Intended for healthcare professionals


A&E attendances in England are growing twice as fast as population

BMJ 2018; 362 doi: (Published 13 September 2018) Cite this as: BMJ 2018;362:k3921
  1. Zosia Kmietowicz
  1. BMJ

Doctors have warned that the NHS needs to expand capacity to prevent services collapsing, as new figures show that demand on emergency services in England has reached a record level.

Last year saw nearly 24 million attendances in hospital accident and emergency departments across the country, an increase of 22% since 2008-09 and of 2% from 2016 to 17, while the population rose by 1% from last year, show data from NHS Digital.1

Rob Harwood, chair of the BMA’s Consultants Committee, described as “unacceptable” the 1.4% of patients in A&E who waited more than 12 hours before being admitted or discharged. Any kind of wait for patients with urgent health needs could be both physically painful and distressing, he said.

The proportion of patients admitted after going to A&E has risen slightly, from just under 17% in 2008-09 to nearly 19% last year.

The figures also show that last year 88% patients spent four hours or less in A&E, against the standard of 95%, which has not been met since 2013-14. The number of patients waiting for more than four hours to be attended to has been climbing steadily since 2011 and has now reached nearly 8000 a day.

The pressure seen in A&E was similar across the year, with only a slight dip in August last year. In addition, the proportion of patients reattending is increasing (8.6% of the total in 2017-18, up from 7.3% in 2008-09), and there were twice as many attendances in areas of highest deprivation as in areas of lowest deprivation (53 500 versus 27 000 attendances a year per 100 000 population).

Harwood said, “As summer draws to a close, winter will present its usual problems for A&Es, with further pressure leading to even longer waits, cancelled operations, and a shortage of beds. Extra capacity must therefore be built into the system, by investing in staff, resources, and services, if the BMA’s projections of a year long crisis are not to become the new normal.

“Without assertive, joined-up action from government and policymakers, both staff and patients will continue to bear the brunt.”

Taj Hassan, president of the Royal College of Emergency Medicine, said that the NHS was entering autumn in a “very fragile state.”

He said, “Overall attendances are up and again bear out the vast increase in patients that staff are treating. We are also edging closer to being in a position where nearly a third of all patients attending a type 1 emergency department [the major 24 hour hospital type of emergency care] require admission, meaning that getting more staffed beds is vital.

“For some major emergency departments to have a four hour wait percentage in the 50-60% range in summer is a major source of risk, and these hospitals must ensure that the limited winter pressure funding is committed to ensuring safety.”

Niall Dickson, chief executive of the NHS Confederation, which represents organisations across the healthcare sector, said that the new long term plan for the NHS in England, due this autumn, would “need radical thinking and more investment in GP, community health, and social services.”


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