The NHS in winter - an alphabet soup of stats

Winter is here and finding out how the NHS is coping is of interest to patients and policymakers alike.

Last winter's pressure in accident and emergency units pushed the system close to its limits and that was clear from weekly updates from the front line.

A year on, there is much speculation about how the service will perform as cold snaps arrive and patient numbers increase, especially among the elderly.

But now it's far more difficult to get a feel for week-by-week NHS performance in England because figures for people waiting to be treated or assessed in A&E units is no longer published every Friday.

Only yesterday did we get statistics for October, let alone the first weeks in December, and they showed another downward slide below the 95% target - and below the figure for Scotland that month.

Ironically, Scotland recently moved from monthly to weekly figures. Wales and Northern Ireland publish theirs monthly.

Overall performance

There has been much criticism of NHS England with suggestions of a deliberate plan to reduce news coverage during the difficult winter weeks.

The counter-argument is that weekly fluctuations can give a misleading impression of hospital performance and be unhelpful to trusts that have been subject to temporary local pressures.

NHS senior management have now brought together all the performance data along with A&E on a monthly basis, including cancer treatment times that used to be quarterly.

By doing that they have created a statistical "super Thursday" every month, allowing a broad judgement of overall performance.

Yesterday's data did not make happy reading for NHS chiefs in England.

Six out of seven key targets were missed - the only one met was on referral to treatment times (the proportion of patients on a waiting list for less than 18 weeks).

It has been suggested that referral to treatment was only inside the target level, and by a small margin, because some trusts did not publish their data.

The chances of it being breached this winter seem high so there could be a month when the headline is "NHS in England misses all key targets".

NHS England is still publishing some weekly data and the first batch was out today, covering the week until 6 December.

It amounts to an alphabet soup of stats.

The key finding was that attendances at major A&E departments were lower than in the same week last year, nearly 328,000 compared with just under 345,000. That could be weather-related.

For the key indicator of emergency admissions, the latest figure is just over 90,000 but there is no comparable figure for last year.

The only other figures come from the Royal College of Emergency Medicine.

It carries out its own weekly survey of more than 40 hospital trusts around the UK.

In the week ending 27 November, according to this exercise, fewer than 88% of patients were treated or assessed within four hours, which was lower than the previous week.

Urgent cases

This has been dismissed by NHS England as it is far from comprehensive (there are 180 hospital trusts in England alone). But it is what it is, and provides the most up-to-date snapshot available.

Anecdotal reports from London hospitals, reported in the Evening Standard, suggest "significant pressure" at present with GPs being urged to refer only the most urgent cases to A&E units.

Bed occupancy is said to be very high. One Midlands trust acknowledged that its four-hour wait performance has been below 80% in recent weeks.

The festive season may well bring additional stresses and strains, along with a possible flu impact.

Twas ever thus and the NHS has got through previous winters despite forecasts of doom and gloom.

But this time we wont have the data till after the event - the Christmas season story won't become clear until February.