A&E attendance highest in spring, not winter

Despite the national focus on winter pressures the data shows the highest number of attendances occur in the spring. However, the data does not include clinical detail on the complexity of attendees’ conditions presented at A&E throughout the year.

In the April to June period this year, 5.6 million people attended A&E, compared to 5.3 million between January and March.

HSCIC medical director Mark Davies said: “There is a myth in terms of activity around winter…Winter isn’t the busiest time of the year.”

The report, Focus on Accident and Emergency, reveals that more than twice as many type 1 A&E admissions take place between three hours 51 minutes and four hours after the patient arrived at A&E than in any other 10-minute period after patients’ arrival. Eleven per cent of all patients were admitted within this period whereas about 4 per cent of total admissions occurred within most other 10-minute period.

For type 3 departments, which deal with minor injuries, the highest number of admissions take place between 21 and 30 minutes.

One foundation trust chief executive said many people are admitted close to the four hour waiting time cut-off because clinicians are used to working to targets. She said: “We all work to targets because that’s entrenched in the service, so the target would have to be changed to three hours to see a further improvement.”  

The data also shows that around one A&E patient in five is admitted to hospital. This rises to almost one in two for patients aged over 64.

Overall attendances have risen faster than population growth. There were 21.7 million attendances in 2012-13 - an increase of 11 per cent on four years ago.

This is largely driven by type 3 attendances, which have risen at 11 times the rate of the population.

The report does not include clinical data, which would make it possible to look at factors such as acuity and patient experience.

The team behind the report found that the data was largely consistent across the years.

Information centre chair Kingsley Manning said: “HSCIC has responsibility for a wealth of national health and social care statistics and therefore, as an independent authority in this area, can usefully harness its expertise to help shed light on the A&E debate.”

Asked about whether changes to GP contracts in 2004 - which enabled GPs to opt out of providing out-of-hours care - had had an impact, he said there was “no obvious relationship” in the data between attendances and changes in primary care provision.

Labour said the government had been arguing that changes to the GP contract in 2004 had led to overwhelming numbers of people attending A&E, whereas the data showed attendances at major units had barely changed.

Shadow health secretary Andy Burnham said the “embarrassing” figures had shown the prime minister and health secretary “that A&E has got steadily worse on their watch and blow apart repeated attempts to evade responsibility for the current crisis”.

He blamed the government’s decision to scrap “Labour’s guarantee of [a GP] appointment within 48 hours”, “deep cuts to social care support and the closure of a quarter of NHS walk-in centres” meant you had “all the ingredients for the current A&E crisis”.

Mark Porter, chairman of the British Medical Association, said: “Rising attendance rates, coupled with the government’s drive to do more with less, mean many emergency departments are under extreme pressure and are close to capacity.

“To alleviate pressure and reduce unnecessary attendance we need to ensure patients know how and where to access appropriate care and that they get the right advice first time round.

“Key to this is having an effective out-of-hours telephone service, yet the disastrous introduction of NHS 111 replaced a clinician-led service with a call centre and was responsible for many people being wrongly directed to emergency departments.”

Dr Porter said elderly patients are often admitted to hospital “because of poor access to more appropriate community-based services”.