Focus on: A&E attendances

This report examinines patterns of A&E activity, the nature of the increased demand and what has driven waiting times upwards.


Published: 24/07/2014

Download report [PDF 1.3MB]

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.

A&E departments are experiencing a perfect storm of factors leading to an increase in waiting times 23/07/2014

Press release QualityWatch

As hospitals throughout the country increasingly fail to hit A&E targets, patients in England were today warned they could expect greater waits in emergency units.

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A&E attendances: get the facts 22/10/2018

Page QualityWatch

Why are patients waiting longer? Could it be case mix, environment, resourcing or other factors? Our infographic answers your questions.

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Suggested citation

Blunt I (2014) Focus on: A&E attendances. Research report. Nuffield Trust and Health Foundation.