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NHS Performance Tracker

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.

Type 1 ED Attendances

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

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.

 

12- Hour Waits from Time of Arrival

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.

 

Excess Deaths

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.

Read: Excess deaths associated with crowding and corridor care

July 2025

visualization

Flourish slides can be found here.

Summary:

  • Busiest July on record: 2,407,884 attendances across all EDs and 1,469,050 in major EDs
  • There were 122,852 12-hour stays, making up 8.3% of all attendances
  • 4-hour performance stood at 76.4% across all EDs and 63.1% in major EDs, highest it has been since 2021
  • 559,392 total emergency admissions, over 22,000 more than last month
  • 28.1% of attendances were admitted
  • Bed occupancy stood at 92.1%, lowest so far this year
  • Daily average of 12,552 patients remaining in hospital while no longer meeting CTR

 

Supplementary ECDS Analysis July 2025 (12-hour length of stay data measured from the time of arrival) data show:

  • There were 122,852 attendances to type 1 departments that waited for 12 hours or more, an increase of 992 from the previous month (121,860) and an increase of 2,443 from July last year (119,409).
    • This is the second highest number on record for the month of July.
  • 8.3% of patients waited for 12 hours or more from their time of arrival, a 0.5 percentage point (pp) decrease from the previous month (8.8%) and a 0.4pp decrease from July last year (8.7%).
  • 1 in 12 patients waited for 12 hours or more this month.

 

The latest Emergency Department performance figures published by NHS England for July 2025 show:

  • This was the busiest July on record across all EDs and the busiest month so far this year with 2,407,884 attendances. This is 57,406 more attendances than the previous month and 86,590 more than last July.
  • Exactly the same for major EDs, attendances came in at 1,469,050, making it the busiest month of the year so far and the busiest July ever.
    • Second busiest month on record for all ED and major ED attendances
  • Across all EDs, 4-hour performance stood at 76.4%, the highest it has been since August 2021 when it stood at 77%. This is an increase of 0.9pp from the previous month (75.5%) and an increase of 1.2pp from July last year (75.2%).
  • In major EDs, performance stood at 63.1%, the highest it has been since November 2021. This is a 1.4pp increase from the previous month (61.7%) and a 1.7pp increase from July last year (61.4%).
  • Across all EDs there were 559,392 emergency admissions, an increase of 22,496 from the previous month (536,896) and an increase of 6,924 from July last year (552,468)
  • Major EDs saw 412,893 emergency admissions, 16,718 more than last month (396,175) and 7,238 more than last July (405,655).
  • 28.1% of patients were admitted, an increase of 0.4pp from last month but 0.4pp less than last July.
  • 115,542 patients experienced a trolley wait of four hours or more, a decrease of 2,629 from the previous month (118,171) and a decrease of 13,788 from last July (129,330)
  • 35,467 patients experienced a trolley wait of 12 hours or more, a decrease of 3,216 from the previous month (38,683) and a decrease of 1,339 from last July (36,806).

 

Beds data for July 2025 show:

  • There were 100,640 G&A beds available, 1,306 more than last month and 1,470 more than July last year.
  • 92,735 beds were occupied, bringing the occupancy rate to 92.1%. This is 0.6pp lower than last month (92.7%) and 0.5pp lower than July last year (92.6%).
  • It would require 8,460 beds to bring occupancy down to 85%.

 

July 2025 discharge delays

  • On any given day, there were around 12,552 patients that were ready to be discharged but still remained in hospital.

June 2025

visualization

Flourish graphs here

Summary:

  • 66.7% of patients were seen within 4 hours, while 10.8% waited 8 hours and 4.35% waited 12 hours.
  • There was an average of 1,860 beds occupied per day due to delayed discharges, the second highest for any June since guidelines changed in 2016.

 

Waiting times (Type 1 EDs):

  • There were 119,383 attendances at major EDs in Scotland, a 5% decrease from the previous month.
  • 66.9% of patients were seen within four hours (79,857). This is a decrease of 1.1 percentage points (pp) from the previous month and an increase of 1.6 pp from June last year.
  • The number of patients seen within 4 hours is 24.7pp lower than in the same time in 2018, despite major ED attendances being slightly lower overall.
  • 12,907 (10.8%) patients waited eight hours or more in Major EDs.
  • This is 235 more 8-hour waits than the previous month, though it is a decrease of 892 from June last year.
  • This is the second highest proportion of 8-hour waits for any June on record, with 1 in 10 patients waiting eight hours or more.
  • 5,195 (4.35%) patients waited twelve hours or more in Major EDs
  • This is a 0.5pp increase from the previous month, and a 0.7pp decrease from June last year.

 

Discharge delays

  • There was an average of 1,860 beds occupied per day due to delayed discharges, a decrease of 8 from the previous month.
  • This is the second highest number of beds occupied per day for the month of June due to delays since the guideline changes in 2016.
  • The number of beds occupied per day has increased by 452 since June 2019.

July 2025

visualization

Flourish slides can be found here.

Summary:

  • This was the second worst July on record for 12-hour breaches, as well as the worst July on record for 4-hour performance and 8-hour breaches. Despite it being summer, it saw the highest number of 8-hour and 12-hour waits so far this year.
  • 54.1% of patients were seen within four hours in major EDs, while 24.3% waited 8 hours or more and 14.8% waited 12 hours or more
  • In the last seven years (since July 2018), the numbers waiting four hours or more increased by nearly double, the numbers waiting eight hours or more have more than doubled, and the numbers waiting 12 hours or more have nearly tripled. This is despite attendances being 4% lower compared to July 2018.

 

Figures for July 2025

  • 71,192 people attended major emergency care facilities, 3,485 more than in June.
  • Overall, 54.1% of patients in major EDs were admitted, transferred or discharged within four hours from arrival
    • This is a 0.9 percentage-point (pp) increase from the previous month, but it is the worst performing July on record (since 2010)
    • 45.9% of patients in major EDs waited longer than four hours (32,657), which is a 3% increase from the previous month (31,701)
    • The number of people waiting more than four hours has increased by nearly double compared with July 2018 (17,359).
  • 24.3% of major ED attendances waited more than eight hours (17,312), 0.2pp decrease from last month
    • This means that just over one in four patients were delayed eight hours or more in a major ED. This is a slight decrease of 0.2pp from last month, but it is the highest proportion of eight hour waits on record for the month of July
    • The number of people waiting eight hours or more has more than doubled from July 2018 (7,559).
  • 14.6% of major ED attendances waited 12 hours or more (10,390), 0.4pp decrease from last month
    • This means that one in seven patients were delayed more than 12 hours, this is a 0.4pp decrease from the previous month, but it is the second highest proportion for July on record.
    • The number of people waiting more than 12 hours has nearly tripled compared to July 2018 (3,749)

Quarter 4 2024/25 (January - March 25)

visualization

See Flourish slides.

Summary:

  • While not the worst quarter on record for attendances waiting more than 12 hours, January 2025 saw the highest proportion of attendances on record waiting this long (23.1%)
  • 34.2% of patients were seen within 4 hours – 3.2 percentage points (pp) less than the same quarter last year
  • Quarter 4 2024/25 was the second worst on record for 4-hour performance
  • The median time patients admitted spent for the quarter was 15 hours 19 minutes, while the 95th percentile quarterly average was 65 hours.
  • The median time spent by patients discharged was 4 hours 45 minutes for the quarter. This is an increase of 13 minutes from the same quarter last year.

 

Quarterly Figures:

  • The average number of monthly attendances for this quarter was 50,244 - this is 4,741 fewer than the same quarter last year.
  • On average, 21.5% of patients waited more than 12 hours in an ED, an increase of 1.5pp compared to the same quarter of the previous year.
  • January 2025 saw the highest proportion of 12-hour delays on record, with 23.1% of attendances waiting this amount of time, or longer. This is an increase of 1.9pp from January 2024. This amounts to almost 1 in 4 patients.
  • The number of attendances waiting 12 hours or more in a type 1 ED for this quarter (32,314) was three times the number of the same quarter in 2019 (10,111).
  • For the quarter ending 31 March 2025, the median time patients admitted spent the longest in January 2025 (16 hours 34 minutes) and shortest in March 2025 (13 hours 23 minutes)
  • During this period, the median time spent by patients discharged home was longest in February (4 hours 49 minutes) and shortest in January (4 hours 40 minutes)
  • This quarter saw 4-hour performance reach new lows for this time of year. In February 2025, only 33.9% of patients were seen within 4 hours – the third worst month for 4 hour waits. This performance is worse than that of the average for winter 2023.
  • Quarter 4 2024/25 was the second worst quarter ever for 4-hour performance. It is only a slight improvement on the worst quarter (quarter 3 2024/25), being 0.4 percentage points higher.
  • In March alone, 575 patients waited at least 57 hours to be admitted to hospital from their time of arrival. January and February both had worse 95th percentiles of 72 hours 22 minutes and 65 hours 20 minutes respectively, but unfortunately the admission data is not provided for this month.

Week 20 2024/25 (24th – 30th March)

visualization

Flourish slides can be found here.

 

Summary for week 20:

  • Bed occupancy stood at 93.5%, no change from last week
  • 26.4% of ambulance handovers took over 30 minutes. 16,205 hours were lost in total (almost two years’ worth of time)
  • 13,166 patients remained in hospital while no longer meeting the criteria to reside
  • 942 beds were occupied by patients with flu, 49 fewer than last week.
  • A daily of 47,053 patients had stays of 7 days or more – 444 than the same week in the previous year.
  • There was a total of 25 diverts, 3 more than last week.
  • There was a daily average of 46,548 absences in week 20, almost 3,000 more than the same time last year

 

Beds

  • There was 93.5% bed occupancy in week 20 for total (adult and paed) beds, no change from the previous week. And an increase of 0.2pp compared to the previous year.
  • There were 100,532 beds open, 125 more than last week but a decrease of 412 compared to the same week of the previous year.
  • An additional 10,086 bed would have been required to meet safe bed occupancy of 85%.

 

Ambulance Offloads

  • There was a total of 91,571 ambulance offloads in week 20, 1,558 fewer than the previous week.
  • 26.4% of handovers took over 30 minutes, this is a 0.9 percentage point decrease from the previous week.
  • In total 16,205 hours were lost to handover delays this week. This is 1,083 fewer hours than the previous week and is the least number of hours lost during winter 2024/25.
    • Despite this, it is still equivalent to almost two years’ worth of time.

 

Beds Occupied by Long-Stay Patients (Type 1 trusts)

  • A daily of 47,053 patients had stays of 7 days or more – 444 than the same week in the previous year.
  • 18,294 patients had a stay of 21 days or more – a decrease of 172 compared to the same week last year.

 

Criteria to Reside

  • There was a daily average of 13,166 patients who no longer met the criteria to reside yet still remained in hospital. This average is 1,197 (10%) higher than week 3, the start of the winter period.

 

Flu (Type 1 trusts)

  • In week 20, the average number of beds occupied by patients with flu was 942, a decrease of 49 from the previous week, and the lowest average for this winter period. Despite this, it is still 141 more beds than the same week last year.

 

Diverts

  • There was a total of 25 diverts, 3 more than last week.

 

Absences

  • There was a daily average of 46,548 absences in week 20, almost 3,000 more than the same time last year. 294 were Covid absences.

(NB. Over the past few years, the winter sitreps have commenced at different points in the winter season. To keep things consistent across calendar weeks, we have called this week’s analysis week 20 in our records, even though it is technically week 17 of publication. This helps us to sync our reporting to get a clearer picture of how winter is playing out, making it easier to spend trends over time.)