Acute sector

The secondary care acute sector comprises 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. 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

• All 12 months of 2024 had record levels of A&E attendances making it the busiest year ever.
• There were 2.35 million A&E attendances in December, an increase of 1.5% compared to the previous month. Demand is 7.6% greater than December last year but similar to December 2019, before the pandemic.  
• There were 552,592 emergency admissions in December, 253 fewer than in November. The number is 1% higher than a year ago but is 1.5% lower than five years ago in December 2019, showing that increased demand isn’t translating into an associated increase in emergency admissions.

Figure 1
A&E attendances 

For planned care, activity levels remained higher than previous years across consultant led treatments, diagnostics, and cancer care in November, despite being slightly below the high or record levels observed in October:

• In relation to elective care, admitted and non-admitted activity was lower than the previous month - where activity was particularly high - but it was enough to equate to a reduction in the overall size of the waiting list for the third month running.
• In November there were nearly 325,000 completed inpatient pathways and 1.23 million non-admitted pathways. The number of non-admitted pathways is 6% greater than before the pandemic.
• After a record high of 1.9 million new RTT pathways in October, the figure for November decreased by 165,000 to 1.74 million in November.
• In November 2024, 2.44 million diagnostic tests were carried out, which is 4% lower than the month before. However, this figure is 5.4% higher than a year ago and 20.8% higher than pre-pandemic levels.
• Activity is greater than the same time last year for MRI and CT scans by 9.9% and 5.7% respectively. However, activity for colonoscopy scans has decreased by 0.4%. compared to the same period a year ago.
• For cancer care, the number of patients completing the 28-day faster diagnosis pathway decreased by 8% since last month reaching 265,160.
• 54,312 patients completed the 31-day pathway, a decrease of 9% from last month. However, activity across the 31-day pathway is double what it was five years ago before the pandemic. 
• 26,689 patients completed the 62-day pathway, a decrease of 7% compared to last month. 

Figure 2
Number of patients told cancer diagnosis within 28 days of an urgent GP referral for suspected cancer 

Waiting times

Waiting times across urgent and emergency care were a challenge for hospitals and systems alike in December 2024.

• Performance against the A&E four-hour waiting time target slipped to 71.1%, down by 1 percentage point from last month, moving the wrong way from the recovery target of 78% by March 2025.
• The performance across type 1 A&E only (excluding other types of A&E delivered by these trusts) also deteriorated by 1.7 percentage points, to 55.3% in December meaning nearly half of all attendances to major A&E departments waited for longer than four hours. 
• Of the 122 trusts with a type 1 A&E department, only 11 trusts met or exceeded the 78% recovery target.

In terms of longer waits in emergency departments from time of arrival or wait to admission: 

• 166,990 attendances at a type 1 or 2 A&E waited more than 12 hours from arrival at A&E, accounting for 12%. This is an increase of 16,400 patients compared to the previous and 10,775 more than last year. 
• There was a jump in the number of patients waiting more than 12 hours from the decision to admit to admission ('trolley waits') this month, reaching 54,207. This is an increase of nearly 8,500 from the previous month (an 18.4% increase). This figure is 23% greater than December last year. Five years ago, before the pandemic, only 2,347 people waited more than 12 hours to be admitted.   

Figure 3
Number of patients spending >12 hours from decision to admit to admission  

Waiting times across planned care remain a challenge but there were some improvements across the longest waits. In addition, the elective and diagnostic waiting lists reduced slightly in size, showing that activity is outstripping demand. 

• The elective care waiting list reduced slightly for the third month running to 7.48 million in November (61,000 fewer incomplete treatments than October). 
• The size of the elective waiting list is smaller than it was a year ago (-1.8%) but 64% greater than five years ago in November 2019, before the pandemic.  
• The NHS reduced waits across all reported time periods (>18 weeks, >52 weeks, >65 weeks, >78 weeks) apart from >104 week waits where there was a very small increase of three treatments. 
• At the end of November, 220,000 treatments on the waiting list had been waiting for more than a year. 
• 84.1% of patients on the waiting list were unique patients. This is an estimated 6.28 million people. 
• The diagnostic waiting list (which is a subset of the broader elective care waiting list) decreased by 0.9% to 1.61 million in November. The waiting list remains similar to last year (0.4% greater) but is 52.5% larger compared to November 2019, before the pandemic.  
• 19.9% of patients waited six weeks or more for a test, a slight decrease from 20.7% last month, but missing the 5% target by some way. 

Figure 4
Total diagnostic waiting list 

Trust variation and speciality variation across the elective care and diagnostic waiting lists. 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 6,310 patients waiting. However, 32 trusts had zero patients waiting longer than 65 weeks.
• 156 trusts reported diagnostic waiting lists this month. 39 met or exceeded the target of 95% of patients seen within six weeks or less. 

For cancer care, performance against two of the three cancer targets improved slightly, while one slipped in November. 

• Performance against the 28-day FDS target improved slightly in November, reaching 77.4% 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. 
• Performance slipped by 0.5 percentage points with 91% of people treated began first or subsequent treatment of cancer within 31 days of receiving a decision to treat/earliest clinically appropriate date, missing the 96% standard.  
• 69.4% of people treated began a 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 by 1.2 percentage points, getting closer to the 70% target for the 62-day standard by March 2025. 

Capacity 

Over winter, maximising capacity is a key priority for hospital staff, particularly with the challenges of seasonal illnesses. However, delayed discharge remains a daily challenge for hospital staff across England:

• On 31 December (a Tuesday), there were 23,669 patients who no longer met the criteria to reside in hospital. Of these, 51% remained in hospital that day. This figure is down from 59.6% on the last day of the month, which was a Saturday in November.
• On average in December, there were 21,629 patients who no longer met the criteria to reside and of these, 55.4% remained in hospital each day. This is up from 55% in the previous month.

More information on the latest bed occupancy figures can be found in the winter section.