Another winter crisis? Five key markers for NHS performance

This week saw the Scottish Government publish its winter preparedness plan for the NHS and social care.

It was released earlier than usual, said the government, to help health boards plan ahead.

With three months to go until Christmas, how is the NHS shaping up - and has the picture improved compared to this time last year?

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A&E

Focusing on the week ending September 15 - the most recent period for which data is available - attendances at emergency departments are roughly the same: 26,259 compared to 26,501 for the same week in 2023.

The percentage of people being seen, treated and subsequently admitted, discharged or transferred within the target time of four hours also remains more or less static year-on-year: 68% compared to 67.4% for the same week in 2023 (the target is 95%).

There was a small year-on-year increase the numbers spending more than 12 hours in A&E, however - 945 (3.6%) last year compared to 1,096 (4.2%) this year.

Attendances and waits at A&E show no significant change year-on-year (Image: DerekMcArthur)

Cancer

Figures published on Tuesday show that 4,450 cancer patients were referred onto the 62-day pathway in April-June this year - up from 4,299 in the same three-month period in 2023.

This is a measure of the number of patients who are sent for diagnostic tests as a result of either probable cancer symptoms or a positive screening result, who then turn out to have cancer and join the waiting list to commence treatment.

Patients are supposed to wait no longer than 62 days between this "urgent suspicion of cancer" referral and the start of treatment.

The 95% performance target was last met in 2012, however.

Year-on-year, the percentage of patients meeting the 62-day threshold has fallen slightly, from 73.7% in April-June 2023 to 73.2% for the same period in 2024.

Performance against the 62-day standard is stagnating (Image: PHS)

Delayed discharge

Getting patients out of hospital as soon as they are ready to leave is vital to maximising hospital capacity.

Year-on-year, however, there has been an increase in the average number of beds occupied on any given day by a patient who should have been discharged: 1,973 in July 2024, compared to 1,811 in July 2023.

According to Public Health Scotland, acute hospitals had around 13,755 available staffed beds in 2023/24.

This was up by 0.4% on 2022/23, but suggests that roughly 14% are being lost to delayed discharge.

Overall, elective activity is up year-on-year - but the picture is not the same everywhere (Image: Getty)

Elective activity

The Scottish Government said one of its key priorities this winter will be to "protect" planned care - in other words, minimising the number of procedures such as hip replacements which are cancelled due to bed and staff shortages, or because operating theatres have to be freed up for emergency surgeries.

Overall, elective activity has been increasing.

In July 2024, a total of 21,815 planned operations were carried out by NHS Scotland - up 8.2% from 20,158 in July 2023.

The biggest year-on-year increases have come from Highland (up 68%) and Fife (up 36%), but this is not universal.

Both Tayside and Greater Glasgow and Clyde did fewer operations in July this year than they did in 2023 (down by 14% and 8% respectively).

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Ambulance waits

This is a key signal of A&E overcrowding. 

If patients cannot be moved out of emergency departments and onto a ward, then ambulances  'stack' outside A&E departments waiting to offload patients.

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The most recent four-week data, up to September 15, shows that the median turnaround time for ambulances arriving at Scotland's A&E departments was 45 minutes and 34 seconds.

One in 10 patients was in the back of an ambulance for at least one hour 37 minutes.

This is essentially unchanged from the same period in 2023, when the equivalent figures were 43 minutes 33 seconds and one hour 32 minutes.