals eased in the final quarter of 2018, when adjusted for population and working days. The number of GP referrals declined by four per cent in the year to Q4 20 18, whilst the number of subsequent attendances remained largely static, declining 0.3 per cent.

Delayed discharge

Overall delayed transfers of care (DTOC) slightly increased at the start of the year, in line with annual demand patterns. January 2019 also experienced an annualised growth of six per cent, to just over 13,000 days in total. Breaking the total figure down by responsible organisation, delays attributed to social care fell by eight per cent in the year to January 2018 to just under 11,300 days. In contrast, delays attributed to the NHS saw an annualised increase of 19.5 per cent.

Air pollution

Though there are signs of longer term improvement, the colder months tend to bring about worsening air quality. As the graph shows, although all roadside pollutant concentrations dropped below the World Health Organisation’s legal limits, concentration levels peaked again in the last few months.