A&E attendances: what lies behind the statistics?

Posted: 28/01/2014

The Health and Social Care Information Centre (HSCIC) has today, 28 January 2014, published its latest 'Hospital Episode Statistics', reporting on attendances in A&E departments in England.

Today's data show an increase in the number of attendances in A&E in 2012-13 of over 4% compared with 2010-11. In total, the HSCIC figures record 18.3 million separate attendances in A&E. This is lower than the figure compiled from weekly attendance statistics reported to NHS England which include walk-in centres, minor injuries units and private healthcare providers that do not currently report to HSCIC. NHS England's weekly reports represent the 'official' statistics but the data collated by HSCIC enable a more detailed analysis of patient demographics and outcomes. In turn, this offers greater insight into patients' needs and informs policy decisions.

There are some interesting and perhaps surprising details to be drawn from the HSCIC report:

• A third of patients only needed reassurance or advice and no clinical treatment. This high percentage is concerning given the issue of overstretched A&E departments.
• Of all the patients who visited A&E, just over 20% were admitted to hospital. That means nearly 80% of patients were successfully managed in A&E. Half of these needed no further care after they left A&E and a quarter were told t see their GP for any follow up.
• More than four out of ten (43%) attendances were by patients aged under 30. This is surprising given that concerns about cuts to social care funding and the need for greater community care, particularly for the elderly and long term sick, have been cited in recent months as reasons for increased demand on A&E departments. It may be that the under 30s are less likely to register with a GP when they are well and turn straight to hospital when they fall ill.
• The elderly are heavily reliant on ambulance services to get them to hospital: ambulance transfers of patients aged over 90 soared by more than 80%.

There also seems to be a clear link between waiting times and the likelihood of being admitted. The Government abandoned a maximum four-hour waiting time a few years ago but there is a duty on hospital managers to explain the reasons if that time is exceeded in more than 5% of cases. There is therefore still some pressure to comply. This is clearly revealed in the statistics which show that admissions peak in the 10 minutes before the end of that four-hour waiting time. There may be valid clinical reasons for this. For example, complex conditions may need investigating – via radiology and test results – which add to the time taken to make a decision to admit a patient. These are bound to take longer than more straightforward cases requiring only reassurance or advice but, interestingly, the rate of admissions falls again once the four-hour mark has passed.

Commenting on the figures, Andrew Clayton, associate in the clinical negligence team at Penningtons Manches, notes: "These data are interesting for a number of reasons, not least the current focus on how to ease the burden facing our A&E departments. Of greatest concern is that over a third of people who went to A&E last year needed only advice or guidance. The clear inference seems to be that there were around six million trips to A&E that may well have been better dealt with elsewhere. Continued and better public education and more targeted investment are needed so to ensure that patients access the right healthcare at the right stage and to manage their expectations and overall safety."

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