An NHS in crisis: patients are now waiting longer for almost every type of emergency care

There’s no doubt that the NHS is deep in crisis. The NHS is facing spiralling waits for emergency and routine care; waves of national strikes; budgets squeezed by inflation; and endless declarations of critical incidents by trust trying to preserve capacity for their sickest patients.

But what does an ’NHS in crisis’ really mean for patients needing emergency care? The unfortunate reality is that patients are likely to face multiple delays on their journey to treatment. The figure below shows the average patient waiting times across different stages of a patient’s journey, from calling 999 to getting into a hospital bed. The time spent waiting at every stage has elongated between 2019 and 2022, despite the waiting times in 2019 already being far beyond national targets.¹

And while this figure does not show the full patient journey and is only a snapshot2 of waiting times in both years, it is indicative of what patients needing emergency care are experiencing. In the time it took for a patient to get a treatment decision in 2019, it’s possible that in a similar timeframe in 2022, a patient would have only just arrived in the A&E department. In aggregate, patients on this pathway could have been waiting three and a half hours longer in 2022 compared to 2019. This includes four times longer waiting for a 999 call to be answered (from 9 to 36 seconds), more than double the time waiting for an emergency (category 2) ambulance (from 22 to 48 minutes) and nearly double the time waiting in A&E for a bed (from 175 to 330 minutes). The data for 2023 so far suggests waiting times this year could go in the same direction. 

These delays raise doubts about the quality and safety of care patients are receiving – for example, handover delays could be exposing a significant number of patients to preventable harm. And there are already a number of harrowing stories of people who have lost their lives due to waiting time delays (BBC News 2023; BBC Sounds 2022). 

'These delays raise doubts about the quality and safety of care patients are receiving'

So what’s the reason for these waiting time delays? The primary cause is the breakdown of the flow of patients across the whole emergency and inpatient pathway. Capacity for patients is limited all the way from the ‘front doors’ of A&E to the ‘back doors’ into social care. And without sufficient capacity, it becomes impossible to move patients along the pathway in a timely way. The lack of capacity is further exacerbated by the gradual growth in demand for services. Only made worse by the long-term effects of the Covid-19 pandemic – for example, missed opportunities for preventive care may have increased patient needs. 

If the NHS is going to get patient waiting times for emergency care under control, it needs to restore patient flow, by rebalancing demand and capacity for emergency and inpatient services. And there are several ways the government can support the system to do that.

First, the government can help provide short-term additional capacity across the whole pathway. The extra £250 million to support hospital discharges is a good start, albeit introduced too late to support the NHS through this winter. However, there is no one single service to blame here – the whole pathway needs support. Second, the government can commit to long-term solutions to increase service capacity. For example, by committing to a long-term strategic approach to workforce planning that focuses on rebuilding the workforce and increasing retention. Without this long-term workforce planning, extra funding for beds and ambulances will have limited impact. And finally, the government can facilitate a reduction in demand by championing long-term prevention strategies – for example, strategies to prevent cardiovascular disease, a significant cause of mortality and morbidity in England.

Any of these options could help provide reassurance to patients that there is a way out of the current crisis. Because the longer the emergency pathway gets, and the longer the NHS crisis goes on, more and more patients will receive sub-standard care.