The NHS service across the four nations of the UK regularly publish important datasets relating to the performance of the urgent and emergency care system. The Royal College of Emergency Medicine analyses this data which is used to inform our policy and campaigns work.
Since May 2021, attendances have remained consistent with pre-COVID attendances. Although there have been fluctuations in demand, attendances have remained relatively stable and consistent with pre-COVID-19 levels.
The four-hour standard is an operational standard pledged in the NHS constitution that 95% of patients should be admitted, transferred, or discharged from an ED within four hours. It is an indicator of patient outcomes and safety, and accountability. The standard has not been met in England since June 2013. In December 2022, the UK Government announced a threshold target of 76% to be hit in England by March 2024. Scotland last met the standard in June 2020; before this Scotland hadn’t met the target since July 2017. Since records began, Wales and Northern Ireland have not met the standard.
Data from each UK nation on 12-hour waits from the patient’s time of arrival shows that more patients than ever before are experiencing extremely long waits in our EDs. In England, the NHS requirement is that no more than 2% of patients should wait 12 hours or more from their time of arrival. This pledge has not been met in England since April 2021.
In summary, October 2023 witnessed an increase in both the number of patients attending Type 1 Emergency Departments and patients subsequently admitted into hospital. Performance against the four-hour target for October hit record lows so far in 2023. On the aggregate four-hour target is 5.8 percentage points below the Government’s intermediary threshold target of 76% to be hit by March 2024.
October saw the greatest number of patients waiting 12-hours or more for any month so far this year, with more than 1 in 10 patients who attended A&E waited this long. There were 2,675 less Type 1 G&A beds available than January 2022, when 5000 new beds were promised. Bed occupancy stood at 94.1%, nearly 10 percentage points more than the recommended safe levels. A daily average of 12,493 patients remained in hospital despite no longer meetings the criteria to reside.
This was the second worst September on record for four-, eight- and 12- hour performance. 33.5% of patients waited more than four-hours or more, 10.4% waited eight-hours or more, and 3.7% waited more than 12-hours in an ED. Winter 2024/25 is on track to be the second worst on record.
We are well below pre-pandemic performance levels. Since September 2019, the numbers waiting more than four hours increased by 2.5 times, the numbers waiting more than eight hours increased by 8 times, and the numbers waiting more than 12 hours increased by 14 times. This is despite attendance decreasing by 6.9%.
It is important to note that the pandemic is not the only reason for poor performance, as evidenced from historical analysis, performance was already significantly decreasing in the years leading up to the pandemic.
In September 2023, there were 113,864 attendances at major Emergency Departments in Scotland.
Visualisations can be found here
This was the second worst October for more than 12 hour waiting time figures. Nearly 1 in 7 people waited 12 hours or longer in an Emergency Department and nearly 1 in 4 waited eight hours or longer.
We are lagging far behind pre-Covid performance. Compared with October 2019, 29% more patients have waited longer than four hours, 49.6% more patients have waited longer than eight hours, and 77.1% more patients have waited longer than 12 hours. This is in spite of a 0.7% decrease in attendance for October 2023 compared with pre-pandemic average October attendance (2011-2019).
It is important to note that the pandemic is not the only reason for poor performance, as evidenced from historical analysis, performance was already deteriorating in the years leading up to the pandemic.
67,401 people attended major emergency care facilities in October.
July to September 2023 was the worst Quarter 2 on record for 12-hour performance, with 16.6% of patients waiting more than 12 hours in an Emergency Department. Indeed, this was the second worst Quarter 2 on record for four-hour performance, with only 44.5% of patients waiting less than four hours.
Quarter 1 (October to December) and Quarter 4 (January to March) are usually associated with the worst performance as they make up the coldest months. However, Quarter 2 2023 was worse for four- and 12- hour performance than any Quarter 1 and 4 from 2011-2021.
We are well below pre-pandemic levels, with a 232.2% increase in the number of people waiting 12 hours from Quarter 2 2019. And a more than double median waiting time for admitted patients. This despite attendance decreasing by 1%.
On average, 56,769 people attended type 1 emergency care facilities each month across Quarter 2 2023.
Using the best available evidence, a scientific study published in the Emergency Medicine Journal, we calculate an estimated number of excess deaths occurring across the United Kingdom associated with crowding and extremely long waiting times. These figures are based on modelling from the EMJ study which show that for every 72 patients waiting between eight- and 12-hours from their time of arrival in the Emergency Department there is one patient death.
Urgent and Emergency Care Daily Situation Reports (UEC SitReps) are a data collection system administered by NHS England. These daily reports on metrics provide us with a real-time understanding of on-the-ground pressure on NHS frontline services over the winter months.
Flourish slides can be found here.