The secondary care acute sector comprises of acute, specialist acute and combined trusts delivering urgent and emergency care, planned care and specialised care for different conditions such as rare cancers, genetic disorders or complex medical or surgical conditions.
It isn't possible to cover the data associated with all acute pathways here. For this summary, we explore trends across A&E services, diagnostics, the elective care waiting list and cancer services. We also look at data relating to current levels of NHS capacity such as general and acute beds and metrics of patient flow.
Demand and activity
2024/25 is set to be the busiest year for A&E departments, with each month reaching its respective record number of attendances. In November, there were 2.31 million attendances, the highest November figure on record. At 6.6% higher than November 2023 and 7.8% greater than five years ago in November 2019, demand for urgent care is extremely high.
There were 552,845 emergency admissions in November, 14,600 fewer than in October. Although there were slightly more admissions than last year, the figure is lower than five years ago, with 6,711 fewer patients being admitted to hospital via A&E than in November 2019. This shows that despite more A&E attendances, this isn't translating into an increase in emergency admissions. This is, in part, due to people accessing the treatment they need in A&E, SDEC services, or they are referred to another, more appropriate service.
FIGURE 1
A&E emergency admissions
For planned care, activity levels increased across consultant led treatments, diagnostics, and cancer care in October.
Admitted and non-admitted planned activity increased in October, and the boost in activity helped reduce the overall size of the waiting list for the second month running. There were nearly 340,000 completed inpatient pathways in October, which is 9.4% more than in September – an additional 29,000 treatments. The number of non-admitted pathways increased by 9.6% compared to the previous month, reaching 1.3 million. However, there were 1.9 million new RTT pathways in October, an increase of nearly 200,000 more treatments from September. 1.9 million is the highest number of new RTT periods on record which shows that demand is higher than ever despite increased levels of activity.
Tests and checks reached record levels with 2.54 million diagnostic tests being carried out in October. Activity levels are 12% higher than a year ago and 21% higher than before pandemic. These sustained levels of high activity are a testament to the positive impact that community diagnostic centres are having on overall activity. The number of key tests such as MRI, CT and colonoscopies all increased compared to previous years.
Similarly, activity increased across all cancer pathways in October on the previous month. The number of patients completing the 28-day faster diagnosis pathway increased by over 10% reaching 289,035. Nearly 59,700 patients completed the 31-day pathway, a 10.8% increase from September, an additional 5,833 patients. Activity also increased by 9% across the 62-day pathway.
FIGURE 2
Number of cancer patients who started treatment within 31 days following a decision to treat
Waiting times
In November 2024, across A&E departments, performance against the four-hour wait target slipped to 72.1%, down by 0.9 percentage points from last month, showing that the recovery target of 76% has still proved out of reach. The performance across type 1 A&E only (excluding other types of A&E delivered by these trusts) also deteriorated by 1.1 percentage points, to 57% in November. Of the 122 trusts with a type 1 A&E department, only two trusts met the 78% recovery target in October.
In terms of longer waits for admissions, 45,791 patients waited more than 12 hours from the decision to admit to admission, an increase of over nearly 4,000 from the previous month. This figure is 7.7% greater than November last year. Five years ago, before the pandemic, only 1,111 people waited more than 12 hours. These long waits before admission are a key metric indicating patient flow challenges within the hospital, but also across the wider health and care system.
An additional measure now published by NHS England indicates flow within A&E departments for all patients, not just those who go on to be admitted. In November, there were 1.4 million attendances at type 1 and 2 emergency departments, and of these, 150,696 waited more than 12 hours in A&E from when they arrived – accounting for almost over 11%.
FIGURE 3
Number of patients spending >12 hours from decision to admit to admission
Waiting times across planned care remain a challenge. The diagnostic waiting list increased this month by 2.7% to 1.63 million. Compared to last year, the waiting list is up by 2.2% and up by 51.7% compared to October 2019, before the pandemic. 20.7% of patients waited six weeks or more for a test, a decrease from 22.7% last month, but missing the 5% target. 157 trusts reported diagnostic waiting lists this month. 40 met or exceeded the target of 95% of patients seen within six weeks or less. There is significant variation across diagnostic waiting lists and specific tests.
The waiting list reduced slightly for the second month running to 7.54 million in October, 32,000 fewer treatments than last month. The size of the waiting list is 2% smaller than it was a year ago but 64% greater than five years ago, before the pandemic. In July, 84.1% of patients on the waiting list were unique patients; an estimated 6.34 million people.
The NHS reduced waits across all reported time periods (>52 weeks, >65 weeks, >78 weeks) apart from >104 week waits where there was a slight increase. In October the NHS has still not eliminated waits >65 weeks. The number of treatments waiting >65 weeks fell by nearly 2,000, now totalling 20,930. The number of treatments waiting >52 weeks reduced by over 14,500, reaching nearly 235,000. There are now 148 people waiting >104 weeks, an increase from 113. At the end of October, 58.9% of treatments had been on the waiting list less than 18 weeks. Overall, 3 million treatments have waited more than 18 weeks.
There is, of course, trust variation and speciality variation across the waiting list. Size of trust also plays a role. The top 10 trusts that currently have incomplete pathways of over 65 weeks, currently have a total of 7,590 patients waiting. However, 26 trusts had zero patients waiting longer than 65 weeks and therefore meeting the target.
Performance against each of the three standards improved in October. Performance against the 28-day FDS target improved in October with 77.1% of people being told if they had cancer, or if cancer was definitively excluded within four weeks (28-days) of an urgent referral. This exceeds the existing standard of 75% and the new 24/25 target of 77%. The NHS has announced that this standard will increase to 80% by March 2026.
91.5% of people treated began first or subsequent treatment of cancer within 31 days of receiving a decision to treat/earliest clinically appropriate date; this is an improvement of 0.9 percentage points since the previous month but misses the 96% standard.
68.2% of people treated began first definitive treatment of cancer within 62 days of an urgent suspected cancer referral, breast symptomatic referral, urgent screening referral or a consultant upgrade. This is also an improvement of 0.9 percentage points, but still falling short of the 62-day standard to reach 70% by March 2025.
Capacity
Over winter, maximising capacity, which is often reduced, is a key priority for hospital staff. Employing a multidisciplinary approach across the hospital, as well as working closely with system partners, helps trusts double down on discharge processes. However, we know that delayed discharge remains a daily challenge for ward managers. On 30 November (a Saturday), there were 20,265 patients who no longer met the criteria to reside in hospital. Of these, 59.6% remained in hospital that day. This figure has increased by 8.2 percentage points since last month. However, on average across November, there were 22,581 patients who no longer met the criteria to reside and of these, 55% remained in hospital each day. This average remains relatively stable from the previous month, with a small increase of 0.5 percentage points.