Emergency medicine
A&E improvements ‘smaller than hoped for’
NHS England has increased resources and made small improvements, but while there has been progress on reducing waiting times, this has been slow and many of the expected benefits from its 2023 recovery plan have not yet been realised. This is according to the National Audit Office’s latest report.
NHSE has made efforts and has targeted funding towards improving A&E waiting times and patient flow through hospitals, but this growth in spending has not been matched with proportionate improvements for patients, according to a new report from the National Audit Office (NAO).1 Crowding in A&E has increased in the last 14 years, making it harder for patients to flow through hospital as normal. The annual numbers of A&E attendances have increased by 6.5 million since 2011-12, and in May 2026, during any 24- hour period in England, there was an average of 2,241 patients waiting in corridors in A&E, and 669 patients waiting in corridors in hospital wards. Costs per A&E attendance have increased by a third to £280 per patient in 2024-25, compared with 2018-19. The NHS constitution includes a maximum four-hour waiting time, aiming to have 95% of patients discharged, transferred or admitted within that time. This target has not been met since 2013-14, but there has been a gradual improvement since 2022-23. Type 1 A&Es, which deal with the most complex and severe cases, have a much worse wait-time performance than Type 2 and Type 3 A&Es who tend to deal with less severe injuries. The percentage of people waiting 12 or
more hours in A&E has tripled since before the COVID-19 pandemic, with ONS analysis suggesting that people who wait 12 or more hours in A&E are twice as likely to die within 30 days of leaving A&E, compared with those who wait two hours. Although there has been an increase in A&E resources, including the
number of staff, this has not correlated to a proportionate improvement in performance, suggesting that other factors such as bed occupancy may be limiting progress. The wider patient flow through a hospital can affect how quickly patients are admitted from A&E to a hospital bed, as when bottlenecks or blockages occur, patients can face delays. The number of patients requiring admission from A&E to a bed in a hospital ward has increased by over a million since 2011-12. Delayed discharge from hospital can also
slow patient flow, with 14.2% of hospital stays involving a delayed discharge in 2025-26. These can be caused by delays from within the hospital such as arranging ‘take-home’ medicine or from outside the hospital, for example, capacity
A&E attendances have increased by 6.5 million since 2011-12, and in May 2026, during any 24-hour period in England, there was an average of 2,241 patients waiting in corridors in A&E.
in care homes. Age UK has highlighted how delayed discharge disproportionately affects older people and patients living with frailty. NHSE estimates that delayed discharge has cost an estimated £2 billion between August 2025 and April 2026. NHSE published a plan in 2023 to improve
A&E care, with the main objective being dealing with reduced patient flow through hospitals resulting from increased bed occupancy rates, which NHSE saw as the “key driver” of falling A&E performance. NHSE allocated £1.6 billion to ICBs and local authorities in 2023-24 and 2024-25 through the discharge fund to help reduce delayed discharge. However, despite achieving many of the aims in this plan, NHSE has evaluated that many of the desired outcomes have not materialised. NHSE is now aiming to speed up the rate of improvement by establishing a stronger system of accountability, financial incentives and placing more focus on local leadership. To help improve patient flow through hospital, and therefore A&E services, the NAO recommends that NHSE and DHSC should: l Identify and spread successful approaches
October 2026 I
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