A&E performance continues to decline
The standard for type 1 A&E performance has been missed since July 2013.
The current A&E standard was introduced in 2010 and states that 95 per cent of patients arriving at an A&E department should be admitted to hospital, transferred to a more appropriate care setting, or discharged home within four hours. In December 2022, performance across all A&E types was its lowest ever and less than half of all attendances at type 1 departments were seen within four hours. In addition, more people are leaving A&E before they’ve been seen by a clinician, with 6 per cent of all people who attended A&E in November 2022 leaving before being seen, up from 2.2 per cent in November 2019.
Demand for A&E services has returned to pre-pandemic levels
Waits for emergency admissions have increased to record levels.
The number of attendances at A&E departments of all types fell during 2020 and 2021 as the public were advised to say away from hospitals while the Covid-19 pandemic first escalated, but has since returned to pre-pandemic levels. An increasing number of people are waiting longer to be admitted onto hospital wards from A&E departments, with the number of people waiting more than four hours for an admission (often referred to as ‘trolley waits’ or ‘corridor waits’) has increased from a total of 29,929 in Q3 2010/11 to 465,154 in Q3 2022/23. Over the past 12 months the number of people waiting more than 12 hours following a decision to admit has increased rapidly, and what was once a rare occurrence is now much more common, with 136,131 people waiting more than 12 hours to be admitted to a ward from A&E departments in Q3 2022/23.
12 hour+ waits have increased rapidly in recent years
However, resources to treat A&E patients have not kept pace with rising demand.
For example, while the NHS has been admitting more patients through A&E, the number of general and acute overnight beds available in Q2 2022/23 was 5.7 per cent less than in Q2 2011/12, and the percentage of them that were occupied has risen from 85.6 per cent to 90 per cent. The NHS is also facing a workforce crisis with more than 133,000 posts currently vacant, impacting trusts' ability to admit patients from A&E in a timely fashion.
The four-hour A&E standard is one of the most high-profile indicators of NHS performance, with declining performance seen as a clear indication of the pressures the health and care system is under. There have been multiple announcements of additional funding for discharge packages through the end of 2022/23 to help speed up performance in A&E departments, and the NHS has outlined a series of steps to help recover performance in urgent and emergency care, with the ambition to improve to 76 per cent of patients being admitted, transferred or discharged within four hours by March 2024, with further improvement in 2024/25.