A&E waiting times

The maximum four-hour wait in A&E remains a key NHS commitment and is a standard contractual requirement for all NHS hospitals. However, the 95% target has been replaced and instead, operational performance trajectories were introduced for NHS providers in July 2016.

This indicator explores four-hour 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 ‘latest data’ posts, which present the most up-to-date information on some key NHS performance measures as the 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. Nevertheless, the vast majority of patients spend less than four hours in A&E. The percentage of people seen in A&E in less than four hours rose dramatically with the introduction of the target in January 2004, reaching the old 98% target 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 Q3 2016/17, this had fallen to 82%, the worst level since the introduction of the four hour target.

Updated March 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.

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

On the whole, there is a year-on-year (apart from between 2012/13 and 2013/14) decrease in the proportion of patients seen within four hours, similar to what was observed in the previous chart. 2015/16 began with a particularly low level of performance, with only 90% of patients seen within four hours, but it began to pick up as the year continued up until July 2015. After this it began to decrease again and in March 2016 had dropped to 81%, the lowest level of any given month at that time. 2016/17 has had performance lower than all other years to date, the latest data shows performance of 81% in February 2017.

Updated March 2017.

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

As well as looking at the number of people who wait beyond a threshold, such as four hours, we can also compare 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 but began increasing after that. Median wait for all patients peaked in March 2016 at 157 minutes.

In January 2017 admitted patients spent an average of 112 minutes longer in A&E than non-admitted patients. The median time spent by non-admitted patients had stayed consistently around 110 minutes until August 2015. The median time spent by admitted patients has been more variable, with a maximum median wait of 239 minutes seen in January 2017.

Updated March 2017.

How long do people wait for treatment to begin?

While waiting no more than four hours from arrival to departure is the iconic measure of A&E performance, there are other important steps in the process where waiting time is important. This chart shows how long patients wait between arriving in A&E and their treatment beginning (in whatever form that takes). The median has changed little since 2011 and ranges between 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 - had fallen slightly, from 195 minutes in May 2011 to 181 minutes in July 2015. However, it has since increased back up to a peak of 223 minutes in March 2016 and stood at 216 minutes as of January 2017. It's worth noting that this measure can be sensitive to data quality issues.

Updated March 2017.

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

For patients that require admission to a hospital ward for further care, the time they wait between the A&E unit making the decision they should be admitted and the patient actually arriving on the ward is very important. The line on this chart shows the percentage of admitted patients who wait more than four hours between the decision to admit and admission. The percentage of people waiting more than four hours to arrive on a ward is highest in the winter months and has increased substantially since 2010. In January 2017 performance was at 16%. The bars on the chart show the number of people waiting more than 12 hours to arrive on a ward. The number of extreme waits peaked in January 2017 at 988. 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 March 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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