A&E waiting times

The NHS Constitution sets out that a minimum of 95% of patients attending an A&E department should be admitted, transferred or discharged within 4 hours of their arrival. In December 2016, NHS Improvement announced that hospitals will soon be rated against a new A&E standard. The 95% target will remain a key performance indicator, but it will be combined with clinical standards and staff and patient experience metrics.

This indicator explores four-hour A&E target breaches since 2004. For in-depth analysis of what's causing increasing A&E waits, see our report Focus on: A&E attendances.

See also our Combined Performance Summaries, which present the most up-to-date information on some key NHS performance measures as data are released by NHS England.

How has the number of people spending more than four hours in A&E changed?

The length of time patients spend in A&E depends on the type of A&E unit they visit. Minor A&Es (types 2 & 3, such as urgent care centres or minor injury units) nearly always treat people in less than four hours, but major (type 1) A&Es deal with a higher number of attendees and more serious cases, meaning they find it harder to achieve the four-hour target. The percentage of people seen in A&E in less than four hours rose dramatically with the introduction of the 98% target in January 2004, and this target was met in Q2 2005/06. Over the next five years, performance varied between 96% and 98% and while there were large increases in the number of people using minor A&Es, increases in major A&E attendances were modest. The relaxation of the target to 95% in 2010 was associated with an increase in patients waiting more than four hours in major A&Es, but performance initially remained close or above the new target until Q2 2012/13. By Q4 2016/17, performance had fallen to 81%, the worst level since the introduction of the four-hour target. Meanwhile, the number of total A&E attendances has increased by one third since Q1 2004/05, almost reaching 6 million attendances in Q1 2017/18.

Updated November 2017.

How strongly do seasons influence breaches?

The impact of "winter pressures" on A&E performance against the four-hour target has been the subject of some debate. There is a general trend for performance to be higher in the summer, despite the fact that A&E sees the highest numbers of attendees at this time. This is explained by changes in the case-mix of people attending. In summer A&E sees a higher proportion of cuts and sprains, most of which can be treated relatively quickly. In winter there is a larger proportion of older people attending and a greater number of people requiring emergency admission to hospital.

Drops in performance are normally observed from November in any given financial year. Performance generally recovers by April the following year.

On the whole, there is a year-on-year decrease in the proportion of patients seen in type 1 A&E departments within four hours. 2016/17 began with a particularly low level of performance, with only 85% of patients seen within four hours, and this only improved slightly over the summer. In January 2017 performance dropped to 78%, an all-time low since the introduction of the four-hour target. The latest data for 2017/18 shows performance following a similar trajectory to 2016/17, reaching 85% in October 2017.

Updated November 2017.

How has the median time spent in A&E changed?

As well as looking at the number of people who wait beyond the four-hour threshold, we can also study the median number of minutes spent in A&E by all patients. Overall, the median waiting time remained at around 130 minutes until the second half of 2014 when it began to increase. Since 2016 the median wait for all patients has fluctuated at around 150 minutes, peaking in March 2016 at 157 minutes.

In September 2017 admitted patients spent on average 234 minutes waiting in A&E. This was almost twice as long as the median waiting time for non-admitted patients, which reached 125 minutes in the same month.

Updated November 2017.

How long do people wait for treatment to begin?

While adherence to the four-hour target is the iconic measure of A&E performance, the length of time between patients arriving in A&E and their treatment beginning is another important indicator. This chart shows that the median treatment waiting time has changed little since 2011 and ranges from a low of 46 minutes in January 2015 to a high of 69 minutes in March 2016.

Interestingly, the 95th percentile value - that is, waiting times for some of the patients that wait the longest - fluctuated at around 185 minutes until August 2015, before increasing and reaching a peak of 223 minutes in March 2016. Since then, the 95th percentile value has been fluctuating at a higher level of about 210 minutes. It's worth noting that this measure can be sensitive to data quality issues.

Updated November 2017.

How long do people wait to move to a hospital ward?

For patients that require admission to a hospital ward, the time they wait between the A&E unit deciding that they should be admitted and the patient actually arriving on the ward is very important. The line on this chart shows that the percentage of admitted patients waiting over four hours between the decision to admit and admission is highest in winter months and has increased substantially since 2010. In October 2017, 9% of patients breached the four-hour target. The bars on the chart show the number of people waiting over 12 hours to arrive on a ward. The number of extreme waits peaked in January 2017 at 989. Whilst this is very small in comparison to the total number of people using A&E, it is clear that a growing number of patients are waiting an extremely long time.

Updated November 2017.

Comments

Last chart ,
How long do people wait to move to a hospital ward?
Is that 4 hrs from DTA OR 4hrs from arrival
what's the rational for 12 hrs from DTA rather than arrival as we count the later in NI?

pkerr (not verified)
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Is the referral to the Primary Care service by the Emergency Department, covered by the 4 hour pledge?

Richard Janulewicz (not verified)
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Can you add the total number of attendances at A&E to give some context. Also it would be worth updating this, particularly if you can get January 2016 data. I suspect it will show a significant change.

SCURR (not verified)
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