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. In addition, NHS England has added a new contractual requirement covering NHS hospitals that no A&E patient should wait more than 12 hours on a trolley.

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.

Updated July 2016. Read our Indicator Update Summary and a response by Dr Clifford Mann, Royal College of Emergency Medicine, exploring the issues surrounding these findings. 

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 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 was 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 was initially still in line with the new target until Q2 2012/13. By Q4 2015/16, this had fallen to 82%, the worst level since the introduction of the four hour target. Although this is also associated with the normal seasonal fluctuations seen in winter A&E waiting times, this was much poorer than previous years. Also, performance in subsequent quarters has not returned to the previous levels seen in non-winter months.

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; however there is variation between the years in what happens subsequently. In 2010/11 and 2014/15 it reached a low level of performance in December but then started to recover in the months after. In 2011/12 and 2013/14 the level of performance continued to drop until February, after which there was some recovery. In 2012/13 there didn't appear to be any recovery until well into the next financial year (May 2013/14).

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.

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 peaked in February 2016 at 156 minutes.

Admitted patients spend an average of 111 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, but has surpassed 120 minutes since October 2015. The median time spent by admitted patients has been more variable, with a maximum median wait of 238 minutes seen in February 2016.

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). People's average experience (the median) has changed little since 2011 and ranges between a minimum of 46 minutes to a maximum of 65 minutes. 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 levels similar to May 2011 - 217 minutes in February 2016. It's worth noting that this measure can be sensitive to data quality issues.

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 also 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, but has clearly increased substantially since 2010. The chart also shows the number of people waiting more than 12 hours to arrive on a ward (columns). While 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.


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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