Hospital Accident & Emergency Activity 2019-20

This comes from the HES data warehouse containing details of all admissions, outpatient appointments and accident and emergency (A&E) attendances at National Health Service (NHS) hospitals in England. It includes private patients treated in NHS hospitals, patients who were resident outside of England and care delivered by treatment centres (including those in the independent sector) funded by the NHS.

HES datasets are the data source for a wide range of healthcare analyses for the NHS, Government and many other organisations and individuals. HES is sourced from the Secondary Uses Service (SUS) database, which is collected from hospitals’ patient administration systems on a monthly basis at record level.

Each record in HES includes a wide range of information including details of the patient (age, gender, geographic details), when they were treated and what they were treated for.

The collection process used for MSitAE data is very different from the process used for HES. 

MSitAE are based on counts made in local NHS and Independent Sector organisations and submitted to NHS England and NHS Improvement in aggregate form, rather than from patient level data.

These are currently the official source of A&E information and should be used in preference to A&E HES where information is held in both data sets.

MSitAE data is available at:

https://www.england.nhs.uk/statistics/statistical-work-areas/ae-waiting-times-and-activity/

The Emergency Care Data Set (ECDS) is a new national dataset for urgent and emergency care which will replace the current HES A&E dataset used to collect information from Emergency Departments across England from 2019-20 financial year.  It will enable more detailed analysis and enhanced understanding of emergency services.

Since October 2017 urgent and emergency care providers have been asked to submit data to ECDS. Those that do this will no longer submit data via the A&E Commissioning Data Set (CDS 010), which means that A&E data will no longer be automatically processed into Hospital Episode Statistics (HES) for that provider. However, in order to seek a continuity in A&E activity data during this transition period from the phased implementation of ECDS NHS Digital with guidance from nominated representatives from the Royal College of Emergency Medicine (RCEM) have put in place a mapping process of reported activity within ECDS to A&E CDS to allow data to be populated for the providers who have switched to submitting ECDS. This mapped data has been used within the reporting of this statistical release.

Details of this mapping methodology can be found within the Technical Output Specification Document on the ECDS project website.

https://digital.nhs.uk/data-and-information/data-collections-and-data-sets/data-sets/emergency-care-data-set-ecds

Additional detail maybe found in the methodological change notice paper.

This change should not impact upon overall total counts of activity presented within these statistical outputs. However, changes are expected in the composition of data from those trusts that have submitted to ECDS and have subsequently been mapped to the A&E Commissioning Data Set format.

Additional analysis has been produced with this statistic release investigating certain possible impacts upon the data that the implementation of ECDS may have on the traditional data classification. This compares data submitted via both mechanisms to NHS Digital for the financial years 2016-17 (prior to ECDS), 2017-18, 2018-19 and 2019-20. It provides a high-level comparison of the coverage and differences in completeness of field values that have been mapped for: All diagnosis codes, investigation codes and treatment codes.

The role of major A&E departments is to assess and treat patients who have serious and unforeseen injuries or illnesses. Major A&E departments are consultant-led, open 24 hours a day and 365 days a year with full resuscitation facilities. Not all hospitals have an A&E department.

In addition to major A&E departments, single specialty A&E departments, walk-in centres and minor injury units are also covered by the A&E HES data. People can attend these services without an appointment. They deal with a range of minor injuries and illnesses. All data tables include all of these groups unless otherwise stated.

Type 1 A&E department = A consultant led 24 hour service with full resuscitation facilities and designated accommodation for the reception of accident and emergency patients.

Type 2 A&E department = A consultant led single specialty accident and emergency service (e.g. ophthalmology, dental) with designated accommodation for the reception of patients.

Type 3 A&E department / Type 4 A&E department / Urgent Care Centre = Other type of A&E/minor injury units (MIUs)/Walk-in Centres (WiCs)/Urgent Care Centre, primarily designed for the receiving of accident and emergency patients.

A Type 3 department may be doctor led or nurse led. It may be co-located with a major A&E or sited in the community. A defining characteristic of a service qualifying as a Type 3 department is that it treats at least minor injuries and illnesses (sprains for example) and can be routinely accessed without appointment. An appointment based service (for example an outpatient clinic) or one mainly or entirely accessed via telephone or other referral (for example most out of hours services), or a dedicated primary care service (such as GP practice or GP-led health centre) is not a Type 3 A&E service even though it may treat a number of patients with minor illness or injury.

Records in the HES Accident and Emergency (A&E) database are called ‘attendances’, and each A&E attendance relates to a single visit by an individual to A&E. An individual patient may have more than one attendance in a period, so these are not the same as a count of patients. Where follow up care is required and provided by the A&E department, a second planned attendance is recorded.

A&E waiting times form part of the NHS Constitution, which contains a list of expected rights and pledges for patients that NHS England takes into account when assessing organisational delivery.

Section 3a of the NHS constitution pledges “The NHS commits to provide convenient, easy access to services within the waiting times set out in this Handbook to the NHS Constitution.” There are a number of government pledges on waiting times, including:

A maximum four-hour wait in A&E from arrival to admission, transfer or discharge;

The operational standard for A&E waiting times is that 95% of patients should be admitted, transferred or discharged within 4 hours of their arrival at an A&E department. Read the NHS constitution.