Chart of the week: The rise of over four-hour A&E waits across the UK

Each week we present analysis of data in chart form to illustrate some key issues and invite discussion. This week, John Appleby and Sarah Scobie look at how each UK country has performed against the 95% A&E four-hour waiting target over the past decade.

Chart of the week

Published: 15/09/2021

The target that patients should not have to wait longer than four hours from arrival in an emergency department to discharge, treatment or transfer was introduced 17 years ago. Over its first few years the target was changed based on experience, as it moved from no one having to wait more than four hours to no more than 5% of patients having to wait that long. It is currently one of the few comparable measures of performance across all four UK countries.

While the focus on waiting times in A&E initially brought success in bringing waiting times down, the last decade has seen inexorable breaches across all four countries of the UK.

Seasonal fluctuations aside (with peaks in spring and troughs in summer), the general trend is clear from the chart. Since 2012, only Scotland and England have met the four-hour target (and then for only 14 and 18 months respectively out of 107).   

The impact of the two main Covid periods – March to April 2020 and December 2020 to January 2021 – on waiting times is also clear. As attendances at A&E dropped dramatically in these months, so too did waiting times as, despite the challenge of Covid, the workload on emergency departments eased temporarily.

But over the first half of this year, waiting times breaches started to return to their pre-Covid trends. In May/June over 40% of patients in Northern Ireland waited longer than four hours, which was the case for nearly 30% of patients in Wales, almost 20% in England, and 13% in Scotland.

The persistent national failure to meet the four-hour target has undoubtedly contributed to the rethink in England over the target, which will be replaced by a new basket of measures, including how quickly patients are assessed and the average time that patients spend in A&E. But no thresholds for these measures have yet been set, or a timetable for introducing them. In the meantime, longer waits for patients are likely as autumn approaches.