Background
The four-hour A&E waiting time target is a pledge set out in the Handbook to the NHS Constitution. The operational standard set in 2010 stated that at least 95% of patients attending A&E should be admitted, transferred or discharged within four hours. The Medium Term Planning Framework for 2026/27 to 2028/29 sets an objective of 82% of patients who attend A&E to be admitted, transferred or discharged within four hours.
This indicator explores breaches of the four-hour A&E target since 2013. For in-depth analysis of what’s causing increasing A&E waits, see our report NHS hospital care: Who is waiting and what are they waiting for. See our NHS performance dashboard for the most up-to-date analysis of key NHS performance measures as data is released by NHS England.
A&E waiting times and attendances
The length of time patients spend in A&E before admission, transfer or discharge depends on the type of A&E unit they visit. In the past, minor A&Es (types 2 and 3, such as single specialty departments or minor injury units) nearly always admitted, transferred or discharged patients in less than four hours, whereas major A&Es (type 1) dealt with a higher number of attendees and more serious cases, and consistently performed worse at the four-hour target.
Performance for type 1 A&E departments declined substantially between 2013/14 and Q3 2019/20 (October to December 2019), to a pre-pandemic low of 71%. Concurrently, the total number of A&E attendances had been increasing over time, reaching almost 6.5 million in Q3 2019/20.
In Q1 2020/21, the total number of A&E attendances fell dramatically to 3.6 million, following the outbreak of the coronavirus (Covid-19) pandemic, and waiting time performance for type 1 attendances temporarily improved sharply to 90%. This may reflect guidance to call NHS 111 with concerns about Covid-19 symptoms, as well as messaging encouraging people to stay at home during the national lockdown.
The number of A&E attendances has now returned to pre-pandemic levels but performance against the four-hour target has worsened. In Q4 2025/26 there were 6.9 million A&E attendances. Waiting time performance worsened for all types of A&E attendances: 60% of patients attending type 1 departments were admitted, transferred, or discharged within four hours, and for patients attending type 2 and 3 departments the proportion was 97%. A&E waiting times tend to be longer in winter, due to the different case mix, with winter pressures from flu and norovirus leading to higher acuity patients who require more time to assess and treat.
NHS England has set interim objectives for the four-hour target. The NHS fell short of the 76% objective for March 2025 and was some way off the objective of 82% for March 2026. In May 2026, 76% of A&E attendances were seen in four hours or less.
Time spent by patients in A&E
As well as looking at the proportion of patients attending A&E who are admitted, transferred or discharged within four hours, we can also examine the median number of minutes spent in A&E. The median waiting time for all patients increased from 2 hours 9 minutes in May 2011 to 2 hours 54 minutes in December 2019, before falling to 2 hours 15 minutes in May 2020 during the Covid-19 outbreak. Since then, the median waiting time for all patients has increased. It stood at 2 hours 59 minutes in March 2026.
For patients who required admission to hospital, the median A&E waiting time remained below four hours until September 2019. In December 2019, the median wait increased to a high of 5 hours 21 minutes. This may reflect the increase in trolley waits (the time patients wait to be admitted onto a ward after the decision to admit has been made) in the winter of 2019/20. After decreasing during the Covid-19 pandemic, the median wait time for admitted patients increased steadily from June 2021 until it reached a new high of 7 hours 39 minutes in December 2022. It has since fallen year on year, and was less than four hours in March 2026.
In March 2026, the median waiting time for non-admitted patients (which has seen a steadier and less dramatic overall increase) was 2 hours 27 minutes, a bit more than half the time for admitted patients. For both admitted and non-admitted patients, longer time spent in A&E is associated with high mortality: even after socio-demographic and clinical factors are taken into account the risk of post-discharge death (at 30-days) increased with total time spent in A&E after approximately two hours. Compared with patients requiring non-immediate care who spent two hours in A&E, the odds of post-discharge death were 2.1 times higher for those who spent 12 hours in A&E.
It is worth noting that this data, provided by NHS England, is provisional and has data quality issues (see ‘About this data’ for more information).
Trolley waits
For patients that require admission to a hospital ward, either from A&E or via other routes, the time they wait between the A&E unit deciding that they should be admitted and the patient actually arriving on the ward is very important.
Trolley waits – the number of patients waiting over four hours between the decision to admit and admission – tend to be highest in the winter months and have increased over time. However, trolley waits continued to increase through 2022. In December 2022, one in three patients (170,283) were waiting over four hours from decision to admission. This improved slightly to 161,141 waiting over four hours from decision to admission in January 2026.
The bars on the chart show the number of people waiting over 12 hours to be admitted to a ward after a decision is made to admit them. The number of extreme waits has peaked in winter for the past four years. In May 2026, 50,212 patients waited for more than 12 hours, representing 9% of the total number of emergency admissions
In recently published data for May 2026, it was estimated that 3% of all patients attending A&E waited over 12 hours to be admitted after a decision to admit was made (data not shown).
Waiting times after a decision to admit do not provide the full picture of very long waits. A more complete view is obtained for waits from arrival to discharge, admission or transfer.
About this data
NHS England data
In March 2019, the Clinically-Led Review of NHS Access Standards Interim Report was released, proposing some significant changes to A&E waiting time targets. A six-month Progress Report from the NHS Medical Director was also published in October 2019.
Field testing of the proposed new standards began in 14 hospital trusts on 22 May 2019. The first stage of testing focused on measuring the “mean time in A&E”, when compared with the existing four-hour target. The field test sites have not been submitting four-hour performance data since May 2019, so an adjusted national time series was published to omit these sites’ A&E performance going back to Q1 2011/12. The time series data presented here for performance against the four-hour target excludes the field testing sites and so is comparable across months and years. Data on A&E attendances is for all trusts, including the field testing sites.
In January 2018, NHS Improvement chief executive Ian Dalton wrote to trusts to announce a formal review of the reporting of A&E performance data. The letter referred to issues in two main areas: the reporting of urgent care (type 3) activity, and the reporting of activity from newer clinical pathways, such as ambulatory care services.
It followed the UK Statistics Authority writing to NHS England to formally raise concerns about the impact of changes to recording practice and the interpretation that should be applied. This prompted questions of whether the data was reliably measuring pressure and performance over winter.
In November 2018, the UK Statistics Authority stated that its concerns had been addressed, however, some concerns remain about the quality of performance data. For more information, see the most recent HSJ article.
NHS England data
Median waiting time in A&E and time to treatment have been calculated using provisional Emergency Care Data Set (ECDS) data since June 2020. Prior to then, they were calculated using provisional A&E Hospital Episode Statistics (HES) data. The measures used have not changed, although data quality measures are still to be developed. Provisional HES and ECDS data may be revised throughout the year. As these indicators are published on a monthly basis rather than in a time series, indicator data published for earlier months has not been revised using updated HES or ECDS data extracted in subsequent months.
NHS England notes that several organisations report data that does not meet the data quality checks required by A&E indicators, which contributes to the unusually high values observed for some measures.