Key NHS sectors still at lowest ever performance levels
The NHS is failing to emerge from its winter crisis, with new figures showing the start of spring has not improved key waiting times.
Data for March shows performance at its lowest ever level across England in areas such as A&E, ambulance responses, 111 handling and waiting times for treatment.
According to the figures from NHS England, March marked the worst performance for A&E on record, with just 87.3% of patients admitted, transferred or discharged from England's A&E departments within four hours - below the 95% target.
Across the last 12 months, the target was hit only once in July, although more than 500,000 extra visits were made to A&E in 2015/16 compared to the previous year.
Ambulance targets, which were missed for most of 2015, also further declined in March.
Some 66.5% of the most serious Red 1 calls - where patients are not breathing or do not have a pulse - were responded to within eight minutes in March, against a 75% target. This figure has been in constant decline since last summer.
Some 58% of Red 2 calls - still serious, such as strokes or fits - were responded to within eight minutes, far below the 75% target and the worst month on record.
A key Government waiting time target - for people to start treatment within 18 weeks of referral by a GP - achieved its worst performance in March since the target was introduced in April 2012.
Every single surgical speciality apart from ophthalmology and gynaecology missed the 18-week target.
Clare Marx, president of the Royal College of Surgeons, said: "It is worrying that the NHS has again missed its waiting times target. It is extremely distressing for patients if their operation is delayed, especially if they are in pain or immobile.
"Dedicated frontline doctors and nurses are treating more patients than ever before. We welcome the extra money the Government promised in the comprehensive spending review, but we still need a long-term plan to address the growing number of patients needing surgery."
She also expressed concern that the number of days patients were delayed leaving hospital - even though they were fit to leave - rose by 11.4% between 2014/15 and 2015/16.
"This problem is increasing due to social care or district nursing services not being immediately available for vulnerable patients in their home," she said. "We believe the underfunding of social care has contributed to this significantly."
The target for people to receive their first treatment for cancer within two months of being referred by their GP with symptoms was also missed during the whole of 2015/16, the new data showed.
Some 82.4% received treatment on time in 2015/16 against a target of 85% - the worst year on record. The target was met every year from 2009/10 to 2013/14.
The 111 non-emergency helpline also performed badly in March, set against a 33% rise in calls compared to the previous year.
Of the 1.5m calls to 111 in March, the proportion abandoned after waiting longer than 30 seconds was 8.4%, the highest since records began, and far above the quality requirement of 5%.
Of calls answered by NHS 111, 70.7% were answered within 60 seconds, considerably lower than the 92.1% recorded in March 2015 and the lowest performance on record.
Of call-backs offered to patients, 35.6% were within 10 minutes, a large drop on the 42.3% in the previous March.
An NHS England spokesman said: "The (111) service continues to do a vital job in terms of helping patients to get the right care, at the right place and at the right time, and in protecting both A&E and ambulance services from unnecessary attendances and call outs.
"Of the calls NHS 111 triaged just 11.2% led to an ambulance being dispatched and just 7.8% were recommended to A&E."
He also said ambulances were now dealing with more calls than last year and more patients had started consultant-led treatment than in the previous 12 month period.
Richard Barker, interim national director of commissioning operations and information at NHS England, said of the A&E figures: "While emergency admissions over the past year are up by a relatively modest 2% and inpatient bed days are stable, March was particularly busy with more than two million treated in A&E, compounded by the effects of the delayed flu spike in March. We also saw the effects of delayed care and industrial action beginning to show up in the figures."
Nuffield Trust chief executive, Nigel Edwards, said: "New figures showing failures to meet key NHS targets have now become almost a monthly routine. The scale and length of this decline in performance show that we are looking at a systemic issue, rather than failings in a few hospitals or particular services.
"Simply piling on more pressure to meet each individual target won't turn things around at this stage. We need to understand the complicated problems at the heart of the issue."
Labour analysed the figures and said there were 53,641 trolley waits of more than four hours in March 2016 compared to 30,768 in March 2015.
It added there were 350 trolley waits of more than 12 hours in March compared to 54 in March 2015.
And it pointed to NHS England estimates that just under 3.7 million people were waiting in March to start their treatment.
This compares to 2.45 million in March 2011 and three million in 2015, it said.
Shadow health secretary, Heidi Alexander, said: "This is Black Thursday for the NHS.
"These figures show an NHS in constant crisis and there appears to be no sign of things getting any better.
"Jeremy Hunt might have been the longest serving Heath Secretary, but on his watch patients are waiting longer than ever before to be treated in A&E.
"The reality is that this deepening crisis is a direct result of the Tories' failed policies."