Hospital Accident & Emergency Activity, 2022-23

This publication looks at Accident and Emergency Care activity in England for the financial year 2022-23. The report includes analysis by patient demographics, time spent in A&E, distributions by time of arrival and day of week, arriving by ambulance, performance times, waits for admission and reattendances to A&E within 7 days.

The data sources for this publication are:

• The Emergency Care Dataset (ECDS)
• MSitAE data
• Workforce (see workforce file for specific data sources)
• Home Nations (see home nations file for specific data sources)

This comes from the Secondary Care Uses (SUS) data warehouse containing details of 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.

The Emergency Care Data Set (ECDS) is the  national dataset for urgent and emergency care which  replaced the HES A&E dataset used to collect information from Emergency Departments across England. Implemented as part of a phased rollout of the dataset which commenced in October 2017, submitted ECDS data was mapped into a legacy HES A&E data format for national reporting during this rollout process. This was completed during the 2019-20 reporting period meaning all activity within the 2021-22 financial year has been reported in the ECDS format enabling adoption of this new data source.  It enables more detailed analysis and enhanced understanding of emergency services.

ECDS is the data source for a wide range of healthcare analysis used by a variety of people including the NHS, government, regulators, academic researchers, the media and members of the public. ECDS is a unique data source, whose strength lies in the richness of detail at patient level at a much more granular level than its predecessor the HES A&E dataset.

Details of the data items captured within the ECDS data set may be found in the ECDS technical output specification (ETOS).

ECDS data is used to:

• monitor trends and patterns in NHS A&E hospital activity
• assess effective delivery of care and provide the basis for national indicators of clinical quality
• support NHS and parliamentary accountability
• inform patient choice
• provide information on hospital care within the NHS for the media
• determine fair access to health care
• develop, monitor and evaluate government policy
• reveal health trends over time
• support local service planning

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.

Learn more about MSitAE data.

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 Emergency Care Database (ECDS) 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. Learn more about the NHS constitution.

The quality of ECDS data is the responsibility of the NHS providers who submit the data to SUS. These data are required to be accurate to enable them to be correctly paid for the activity they undertake. NHS England has a well-developed data quality assurance process for the CDS and ECDS data and the data quality of provisional data is reported monthly to improve the quality before the annual finalisation. Details about the quality of HES data can be found on the supporting information page and the monthly reports are available. The points below show data quality information for this annual release.

Royal Cornwall Hospitals NHS Trust (REF) - Due to a system configuration issue which the supplier has been unable to resolve, since January 2023, records which have an NHS Number Status Indicator of '02' are missing the data items Person Birth Date, Organisation Code of Residence and Postcode in submissions from Royal Cornwall Hospitals NHS Trust (REF). This may cause a reduction in certain record counts in this publication and will impact the data quality score for RCHT.

Summary Report Tables

These are high-level summary reports of NHS Accident and Emergency activity and performance of hospitals in England, during 2022-23 and as a comparison over time.

The data source for these tables is ECDS. 

Planned A&E attendances are excluded, unless otherwise stated.

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. This may mean that some of the stated percentages can't be calculated from the stated figured. 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

National Report Tables

These are more detailed report tables at the national level. The tables include: 

• Attendances by demographics
• Attendances by attendance category and department type
• Attendances by attendance source, arrival mode and discharge destination
• Attendances by time of day distribution
• Attendances by clinical breakdowns

The data source for these tables is ECDS. 

MSitAE Report Tables

These are high-level summary reports of NHS Accident and Emergency activity and performance of hospitals in England, during 2022-23 and as a comparison over time.

The data source for these tables is MSitAE, with ECDS as a comparison. 

Provider Level Analysis

In addition to national breakdowns, this report provides an interactive dashboard and CSV file that can be used to explore similar breakdowns to what is seen in the Summary and National Report Tables, but at the provider level. 

The data source for these tables is ECDS. 

A&E CQI Report

A finalised version of the monthly Provisional Accident & Emergency Care Quality Indicators publication, focusing on the 2022-23 financial year is included in this report.

The data source for these tables is ECDS and MSitAE.

Home Nations Comparative Analysis

An additional file has been published providing supplementary information to this report that provides a comparison of the number of unplanned A&E attendances, 4 hour and 12 hour waiting time performance for each of the four home nations (England, Scotland, Wales and Northern Ireland). To compare across all nations this comparison is for Type 1 or Major A&E departments within each nation.

See separate section 'Home Nations Comparative Analysis' for further details.

Metadata

The table descriptions that accompany this publication are given in the document entitled 'Hospital Accident and Emergency Activity, 2022-23 - Metadata Document'; this includes descriptions of the tables included in the report, as well as providing useful links to other relevant webpages and documents.