December has kicked off with NHS hospital performance against the four hour A&E target standing at just 82.45 percent - 12.55 percentage points lower than the 95 percent standard, reports the Royal College of Emergency Medicine (RCEM).

While the result it better than that at the same period of last year (81.28 percent), there has been a “marked deterioration” from the prior week’s figure of 85.23 percent.

The College has now launched its annual Winter Flow Project, which gathers data from over 50 different NHS sites in the UK every week on a number of targets, to look at system-wide pressures impacting on the emergency care system over the winter period.

The data is aggregated to ensure that analysis is focused on the wider health care system rather than the performance of individual NHS trusts or boards.

Also, the figures show that the number of patients subject to delayed transfers of care worsened in the fourth week of November, with 1,997 recorded instances, up from 1,982 the previous week. The number had been falling since the third week of October, when figure was 2,176.

According to the report, a total of 3,530 elective operations were cancelled in the last week of November, up from 3,388 the previous week. It also notes that a total of 27,328 elective operations have been cancelled over the project to date, which equates to an overall average of 62 cancelled operations per site per week.

“The data published this week shows that although we are at the start of what is widely expected to be a challenging winter, NHS providers continue to strain every sinew to maintain performance,” noted Gordon Miles, RCEM chief executive.

“It is also evident that efforts mandated by NHS England to free up acute beds by reducing the number of Delayed Transfers of Care have had some impact; although NHS Providers have been right to point out that whatever progress is being made is unlikely to be enough to free up 3000 beds.”

He also argued the what the figures “make clear is that Providers are making determined efforts to lower their bed occupancy levels by cancelling increasing numbers of elective operations,” which indicates that “to some extent, care is already being rationed.”

But this could turn out to be a “false economy” as clearing the backlog “will eventually require large sums of money the NHS currently does not have”, and because “patients with untreated problems are likely to turn up in Emergency Departments requiring treatment which might otherwise been unnecessary,” he warned.