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NHS Emergency (A&E) Departments are now in a year-round permacrisis which additional winter pressures and the annual surge of seasonal infections merely worsen.
The dramatic and televisual nature of long waits, overcrowding, trolleys in corridors and cupboards, queuing ambulances and harrowing stories from patients, their families and A&E staff are an endlessly repeating staple of news reporting about the NHS.
However, the root causes lie outside A&E itself in the wider health and social care system. They result from years of harmful policy decisions or complacent inaction over several parliaments.
What happens in A&E is a prominent shop window into the current state of our services, systems, operations and capacity. I see no credible new plans for action on those wider causes, despite Wes Streeting’s supportive soundbites.
Worsening A&E Performance Since 2010
Analyses of national NHS performance data show us just how badly performance has declined over the past 15 years.
In December 2024, 28.9% of patients in English A&E departments waited more than four hours to be admitted, transferred or discharged.
In that one month, 154,689 patients waited more than four hours in A&E for an inpatient bed after a decision to admit them and 54, 207 waited for 12 hours. Ten percent of all A&E patients in 2024 waited more than 12 hours in the department, whether being admitted or not.
In the first quarter of 2014, less than 150 patients waited more than 12 hours for admission to a bed, compared to 150,000 in the first quarter of 2024.
This is unacceptable and dangerous, as shop-floor clinical staff and their associations have been saying loudly.
In 2010, after many years of operationally focused reduction in A&E wait times, the coalition Government, who had driven this change, relaxed the previous national standard that 98% of A&E patients should be admitted, transferred or discharged within four hours to 95%, but it was still being consistently hit that year. That standard has not been met since 2015 and performance has declined ever since.
That Government has challenged NHS trusts to hit 78% by March 2025 as some kind of “stretch target” shows how bad things have got.
The dramatically worsening performance cannot be explained away just by rising demand. There were 21.6 million A&E attendances in 2011/12 versus 26.2 million in 2023/2024.
Long waits and overcrowding have a knock-on impact on ambulance services which now consistently miss national time standards for handing patients over to A&E staff. This in turn means hard choices between caring for patients in the back of the parked ambulance or in spaces not equipped for patient care.
And it stops crews getting out on the road for their next job, even though ambulance response time targets are now also consistently missed.
There are human tragedies behind the dry datasets.
The Human Cost
Long A&E waits and overcrowding are linked to higher death rates. A report this month from the Office for National Statistics showed that patients who wait 12 hours or more in departments are over twice as likely to die in the following 30 days as those waiting two hours or less.
A 2024 study from the Royal College of Emergency Medicine estimated an extra 300 deaths a week associated with waits of longer than 12 hours.
Staying for hours in a noisy, chaotic and rammed department, never designed for ongoing inpatient care is bad news, especially for frailer, older, confused or disabled patients. They can be left disoriented, distressed and deconditioned, worsening their health and the worry for their loved ones.
Working in such a fraught environment for months and years on end is also hugely pressurised for clinical staff, leading to burnout or the “moral distress” that results from not being able to deliver the safe, compassionate standard of care they want to.
The recent Royal College of Nursing Report “On the frontline of the UK’s corridor care crisis” provided a disturbing account of those experiences for patients and nurses alike, with personal testimony from 5,408 nursing staff.
There is little immediate prospect of building a way out of the crisis when this month has also seen the postponement and watering down of the last government’s “40 New Hospitals” programme – which was always smoke and mirrors overpromising, as I wrote in Byline Times in 2023.
The National Audit Office also recently reported a backlog of at least £49 billion in repairing public buildings wi