People with serious or life-threatening emergencies need to receive the right care in the right place in the right time. This will maximise their chances of survival and good recovery. Other urgent medical concerns may also require rapid attention or advice, in order to prevent deterioration of a person’s physical or mental condition.
Although A&E departments are a key focus, the urgent and emergency care system encompasses many more services, including urgent GP appointments, ambulance services, community services and more.
Reflecting on winter 2018/19, it is clear that the emergency care system is under tremendous pressure. A&E attendances and emergency admissions were substantially higher than the year before, and even with the milder weather, performance against the totemic four-hour A&E target fell to the worst level since the data set began. The ability of services to maintain the rate of potentially preventable emergency admissions provides us with some optimism, but the responses from patient surveys leave a lot to be desired.
Below is a summary of our indicators relating to emergency care, with links to more detailed content and analysis. See also our Combined Performance Summaries, which present up-to-date information on key NHS performance measures as data are released by NHS England.
A&E waiting times
- The percentage of patients attending A&E that were admitted, transferred or discharged within four hours has fallen substantially since 2010. In February 2019, performance had dropped to an all-time low of 75.7%, recovering slightly to 79.5% in March.
- The total number of A&E attendances has increased over time, reaching over 6.2 million attendances in Q4 2018/19 (January to March).
- The median A&E waiting time increased from 134 minutes in February 2012 to 165 minutes in February 2019.
- Trolley waits – the time patients wait between a decision to admit and the patient arriving on a ward – have increased considerably since 2010. However, the peak in January 2019 was lower than it was in January 2018 and January 2017, indicating that there may have been a small improvement over the last two years.
Ambulance handover delays
- Since 2010-11, there has generally been an upward trend in the number of ambulances experiencing a handover delay of over 30 minutes during the winter period.
- The most recent winter began with fewer ambulance handover delays than last year, but between Week 3 and Week 6 of 2019 there were more delays than the previous year.
Ambulance response times
Note that due to a new set of performance targets for the ambulance service, performance can only be reliably compared from April 2018 onwards.
- The target that all ambulance trusts must respond to Category 1 (life-threatening) calls in 7 minutes on average was met for the first time in March 2019. The 90th centile target for Category 1 calls, set at 15 minutes, is consistently being met.
- The national standards for Category 2 (emergency) calls, Category 3 (urgent) calls and Category 4 (less urgent) calls are being missed. The responses times for Category 2 calls are of particular concern, since they include people who may have had a heart attack or stroke, or be suffering from sepsis or major burns.
Potentially preventable emergency admissions
Ambulatory care sensitive (ACS) conditions are conditions where effective community care and person-centred care can help prevent the need for hospital admission.
Urgent care sensitive conditions are acute exacerbations of urgent conditions which a care system should treat and manage close to home and without the need for hospital admission in as many cases as possible. Although some of these admissions are necessary, a high rate may indicate avoidable admissions.
- Between 2008/09 and 2017/18, the number of emergency admissions for ACS conditions and urgent care sensitive conditions increased by 9% and 11%, respectively. However, rates of emergency admissions for these conditions remained relatively stable over the same time period.
- The rate of emergency admissions increased for falls, cellulitis, urinary tract infections and COPD, but decreased for angina and non-specific chest pain.
Hospital bed occupancy
- Between Q1 2010/11 and Q3 2018/19, the total number of NHS hospital beds decreased by 12%, from 144,455 to 127,589.
- The total bed occupancy rate increased from 85% in Q1 2010/11 to 88% in Q3 2018/19.
- General and acute hospital bed occupancy reached a peak of 93% in Q4 2017/18 (January to March).
Mental health crisis care
- Between 2014 and 2018, the proportion of Community Mental Health Survey respondents who knew who to contact if they had a crisis increased from 68% to 71%.
- The proportion of respondents who had tried in the previous 12 months to make contact in a crisis and ‘definitely’ got the help they needed decreased from 45% in 2014 to 39% in 2017.
Overall patient experience
- In 2016, 27% of Emergency Department Survey respondents who had attended type 1 A&E departments rated their overall experience as 10 (very good) and 2% rated their experience as 0 (very poor).
Medication side effects
- For Emergency Department Survey respondents who were prescribed any new medication, less than half (45%) said that a member of staff 'completely' told them about medication side effects to watch for, and 37% of respondents said that they were not told.
Confidence and trust in clinicians
- 75% of Emergency Department Survey respondents who had attended type 1 departments stated that they ‘definitely’ had confidence and trust in the doctors and nurses examining and treating them, however 6% did not.
Respect and dignity
- 78% of Emergency Department Survey respondents said that they were treated with respect and dignity while they were in the emergency department all of the time, but 5% said that they were not.
Involved in decisions
- One in ten Emergency Department Survey respondents said that they were not involved as much as they wanted to be in decisions about their care and treatment.