NHS support plan launched to help hospital and A&E departments keep waiting times in check

Plans to strengthen performance in urgent and emergency care are being put in place across the country to help hospital A&E departments meet demand and tackle waiting time pressures.

Read the A&E improvement plan and accompanying letter to staff.
(these documents are no longer available here but can be found on the National Archives website)

NHS England has joined with the NHS Trust Development Authority (NTDA) and Monitor, which are responsible for provider regulation, to ensure coordinated action to ease the immediate pressures.

At the same time, a review will take place to understand the causes of problems, which differ around the country.

A&E departments have seen a rise in the number of patients they are seeing in recent years, with an extra 4 million people a year using emergency services compared with 2004.

Although 90 per cent of A&E patients are seen within four hours – and last week the NHS met its 95 per cent standard overall – concern has been growing about the underlying trend of more patients waiting longer.

The maximum four-hour wait in A&E remains a key NHS commitment to the public, set out in the NHS Constitution.

The support plan, published today (Thursday), says: “Long waiting times in A&E – often experienced by those awaiting admission and hence ill patients – not only deliver poor quality in terms of patient experience, they also compromise patient safety and reduce clinical effectiveness”.

NHS England will therefore ensure healthcare leaders from different parts of the local NHS come together to form urgent care boards, covering all A&E departments.

These boards will, by the end of May, ensure local recovery and improvement plans are in place for each A&E on their patch. Monitor and the NTDA will expect hospitals and other providers, for example community services, to participate. This follows on from the monitoring and support programmes both regulators have been carrying out with the trusts for which they are responsible in recent weeks.

The three organisations will ensure a coordinated national approach and monitor progress. They will also ask NHS organisations to bring forward planning for next winter so hospitals are well prepared.

For the longer term, NHS England has already announced a review of the model of urgent and emergency services, led by Sir Bruce Keogh.  The review will consider and develop a new national framework for urgent and emergency care that can help the NHS deliver improvements to patient care in the future.

A&E attendances have risen steadily over the past decade, although they have been relatively flat in recent months.

To help with the immediate pressures, NHS England is ensuring that money is freed up and available to improve A&E services.

Above certain limits, hospitals are currently paid 30 per cent of the fee for emergency admissions on the nationally-set NHS tariff. The aim of this policy is to help reduce unnecessary hospital admissions and improve services in the community.

The support plan says urgent care boards should oversee use of the remaining 70 per cent of the fee.  Expenditure, which will be closely monitored, should be linked to specific improvements, including in A&E.

Professor Keith Willett, who is NHS England’s National Director for Acute Episodes of Care and a trauma surgeon, said: “When pressure builds across the health and social care system, the symptoms are usually found in the A&E Department.

“I’ve lived that environment for 30 years and I know just how tough it can be.  What we all want is great service for patients that meets and often exceeds the minimum standards.  To get there, we need the whole NHS system, in the community and hospitals, to recognise the problems and help to relieve the pressure on their colleagues in A&E.

“In the longer term we need to combine all the expertise in the NHS to determine how best to organise emergency care in future so that people get appropriate, effective and rapid care whenever and wherever it is needed.”

While the recovery plan is underway, a review will bring together data and evidence on the factors which may cause problems in A&E departments as it is clear that problems vary across the NHS.

These factors include:
• increased numbers of patients visiting A&E – although some performance problems have arisen when numbers have been lower than usual;
• seasonal illnesses such as flu and norovirus;
• patients attending A&E who are more ill than usual leading to more acute admissions;
• hospital processes around efficient admittance and discharge leading to a delay in beds being available;
• delays in discharge as local primary, community or social care services are not in place.

A&E services are commissioned by clinical commissioning groups (CCGs), led by local GPs. NHS England oversees CCGS while Monitor and the NTDA oversee NHS providers.

NHS England has made meeting the four-hour wait in A&E a standard contractual requirement for NHS hospitals.  It has added a new standard requirement that no A&E patients should wait more than 12 hours on a trolley.

NHS England has also stepped up the monitoring of people’s experience in A&E departments, adding to the picture on performance.

Since 1 April 2013, hospitals have been asking patients: “How likely are you to recommend our A&E department to friends and family if they needed similar care or treatment?” Results will be published monthly from July.

For further information, please e-mail the NHS England media team at or call 07768 901293


  1. Anne Keat says:

    Might I suggest that the title ‘Minor Injuries Unit’ be abandoned for Casualty as these units always were called? To the average member of the public no injury is ‘minor’ particularly to children. So, guess what, they go to an A&E department and add to the many others who do just the same. Take for example a county like Wiltshire, which in the past had 9 Casualty Departments. I do not suggest they are all resurrected but now only one of those 9 have a 24/7 service so people have to add to the numbers travelling miles to the nearest A&E. I worked for several years in one of these Casualties and we coped with a huge variety of injuries and illnesses as well as many who really had little wrong with them, but at least did not go to a larger A&E.
    I do hope that common sense may prevail and as a starter how about having a higher rate of pay for those working in emergency medicine?

    • Jill McMillan says:

      How about renaming A&E departments EMERGENCY departments. Have a national guideline as to what constitutes a visit to an emergency department and bill anyone who goes there with and illness/injury not listed. Maintain minor injurydepartments with experienced staff who know what they are doing and who can refer to the ED when necessary.

  2. anthony r abbott says:

    One of the reasons why A&E are overwhelmed is because local doctors sugeries have been allowed to relinquice primary care at a local level and al patients are now refered to A&E by doctors out of hours and during hours because they no longer practice primary physio cuts and brusies,inhouse minor surgery.doctors no longer on duty on surgery shift patterns 24.7.52. a lot of doctors(inparticular lady. Doctors)are working part time.In the past doctors worked a round the clock system visiting the homes of patients etc. Now if you ring out of hours you are told to go to A&E. 111 is completely useless run by non medical management R patients arn t going to wait hours for urgent medical treatment only to be told by 111 to go to A&E its just crasey! The old system was best,as they say if it works dont touch and the nhs has!!!!!!and made a pigs ear of it. Repeat GPs no longer carry out primary care which they should do this is now for A& get your house in order.

  3. Mark Pittman says:

    A & E departments can be split into two units. A main department and a Minor / See & Treat area. Research has repeatedly shown, on average 60-80% of A & E attendances are minor / See and Treatable. ENPs have consistantly shown they can run these units at a third of the labour costs, and are more effective and efficient at dealing with minor conditions. The MIU Southmead Hospital is one such unit with a nine years track record of dealing with < 20,000 pts per year with one third being under 18 yrs old. The 'In & Out ' times are very good which also help to balance Trusts actual. ENP's are an under developed labour force.

  4. Peter Waugh says:

    I’m a retired director-level NHS manager and work with GPs to develop services and premises. And I have had to attend A & E this year for first aid. I have read the planned action from this website. I would add in the following ;1. Every A&E must have a specialist consultant with responsibility to include professional overview of the supply and demand for services and sound resource and systems planning . 2. Attendance rates by GP of registration needs to be put openly to LMCs and action plans firmly expected by commissioners from GP practices with high attendance, often masked by proximity to the hospital, age profile and deprivation profile as compounding factors. 3. Information systems should register the arrival time of the patient as well as the triage time to avoid laundering.4. GP practices should be rewarded and expected to do more to promote smoking cessation, fitness, sensible drinking and weight loss. Large health promotion rooms in modern medical centres are being funded on notional rents which are used very little.This contrasts very badly with GPs eagerness to transfer hospital care to their surgeries for the higher rewards and professional lustre. 5. The connectivity and reliability of community health and social services is often woeful with little use made of IT for information sharing and communications.6.Assessment information should routinely be shared between professionals to save time , and discharges coordinated with community services.7. There should be a GP presence or oversight for every A & E department, looking at frequent attenders, local GP performance and the pattern of attendance by symptom, as well as taking on-site referrals. 8.The notion of ‘inappropriate attendance’ needs to be tempered by a look at the quality of the GP service – too often, the patient may be accurately assessing their own best interests.

  5. Michael Vidal says:

    I may have missed it but I do not recall seeing any mention of patient engagement or involvement in this process. It may be me but surely it is impossibnle to understand why patients are turning up at A&E and therefore how to tackle the problem without talking to patients. This begs the question how are you going to involve patients in this process a question that does not have appeared to have been addressed in this plan.