24 Jul 2014
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This report from our QualityWatch programme, in partnership with the Health Foundation, looks at patterns of A&E activity, the nature of the increased demand and what has driven waiting times upwards.


The A&E department – a vital component of the NHS and one where access is uncontrolled – was once famously described by Tony Blair as the “shop window of the NHS”. They are the hubs of local emergency care systems and foremost in the mind of the public as the place people can go for care at any time of day or night.

For some time now, A&E departments have struggled to meet the target that at least 95 per cent of people should spend less than four hours in A&E from arrival to departure.

Many reasons have been suggested for this decline, but this QualityWatch in-depth analysis of A&E activity uses de-identified person-level data to examine the influence of some of the most commonly proposed causes of pressure in A&E, including:

  • rising demand (although major A&E departments have not seen attendance grow beyond that which would be expected with a growing and ageing population, marginal growth can have a significant impact if a system is already at its maximum capacity)
  • levels of crowding inside A&E departments
  • availability of inpatient beds
  • changing case-mix in A&E as our population ages and long-term conditions become more prevalent
  • satisfaction with access to GP practices
  • the influence of temperature.

Our findings raise important questions about whether A&E has reached maximum capacity and what options the NHS has to address the situation.

QualityWatch is a new major research programme from the Nuffield Trust and the Health Foundation, which provides independent scrutiny into how the quality of health and social care is changing over time.

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