Pulling the curtain back on A&E hospital services
Within the realm of news reporting on the NHS, accident and emergency (A&E) services are a particularly popular topic. Each month, data spreadsheets are published by NHS England that report on the functioning of emergency services, covering things like how long ambulances take to reach patients and how soon patients are attended to at A&E departments. Scrutiny on the service garners a lot of media attention, and the resultant news story is often bleak.
This is with reason. The number of people waiting long hours in A&E departments for treatment is very high and has been getting worse over the past couple of years. Before the Covid-19 pandemic, there were a few thousand patients waiting over half a day (12+ hours) to be admitted after the decision for admission had been taken: as of December 2019, over 2,000 waits was considered alarmingly high. That number is now far lower than some of the best performing months (23,000+ waits) over the past five years.
There are other ways of estimating waiting times for the service, one of which is counting the interval of time between arrival at A&E and admission to a bed. Looking at that reveals an even worse picture for patients. In February this year, over 72,000 patients attending A&E waited over 12 hours from arrival to admission, representing one in three admissions. The situation has become so dire that patients are being treated in hallways and other unused spaces within hospitals that are not designed for clinical care. Counting these instances has become the latest among a long list of metrics that all tell one resoundingly clear story: A&E services are severely overwhelmed, and patients are suffering because of it.
This suffering is not just in the form of unpleasantness over having to wait longer. There is growing evidence that clinical outcomes for patients get worse the longer they spend in A&E – including increased mortality, longer length of stay in hospital once admitted, and higher chances of readmission.
What’s more, the likelihood of facing long waits is not evenly distributed among all patients who show up to A&E.
Elderly, often frail, persons are more likely to spend longer waiting for a bed than their younger counterparts – in 2025, 43% of those aged over 81 years were waiting over 12 hours for a bed, compared to 11% of young people and teenagers aged 11-20 years.
Like age, clinical complaint also factors into how long people must wait. Complaints about airways/breathing, gastrointestinal, or neurological issues – problems that are internal, possibly more complex, and need longer to resolve – constitute the biggest segment of those who wait over 12 hours. The presumption may plausibly be that the most vulnerable patients are likely to be assigned a bed sooner, but evidence is stacked the other way round. It is the elderly and those with serious medical needs who face worse delays.
Although it is clear that there are grave issues within A&E services that need to be fixed, they are a bundle of highly complex problems with no singular solution. With an ageing population and high numbers of people with long-term conditions, reliance on A&E services is growing, as the only open door available to patients when community health services are inadequately able to fulfil demand.
Difficulties discharging patients from hospital are linked to arduous hospital processes beforehand, as well as problems with care coordination and squeezed capacity within social care services outside hospital. Patients who wait longer to be admitted have a longer length of stay in hospital, resulting in a negative feedback loop of increasing care needs and greater challenges with discharge from hospital.
Historical data tells us that long waits are not a permanent feature of A&E, and the service is not doomed to stay the way it currently is. Politicians are making commitments to improve the service and are looking for quick fixes to fulfil them. However, so many of the problems seen within the walls of A&E departments are linked to other health and social care services and demographic challenges. When viewed from that vantage point, the interlinked spider’s web that presents itself, of which A&E is only one part, is a messy but accurate depiction of the challenges that need to be dealt with.
As a result, addressing issues within the services that are associated with A&E is imperative to improving A&E services, and can ultimately spare patients from the horrible experience of waiting hours when they are frightened and in pain.
Stuti is a researcher at the Nuffield Trust, a think tank for health and social care policy. She uses quantitative research methodology and coding software to understand, interpret and visualise data on public healthcare services. Her repository of work includes NIHR-funded rapid evaluations and projects on mental health services and NHS performance and accessibility. Stuti holds a BA in Psychology from Skidmore College, New York and an MSc in Global Mental Health from King’s College London and the London School of Hygiene and Tropical Medicine.
