NHS pressure worsens as key targets missed

The NHS is missing many of its key targets with more patients getting stuck in hospital, latest figures show.

Data from NHS England showed in September the health service missed its A&E target to see, treat or discharge patients within four hours.

Performance also fell short on access to cancer treatment, diagnostic tests and ambulance response times.

To make matters worse, hospitals have been struggling to get patients out when they are ready to leave.

A snapshot taken on the last Thursday of September showed more than 5,000 patients in England were occupying beds, even though they could have been discharged.

Industrial action

This was the worst level since records began in 2010 - with the rise in delays over the past few months largely driven by problems accessing social care services, such as help in the home.

Elsewhere in the UK, the NHS has been struggling as well with the four-hour A&E targets being missed everywhere. Scotland is performing the best.

Analysis: How bad is it looking?

On almost every measure, the NHS in England is in a worse position than this time last year.

And as we enter winter, that spells bad news: last year's was the worst for a generation with A&E waits hitting their highest levels since targets were introduced in 2004.

But the pressures are now spreading more to other parts of the system. Once in hospital, doctors are finding it difficult to discharge patients because the support services in the community needed for the most vulnerable are not available.

Waits for diagnostic tests are lengthening and the key cancer target has been missed for well over a year.

Even on routine treatment - hips and knees - the signs are not good. The target is being met, but on the current trajectory it will be missed by the end of the year. The weather may be mild, but winter has come early for the NHS.

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The monthly data for England also showed:

• Ambulances missed their target to answer 75% of the most serious 999 calls in eight minutes - the fourth month in a row it has not been achieved.

• A&E units missed their four-hour target to see, treat or discharge A&E patients - the 12th time in 13 months performance has dropped below 95%.

• At the end of September, 1.9% of patients had been waiting over six weeks for diagnostic tests - nearly twice the proportion that should be suffering such delays.

• One of the key cancer targets - the 62-day target for treatment to start - was missed with nearly one in five patients waiting longer.

• The NHS 111 phone service missed its target to answer 95% of call within 60 seconds.

However, there were some measures the NHS in England did meet. In total six of the eight cancer targets were achieved, while the 18-week target for patients to be seen for non-emergency operations such as knee and hip replacements was met.

Health secretary Jeremy Hunt told the BBC: "The NHS frontline is under a huge amount of pressure at the moment but we have a very good plan put together by the NHS being backed by the government financially on the back of a strong economy and, as we implement that plan, we're confident we can turn these numbers around."

He added: "Winter is always a difficult period for the NHS but staff are working incredibly hard on the frontline right now and we should remember that even despite that pressure nine out 10 people are being seen, treated and discharged within four hours."

The rising problems come as junior doctors are being balloted on industrial action over a dispute with government about their new contract.

The result of that vote is expected next week and could lead to 35,000 junior doctors walking out as winter hits with three dates - 1, 8 and 16 December - put forward by the British Medical Association on Thursday.

The NHS is also under pressure to save money with figures for the first three months of this financial year showing overspending has hit nearly £1bn - more than the total for the whole of the previous year.

Dr Mark Holland, the president of the Society for Acute Medicine, said this was creating the "perfect storm".

He added: "There is already talk of putting ambulances on divert, of taking patients to other hospitals.

"That intensity is beginning to creep up. Not on a day-to-day consistent basis like last December and January, but it's starting and it feels like it is occurring a wee bit too early.

"The question this winter is how resilient we will be and what will be the tipping point. And that is the unknown factor which is very, very worrying."

Shadow health secretary Heidi Alexander said it looks like it will be the "most difficult winter for 30 years".

She added: "There is now clear evidence that the cuts to social care are not only devastating for the lives of vulnerable older people, but are having a knock-on effect on the NHS."

An NHS England spokeswoman said the health service was coping well given the context as it was seeing a "record number" of patients.

"Nobody could argue there isn't ongoing pressure on the NHS but despite this, it is delivering a good service for the vast majority of patients," she added.

Meanwhile, the British Medical Association has released details of the days industrial action could take place. The union said it wanted to give as much notice as possible to avoid disruption for patients.

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