The National Audit Office has found that NHS A&E performance improvements remain smaller and slower than hoped for. 

NHS England 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. 

A new report from the National Audit Office (NAO) has found that crowding in A&E has increased in the past 14 years, making it harder for patients to flow through hospitals as normal. 

The annual numbers of A&E attendances have increased by 6.5 million since 2011-12, and in May this year, 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 also 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. 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.

“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,” said NAO head Gareth Davies. 

Performance problems

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.

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 in care homes. Age UK has highlighted how delayed discharge disproportionately affects older people and patients living with frailty. NHS England estimates that delayed discharge has cost an estimated £2 billion between August last year and April this year.

NHS England published a plan in 2023 to improve A&E care, with the main objective being to deal with reduced patient flow through hospitals resulting from increased bed occupancy rates, which NHS England saw as the “key driver” of falling A&E performance. NHS England allocated £1.6 billion to ICBs and local authorities in 2023-24 and 2024-25 through the discharge fund to help reduce delayed discharge.

Despite achieving many of the aims in this plan, however, NHS England has evaluated that many of the desired outcomes have not materialised. It 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.

“While long waits for care are most visible inside hospitals, many of the solutions lie in the community. They include improved access to GPs and their teams, ambulance crews treating more patients on the scene, and better coordination with social care to speed up discharges,” said Ciarán Devane, chief executive of the NHS Alliance. 

“Steps like these can reduce the logjam in hospitals, or prevent the need for a visit to A&E in the first place.”