A&E performance hits record low despite fewer attendances

The national performance against the target that 95 per cent of attendances should be seen within four hours dropped to 77 per cent in the data for August 2021, when 1.8 million people attended an A&E.  

In August 2019, 86 per cent of the 1.9 million attendances were seen within four hours. 

Senior hospital figures warned September’s A&E performance was also likely to be grim.

One chief executive told HSJ attendances had increased in the past week and the service was looking “swamped”. Another trust chief executive said that pre-covid a small number of trusts faced being overwhelmed each winter, but now it was almost everywhere.

August’s official data showed record low performances for many trusts, including five that saw less than 50 per cent of patients attending their main type one A&E unit within four hours. These were: Barking, Havering and Redbridge University Hospitals Trust; Royal Cornwall Hospitals Trust; North West Anglia Foundation Trust; Blackpool Teaching Hospitals FT; and Torbay and South Devon FT. 

In August 2019, no trusts had lower than 50 per cent on this measure.

Some trusts have also recorded drastic falls in their performance between August 2019 and 2021. The biggest such fall for type-one A&E performance was at Royal Cornwall Hospitals Trust, where it fell from 77.3 per cent to 44.4 per cent, a drop of 32.9 percentage points. The trust has been approached for comment. 

Chief analyst at The King’s Fund Siva Anandaciva said: “It would be a mistake to think that pressures on emergency services are easing. A&E departments are still seeing steady increases in demand and there are increasing reports that the case-mix of attendances at major departments is becoming more acute and complex.

“As anyone who has lived through an NHS winter will know, rising demand for emergency care will inevitably have an impact on how much planned elective care can be delivered.

“The government has set out a funding offer to the NHS but we are still waiting for a coherent plan on how the NHS will be expected to balance elective recovery and rising pressures in emergency care over the coming winter. Without this, we risk repeating the previous pattern of operations being cancelled at the last minute, ambulances queuing outside hospitals and patients waiting longer for the care they need.”

NHS England medical director Stephen Powis said staff had “pulled out all the stops”.

He said in a statement: “We do not know how many of those who held back from accessing care during the pandemic still need treatment, but we expect more to come forward in the coming months, and I urge anyone who needs the NHS to come forward, including through NHS 111 Online so that staff can help you with the best option for your care.”

The government has announced plans to scrap the four-hour target but it is not clear when this will happen.