Emergency medicine £6.6 billion
The total amount hospital Trusts reported spending on emergency services in 2024-25 10% percentage of attendances at Type 1 A&Es (which treat the most urgent cases) and Type 2 (single medical specialty) who waited 12 hours or more from their arrival in A&E to be discharged, transferred, or admitted, in 2025-26
8.1 days
The average length of time someone admitted to hospital from A&E spent in a hospital bed in 2025-26, up from 7.3 days in 2019-20 (an 11% increase)
92%
The average percentage of general and acute hospital beds occupied in 2025-26. The Royal College of Emergency Medicine considers that a level of 85% supports patient safety and achieving the four- hour A&E performance target
408,350
The total number of days (known as ‘bed days’) spent by people in a hospital bed after they are well enough to go home in the month of April 2026 – this accounts for 14.7% of all bed days used in this period
£2 billion
NHS England’s (NHSE’s) estimate of the total cost of delays to discharging people once they are well enough to go home, between August 2025 and April 2026
The four-hour target
The NHS has not met the four-hour target for 95% of people attending A&E for any year since 2013-14, but performance after COVID-19 is slowly improving. In 2013-14, performance was, on average, 95.7%, which then declined to a low of 70.8% in 2022-23. Performance has improved gradually since, and in 2025-26 the NHS met the four-hour target for 74.9% of attendances. NHSE measures performance against the four- hour metric across all types of A&Es nationally and at Trust level. It highlights that there will be
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variation between types of A&E depending on the complexity of patients and other factors. While Type 2 (specialties like ophthalmology)
and Type 3 (urgent treatment centres for minor injuries) A&Es perform consistently at around 96% or above, Type 1 A&Es (which see the majority of patients and tend to deal with the more complex and urgent cases) have much worse performance. Type 1s’ performance on the four-hour metric fell to a low of 56.7% in 2022-23, but improved to 60.9% in 2025-26.
from high performing Trusts, using oversight powers to support improvement in all hospitals.
l Support Trusts to more consistently use end-to-end hospital flow management tools and reduce discharge delays caused from within hospitals, as well as improving coordination between hospitals, community services and social care.
l Include patient experience within routine performance monitoring, for example through patient feedback on timeliness and quality of care.
l Support Trusts to better understand the relationship between costs, performance, patient numbers and acuity of cases.
“Despite significant efforts to improve A&E performance, patients continue to experience long waits and delays in care. NHS England and DHSC need to understand more fully why improvements have been slow and ensure successful approaches are adopted more consistently across the system. “A stronger focus on patient flow, timely
discharge and patient experience will be vital to
improving outcomes for patients,” commented Gareth Davies, head of the NAO. Responding to report, Siva Anandaciva,
Director of Policy, Events and Partnerships at The King’s Fund, said: “A&E performance delivered by the NHS was once the envy of the world but as anyone that has walked into a waiting room in recent years will be able to say, that is no longer the case. “A&E staff are still working hard around the
clock to care for the public when they need help the most. But the slow rate of progress in meeting national performance targets means we are still worlds apart from the short A&E waits seen under the previous Labour government 20 years ago. “Emergency rooms are one of the places
where the public need a responsive NHS the most. It is the place where people enter the healthcare system their most anxious, where they likely need the most serious care, and where long waits can have the most devastating of consequences, as the NAO’s report notes. “Since the general election, the direction of
travel set by the government has been incredibly clear on driving down waiting lists for planned hospital care – such as knee operations and cataracts – and has used additional ‘sprint funding’ to pay for more of this type of NHS activity. But the picture has been a lot more muddled for A&E. It is still very unclear whether there is a credible plan to get A&E performance back to the desired national standards by the end of the Parliament and deliver the shorter waits that the government promised in its manifesto. “The situation is more complex than simply
asking A&E departments to ‘work harder’ or allocate more resources to them so waiting times can be driven down. A&E is where pressures across the NHS show up first. If hospital beds are full of patients because there
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