A&E waiting times: number of people seen within four hours hits record low in England

The number of people being seen within four hours in English A&Es has hit a record low.

Data from NHS England shows that in November 2022 just 68.9% of people were seen within four hours at A&E, missing the 95% target by a large margin. The figure for October was also low, although slightly higher than November at 69.3%.

These figures are the lowest since records began in 2010, which exceeded the target at 97.3%. The target of 95% of patients being seen by A&E within four hours hasn’t been met since July 2015, where 95.2% of people were seen within the recommended time frame. The figure has also been lower than 80% since July 2021.

Hull University Teaching Hospitals NHS Trust had the lowest number of patients seen within four hours in November at just 41.8% - less than half the target. Bolton NHS Foundation Trust and Shrewsbury and Telford Hospital NHS Trust also had low figures, with just 49.4% and 48.8% of patients seen within four hours at A&E respectively.

This comes after ambulance response times for Category 1 incidents - which include life threatening conditions such as heart attacks - were the highest in October since current records began.

Data from NHS England showed that Category 1 response times were 9 minutes 56 seconds on average in October - the highest since records started in 2017. They improved slightly in November, but patients in England were still waiting nine minutes 26 seconds on average for an ambulance, which is two and a half minutes longer than the seven minute target. These figures exclude London, where data was not available.

In November 2022, ambulance services answered 27,968 calls to 999 per day in England, fewer than the 29,697 per day in October, and the average for 2022-23 so far (28,450). However, the numbers of call-outs, and those where patients needed to be taken to an emergency department, increased to 22,447 and 11,681 per day.

Staff working in A&E in England dealt with 2,166,710 patients, this being more than any previous November on record.

Winter viruses in high circulation

The latest weekly NHS winter update shows there were an average of 712 patients a day occupying beds in hospital with flu last week - up from 482 cases the previous week and compared to 31 patients per day in the same week of December 2021.

Winter viruses are in high circulation post-Covid pandemic, with norovirus cases increasing by almost 90% on the same time last year. The number of paediatric beds closed and occupied due to Respiratory Syncytial Virus Infection (RSV) is five times higher than the same week last year, with an average of 132 each day (compared with 22 last year).

Although cases of invasive Strep A infections remains low, the NHS has seen an increase in the number of children presenting with the infection. NHS leaders have written to local health areas to consider setting up Acute Respiratory Infection hubs to enhance same-day access to specialist advice and care.

Hospitals and local areas also continue to deal with issues in discharging patients who are medically fit from hospital, with data showing an average of 13,358 patients who were ready to leave remaining in hospital each day last week. Overall general and acute adult bed occupancy rates remain high for this time of year at 95.4% last week, compared to 93.8% at the beginning of December last year.

Bed blocking means hospitals don’t have space to admit new patients while those medically fit are waiting to be discharged but can’t be due to issues in social care. This can then cause delays with paramedics handing over patients at hospitals as A&E departments are full and patients can’t be moved from the emergency department to wards due to lack of beds, hence holding up ambulances from responding to 999 calls.

NHS England’s National Clinical Director for Urgent and Emergency Care, Professor Julian Redhead, said: “Despite the ongoing pressures on services which are exacerbated by flu hospitalisations, issues in social care meaning we cannot discharge patients who are ready, and record numbers needing A&E, staff have powered through to bring down some of our longest waits for care.

“We have already said we are dealing with a perfect storm of pressures this winter, including increased demand for emergency are, and today announced an expansion of mental health crisis services which will ensure people suffering a mental health crisis get the help they need as quickly as possible, and reduce the chances of a patient needing to go to A&E.

“That is all on top of the measures announced NHS’ winter plan published in October which includes new hubs dedicated to respiratory infections and a falls response service to free up ambulance capacity.

“But the public can also play its part by using the best services for their care - using 111 services for urgent medical advice and 999 in an emergency - and to come forward for vaccinations, if eligible, to protect you and others around you against serious illness.”