Accident and emergency (A&E) departments treat people with urgent illnesses, from minor injuries to life-threatening conditions. Type 1 A&E departments are what we typically think of as A&E - based in major hospitals - and account for around two thirds of A&E attendances. Speciality and minor injury A&E departments (type 2 and type 3) account for the remaining third of attendances.
The current A&E standard was introduced in 2010. It states that 95% of people arriving at an A&E department should be admitted to hospital, transferred to a more appropriate care setting, or discharged home within four hours.
A&E performance continues to decline
The standard for type 1 A&E performance has been missed every year since July 2013. The Covid-19 pandemic then led to further decline in performance across all A&E types. Performance has not yet recovered, and in 2023/24 only 58% of all attendances at type 1 departments were seen within four hours. It is also the case that more people are leaving A&E before they've been seen by a clinician - 5% of people who attended A&E in February 2024 left before being seen, up from 2.1% in February 2019.
Longer waits in A&E are contributing to poorer patient experiences. In 2022, 38% of patients surveyed at major A&E departments reported that their experience was very good, down from 47% in 2018.
A&E performance continues to decline
Quarterly A&E performance in England, Q3 2011/12 to Q4 2023/24
Waits for emergency admissions have increased
Just over a quarter (28%) of people who attend a major A&E department end up being admitted into a hospital bed. In recent years, long waits for admission have reached record levels. The number of people waiting more than 12 hours after a decision to admit (sometimes referred to as ‘trolley waits' or ‘corridor waits') has increased from less than 150 in the first quarter of 2014 to nearly 150,000 in the first quarter of 2024.
The number of waits of 12 hour or more for admission has increased rapidly in recent years
Quarterly number of patients spending more than 12 hours from decision to admit to admission
Demand for A&E services is rising
Before the Covid-19 pandemic, demand for A&E services had been growing. Demand fell during 2020 and 2021 as the public was advised to stay away from hospitals while the pandemic was escalating, but demand has since returned to pre-pandemic levels. A&E attendances in 2023/24 were 5% higher than pre-pandemic in 2019/20.
However, resources to treat A&E patients have not kept pace with demand. For example, although admissions from major A&E departments have increased by 31% since 2011/12, the number of general and acute beds has fallen by 1%. The NHS is also facing a workforce crisis, with more than 70,000 vacancies in the acute sector, impacting trusts' abilities to admit patients from A&E in a timely manner.
Numbers of admissions from A&E have grown, but the number of acute and general beds have fallen
The four-hour A&E standard is one of the most high-profile indicators of NHS performance, and declining performance is 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 to the end of 2024/25 to help speed up performance in A&E departments. The NHS has also outlined a series of steps to help recover performance in urgent and emergency care. The current aim is for 78% of people to be admitted, transferred or discharged within four hours by March 2025.