Last month, the then Secretary of State for Health and Social Care told the House of Commons that there would be “no changes to the target for four-hour waits in A&E”. This represents a dismissal of NHS England’s plans to replace the totemic target with a bundle of metrics, as part of the clinically led review of NHS access standards. The review had initially been requested by the Prime Minister in June 2018. Since then the proposed standards have been trialled in 14 hospital trusts, with key recommendations published.
In the same speech, she acknowledged the issues of ambulance handover delays, delayed discharge from hospital and variation in waiting times across the country. But what about variation by age group?
Our chart below, showing the percentage of patients leaving the A&E department within four hours, tells us two key things. Firstly, that A&E waiting times have deteriorated considerably since before the pandemic, when the four-hour target was already being missed. Secondly, that there is substantial variation in waiting times by age group, with older people consistently waiting much longer than younger people.
In July 2022, only 25% of people aged 90 and over left the A&E department within four hours, compared to 69% of 20–29-year-olds. The association between waiting times and age is so clear that longer waits for adults are clearly ordered by decile of age. This is very likely to be related to the rate of hospital admission; older people are more likely to require admission to a hospital ward, for which waiting times are longer.
Nevertheless, for children and infants, who generally have shorter waiting times in A&E than adults, the changes over time are substantial. For example, in July 2019, 94% of babies under two years of age left A&E within four hours, but this dropped to 81% in July 2022. Nearly one in five babies under two waited longer than four hours. This indicates a substantial worsening of timely care, even for the youngest age groups. While longer waits are affecting people of all ages, it raises a question over how much further waiting times can deteriorate before the care is described as inadequate and a red flag for patient safety.