Board report: English systems in winter

Page last updated: 20 September 2023

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Our analysis of public data

Overall ratings for each of the three major care settings are below average in the Midlands and East of England

NHS region Care homes NHS acute hospitals GPs
East of England 79% 33% 93%
London 85% 45% 94%
Midlands 76% 45% 95%
North East and Yorkshire 82% 57% 97%
North West 79% 66% 96%
South East 83% 76% 94%
South West 87% 69% 96%
England 81% 57% 95%
Table showing percentages of services in each NHS region with an overall rating of good or outstanding on 8 March 2023. Figures do not include trust-level ratings.

The Midlands has the lowest proportion of care homes rated Good or Outstanding in the country and the second lowest overall GP ratings.

Overall ratings for care homes, NHS acute hospitals and GP practices were all above the England average in the South West.​

There is significant regional variation in ambulance handover times

Over a quarter of people had to wait more than 60 minutes for an ambulance handover in the South West in January 2023, compared to only 2% in the South East​.

NHS region Percentage
South West 26.2%
East of England 18.6%
Midlands 11.2%
London 8.6%
North East and Yorkshire 7.7%
North West 7.6%
South East 2.1%
England 10.4%
Table showing percentage of ambulance handovers that were delayed by over an hour in each NHS region. Source: NHS England urgent and emergency care data.
  • Although the South West has some of the highest ratings in the country, in January 2023 they had the highest proportion of ambulances waiting for over an hour to handover patients at hospitals.
  • The East of England had some of the lowest ratings for acute hospitals, and the second worst performance for ambulance handovers delayed over an hour.
  • Does it mean that people who use these services have a greater risk of experiencing poor outcomes?​
  • Of the 5 trusts with highest proportion of ambulance handovers over 60 minutes, 4 were in the South West.

The London region had some of the lowest conversion of A&E attendances to emergency admissions in the country

Region Integrated care board Percentage
East of England NHS Mid and South Essex 30%
South West NHS Dorset 27%
South East NHS Buckinghamshire, Oxfordshire and Berkshire West 26%
South West NHS Bristol, North Somerset and South Gloucestershire 26%
North East and Yorkshire NHS South Yorkshire 24%
England median 20%
Table showing highest five integrated care board areas for the proportion of A&E attendances that became emergency admissions in January 2023. Source: NHS England emergency admissions data.
Region Integrated care board Percentage
London NHS South East London 14%
Midlands NHS Derby and Derbyshire 14%
London NHS North East London 14%
South West NHS Cornwall and The Isles of Scilly 14%
London NHS North Central London 11%
England median 20%
Table showing lowest five integrated care board areas for the proportion of A&E attendances that became emergency admissions in January 2023. Source: NHS England emergency admissions data.

In the East of England, the NHS Mid and South Essex Integrated Care Board admitted 30% of all the patients who arrived at hospital via A&E in January. High proportions of these 'conversions' might be because of relatively high severity of illness or injury, or possibly a lack of alternative interventions.

Of those admitted to hospital from A&E, the time taken varied hugely from the decision to admit them to the moment they secured a bed

Region Integrated care board Percentage
East of England NHS Mid and South Essex 0%
East of England NHS Bedfordshire, Luton and Milton Keynes 1%
South East NHS Hampshire and Isle of Wight 1%
South East NHS Frimley 2%
Midlands NHS Coventry and Warwickshire 2%
England median 12%
Table showing lowest five integrated care board areas for the proportion of waits longer than 12 hours from decision to admit (DTA) to admission in January 2023. Source: NHS England emergency admissions data.
Region Integrated care board Percentage
East of England NHS Norfolk and Waveney 25%
London NHS South West London 27%
London NHS North Central London 28%
South West NHS Gloucestershire 29%
South West NHS Cornwall and the Isles of Scilly 34%
England median 12%
Table showing highest five integrated care board areas for the proportion of waits longer than 12 hours from decision to admit (DTA) to admission in January 2023. Source: NHS England emergency admissions data.

Residential and nursing adult social care capacity remains relatively steady across England

Regional variation since April 2022 may have affected local discharge pathways​.

NHS region Overall beds Nursing beds Residential beds
East of England -3.6% -5.3% -2.3%
South West -0.9% -2.6% 0.6%
South East -0.6% -0.1% -1.2%
North West -0.5% -1.1% 0.2%
North East and Yorkshire 0.0% -3.8% 3.2%
London 1.2% 2.5% -0.6%
Midlands 3.3% 3.0% 3.5%
England 0.0% -0.8% 0.8%
Table showing the percentage change in the number of beds since April 2022. Source: CQC register of services.

Since April 2022, the number of registered home care agencies has risen across the country

NHS region April 2022 January 2023 Percentage change
East of England 1,538 1,573 2.3%
South West 1,055 1,090 3.3%
North West 1,200 1,244 3.7%
South East 1,796 1,895 5.5%
Midlands 2,373 2,509 5.7%
London 1,870 1,978 5.8%
North East and Yorkshire 1,443 1,535 6.4%
England 11,275 11,824 4.9%
Table showing percentage change in the number of domiciliary care agencies since April 2022. Source: CQC register of services.

London, the South East and the Midlands had a greater than average increase in hospital patients who no longer met the criteria to stay in hospital occupying beds overnight

NHS region April to August 2022 September 2022 to January 2023 Percentage change
London 1,098 1,399 27%
South East 1,830 2,127 16%
Midlands 2,023 2,207 9%
North West 2,216 2,342 6%
South West 1,940 2,025 4%
East of England 1,191 1,226 3%
North East and Yorkshire 2,244 2,244 0%
England 12,543 13,571 8%
Table showing mean daily patients waiting for discharge for each NHS region. Source: NHS England discharge data.

The London region had the greatest proportion of reattendances to A&E within 7 days

NHS region Reattendance percentage
London 9.3%
North East and Yorkshire 8.9%
North West 8.6%
South East 8.6%
East of England 7.8%
South West 7.8%
Midlands 7.6%
England 8.4%
Table showing percentage of people reattending A&E within 7 days in each NHS region in December 2022.

The proportion of A&E attendances which were attendances within 7 days of a previous admission varied between regions, with London having the highest rate. This was reflected in 2 of the 5 ICBs with the highest rates of reattendances being from the London region.

NHS region Integrated care board A&E reattendance within 7 days
London North Central London 11.3%
North East and Yorkshire North East and North Cumbria 10.0%
South East Kent and Medway 9.9%
London North East London 9.9%
Midlands Staffordshire and Stoke-on-Trent 9.4%
England 8.4%
Table showing ICBs with the highest rates of A&E reattendance within 7 days in December 2022.
NHS region Integrated care board A&E reattendance within 7 days
Midlands Birmingham and Solihull 6.6%
South West Bath and North East Somerset, Swindon and Wiltshire 6.5%
East of England Norfolk and Waveney 6.4%
Midlands Derby and Derbyshire 6.2%
Midlands Shropshire, Telford and Wrekin 6.1%
England 8.4%
Table showing ICBs with the lowest rates of A&E reattendance within 7 days in December 2022.