Hospital Accident & Emergency Activity, 2022-23

In 2022-23 there were 25 million attendances in Accident and Emergency, an increase of 4 per cent compared with 2021-22. 

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

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

For 2022-23 71 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

In March 2022 the reported monthly average number of attendances per day spending 4 hours or less in A&E was 44,777.

Between April and June 2022 this figure rose, reaching a high point of 46,807 in June 2022. Between then and December 2022 it then generally fell, reaching a low point of 40,822 in August 2022. Since December 2022 the numbers have started rising again and were 44,550 in March 2023.

During 2020-21, when the COVID-19 outbreak was impacting significantly on hospital activity, the 12 month rolling average decreased from 52,312 down to 36,473. Since April 2021 the average has gone up to 43,590 as at the end of March 2023, an increase of  4,968. However, this is still less than the position in March 2020.

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

During 2020-21, when hospital activity was significantly impacted by COVID-19, the 12 month rolling average of number of attendances per day spending over 4 hours in A&E fell sharply to 5,601. Prior to this there had been a more or less continuous period of steady increase, reaching 10,039 in February 2020.

Since April 2021 there has been a steep increase in attendances lasting over 4 hours in A&E, with the 12 month rolling average reaching 18,028 in March 2023, and the figure for the month of March 2023 itself being 17,760. 

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 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 1,789,130 in 2022-23. This is a 80 per cent increase since 2021-22, and a 491 percent increase since 2020-21 and is the highest number of patient attendances spending over 12 hours from arrival in A&E since this publication began.

The number of patient admissions spending over 12 hours in A&E is 410,092 in 2022-23 (from decision to admit to being admitted). This is just more than three times as many as in 2021-22.