Troubling situation in A&E services is bellwether for pressure across the NHS and care system

Sarah Scobie responds to the latest NHS performance stats from NHS England and NHS Improvement.

Press release

Published: 14/10/2021

Commenting on the latest NHS performance stats from NHS England and NHS Improvement, Nuffield Trust Deputy Director of Research Sarah Scobie said:

“The unfolding situation in urgent and emergency care services is troubling, and the deterioration of performance does not seem to be slowing. A quarter of all A&E patients were not seen within the four-hour target in September 2021, which is the worst performance on record.

“With the number of patients seeking care at A&E units back to pre-pandemic levels, we see severe bottlenecks for this route into the health and care system, amid ongoing demand from Covid, and an increase in colds and respiratory illnesses. NHS staff cannot keep up with demand, with staff absences playing a part increasingly steadily throughout September – there were an average of over 73,500 staff absent in the last week of September. At this point, staff will be gearing up for a very difficult time ahead, given waits traditionally lengthen in the winter period.

“The slowdown in ambulance response times is also very concerning. Category two callers, which constitute patients with severe illnesses, such as heart attacks and strokes, are taking twice as long to be reached than expected. One in ten of these category two patients are now waiting over an hour and a half for ambulances.

“Unfortunately, the pressures in accident and emergency care are a bellwether for the spikes in pressure also seen across the whole NHS and care system. Demand for GP appointments is also very high. Today’s GP funding announcement has some focus on boosting urgent same-day care, but it is difficult to see this reducing pressure on A&E staff without growing and retaining the number of GPs that we need.

“The upcoming government spending review will also be an important moment. How well the NHS will be able to cope with the ongoing Covid challenge and a record waiting list of 5.7m people will depend on the investment available in buildings, technology and equipment and to stabilise and reform the difficult situation in social care.”

Notes to editors

  1. The Nuffield Trust is an independent health think tank. We aim to improve the quality of health care in the UK by providing evidence-based research and policy analysis and informing and generating debate.
  2. The latest monthly combined performance figures from NHS England can be found at:
  3. For all queries or to arrange an interview, contact:
    1. Simon Keen: 07780 475571 /; or
    2. Meesha Patel: 07920 043676 /