Hospital Accident & Emergency Activity 2020-21

This section focuses on the performance of time to departure against the 4 hour national standard, and patients waiting over 4 hours. The results are presented as:

• Percentage of attendances spending 4 hours or less in A&E

• Average number of attendances of 4 hours or less and over 4 hours

• Provider map of percentage of attendances spending 4 hours or less in A&E

• Total time in A&E from Hour of Arrival to Transfer, Admission or Discharge

For 2020-21 87 per cent of patient attendances spent 4 hours or less in A&E. At a national level, the standard of 95 per cent has not been met annually since 2013-14, although it has been met in some individual months during this period.

Note: The standard set in the NHS Constitution is the percentage of attendances discharged, admitted or transferred spending 4 hours or less in A&E. This was 98% up to quarter 1 (end June) 2010; from quarter 2 (July) 2010 this was reduced to 95%.

Fourteen hospital trusts are excluded from the ‘Number and percentage attendances 4 hours or less / over 4 hours’ due to their involvement with testing new proposal standards for emergency care, which has made them exempt from this measure. More details can be found on the link below:

https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2019/06/Publication-of-May-AE-data.pdf

Prior to March 2021 and the announcement of the first national lockdown the lowest reported monthly average number of attendances per day spending 4 hours or less in A&E since April 2014 was 46,084 in January 2015.

However, from March 2020, at the start of the COVID-19 outbreak, each recorded monthly average has been less than this value with a low of 24,511 attendances per day in April 2020.

The 12 month rolling average showing little variation between April 2014 to February 2020 with a range of 2,326. However, from March 2020 to March 2021, there is a marked decrease from 51,379 down to 36,731, a range of 14,647.

Fourteen hospital trusts are excluded from the ‘Number and percentage attendances 4 hours or less / over 4 hours’ due to their involvement with testing new proposal standards for emergency care, which has made them exempt from this measure. More details can be found on the link below:

https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2019/06/Publication-of-May-AE-data.pdf

The number of attendances per day spending over 4 hours in A&E increased steadily from April 2014 to February 2019 with a 12 month rolling average increasing from 2,229 to 7,308. From this point, the increase became more marked up to February 2020 with a peak 12 month rolling average of 9,774. Since March 2020 this has been steadily decreasing to 5,585 in March 2021.

Users should note there was a reduction in attendances from March 2020, at the start of the COVID-19 outbreak.

Fourteen hospital trusts are excluded from the ‘Number and percentage attendances 4 hours or less / over 4 hours’ due to their involvement with testing new proposal standards for emergency care, which has made them exempt from this measure. More details can be found on the link below:

https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2019/06/Publication-of-May-AE-data.pdf

This displays a map of England with a coloured circle for every major A&E provider. There were three providers that met the standard, measured across the whole year, in 2020-21.

Major A&E Departments only are included (Type 1).

Fourteen hospital trusts are excluded from the ‘Number and percentage attendances 4 hours or less / over 4 hours’ due to their involvement with testing new proposal standards for emergency care, which has made them exempt from this measure. More details can be found on the link below:

https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2019/06/Publication-of-May-AE-data.pdf

Table 7: Percentage of Patient Attendances Spending 4 Hours or Less in A&E, by Provider (Source: MSitAE)

Click on the link below to open the interactive map:

Access the map

As a proportion of all patient attendances the two hours between 8:00 and 9:59 have the lowest percentage (14 per cent) of attendances spending over 4 hours in A&E.

This time period also has highest percentage (20 per cent) spending one hour or less in A&E.

For the hours between 22:00 and 05:59 around 1 in 4 patient attendances are spending over 4 hours in A&E.

Major A&E Consultant Led Departments only are included (Types 1 and 2).

Excludes unknown time in A&E and planned A&E attendances.

This section focuses on patients waiting over 12 hours. There are two different measures of A&E waiting times, which should not be confused. Total time spent in A&E from arrival to discharge, transfer or admission and waiting time from decision made by a clinician to admit the patient to their admission.

1. Total time spent in A&E from arrival to discharge, transfer or admission: This is collected in monthly MSitAE and is the official measure of the 4 hour total time standard. It can also be calculated from HES/ECDS which can be used to measure total time in A&E, for example 4 hours and 12 hours are shown in this report.

2. Waiting time from decision to admit a patient to admission to a ward: This is sometimes referred to as a ‘trolley wait’ and is collected in monthly MSitAE as over 4 hour and over 12 hour waits; any 12 hour waits may be subject to fines from commissioners. These numbers are much lower than total time waits as only patients who are admitted are included.

The number of patient attendances spending over 12 hours from arrival to being transferred, admitted or discharged is 302,784 in 2020-21. This is a 42 per cent decrease since 2019-20, and is the lowest number of patient attendances spending over 12 hours from arrival in A&E since 2016-17.

The number of patient admissions spending over 12 hours in A&E is 14,150 in 2020-21 (from decision to admit to being admitted). This is a 14 per cent increase since 2019-20 and over four times more than in 2018-19.

These figures are not comparable to those presented in Table 9 as this measure is only applicable to admitted patients.