Trusts have done remarkably well to stabilise performance, given the demand, workforce and financial pressures they face. But, as we move towards the end of the year, bed occupancy is still above recommended levels and other substantial risks remain. Trusts are working hard to mitigate these risks

A&E performance

Between April and October 2017, almost 14 million patients attended A&E. When compared to the same period last year this is around 600 more patients attending A&E every day in England.

In October 2017, there were more than 500,000 emergency admissions, equating to over 16,500 patients per day. When compared to October 2016, this is a 4% increase.

However, in October 2017 performance against the four-hour target was 90.1%, better than the 89.1% achieved in October 2016.


In September 2017 there were over 168,000 delayed days, 14% less than September 2016.

However, in Q2 2017/18, the DTOC rate was 5.2%, well above the government target of 3.5%. 

Bed availability

In Q2, the NHS had 127,614 beds open, 2% less than the same quarter last year. At the same time as reducing open beds they have reduced overall overnight bed occupancy to 87.1% in Q2 2017/18, compared with 87.6% in the same quarter last year. 

Referral to treatment

In September 2017, 89.1% of patients had been waiting less than 18 weeks for treatment, compared to 90.4% in September 2016.

There are currently 3.83 million patients on the waiting list.

In October 2017, 287 urgent operations were cancelled, compared to 363 in October 2016.

Mixed-sex accommodation treatment

Mixed-sex accommodation (MSA) breaches reached a six-year high in October 2017 with 1,140 breaches (equating to a 0.7 breach rate). The last time both the number of MSA breaches and the MSA breach rate exceeded this level was in October 2011.


As at August, the NHS employed 1.2 million staff. Overall, there has been a 2% growth in the total number of full-time equivalent staff since August 2016. However, there are now fewer nurses than at the same point last year (-1%).

Mental health 

In August 2017 there were over 113,000 new referrals to psychological therapies, a 7% increase on the same month last year. However, in August 2017 88.5% of those who finished treatment had waited less than 6 weeks, an improvement on the 87% achieved in August 2016.


To ensure they use their resources most effectively and patients receive the most appropriate response to their call the ambulance sector is currently implementing a set of new protocols and standards. In September 2017 the four trusts who have implemented the new system achieved an average response time for the most urgent calls of 8 minutes and 7 seconds.

Despite the sector’s performance improvements, risk still remains in the system:

  • Lack of capacity
    The NHS is already running at 87.1% bed occupancy, which means there is very little give in the system. This is above recommended levels
  • Workforce constraints and morale
    Including shortages in key staff groups such as paramedics, emergency medicine and general practice
  • Pressurised finances
    Particularly securing funding for admission avoidance and support schemes
  • New heightened public health risks this year
    Including a more virulent flu strain
  • Pressurised ambulance sector
    Due to the new ambulance response programme which has required implementing a new dispatch model.