489:
the time they are admitted to a ward. Measured in this way
February and March 2022 show around one in five admissions through ED waited more than 12 hours from arriving until being admitted to a ward â equating to around 158,000 cases, 22% of attendances. Problems were particularly severe for people with mental health problems, with many examples of mental health patients waiting up to three days in emergency departments for a mental health inpatient bed to become available. When time was measured from time of arrival in the department to admission to a ward the figures of people waiting more than 12 hours were about six times greater than the nationally published figures which in July reached 29,317.
442:, tracked 41 million visits to A&E departments in England in order to better understand the pressures leading to increased waiting times and breaches of the four-hour target. Researchers identified a rise in older patients and related increase in long-term conditions as key factors, alongside extremes of temperature (in both summer and winter) and crowding at peak times. They noted that the majority of pressure was falling on major A&E units, and proposed that rising demand as a result of ageing and population growth may be pushing already stretched emergency departments beyond maximum capacity.
63:
ambulances have been forced to queue up outside a busy emergency departments so that the ambulances might not be able to meet their target in responding to emergency calls, but the hospital can meet its A&E target. Excess emphasis on the targets can mean that other important aspects of care, especially those not easily measured, may be neglected. Some have however praised targets for producing faster reductions in waiting times in
England than other UK countries between 1996 and 2006.
170:
318:
573:. 2,432 patients had waited longer than a year in November 2018. In January 2019 NHS England announced that in future both providers and commissioners would be fined ÂŁ2,500 for each such patient. In February 2022 299,478 patients had been on the list for over 52 weeks. Of those 23,281 had been waiting more than 2 years.
529:
not to do so, or they choose to wait. The proportion of people waiting more than the six week target for diagnostic tests was at its highest since records began in
September 2018. By August 2019 less than 49% of hospital services were achieving the target and across England the average wait was around 23 weeks. The
498:
patients waiting more than 12 hours. The Welsh NHS Confederation responded to the figure by stating its disappointment but acknowledging numbers of patients attending with complex needs were increasing in Wales. Ambulance response times however improved and hit their target for the first time since
October.
379:
Nuffield Trust have identified Welsh underperformance as influenced by the Welsh population being older, sicker and having more deprivation than any other UK nation. Performance against the target has like all other UK nations in recent years, having declined by 7.5% between May 2018 and
September 2019.
622:
Between
January and March 2018 25,475 operations were cancelled at the last minute for non-clinical reasons by NHS providers - 20% more than the first quarter of 2017, and the highest number since records began in 1994â95. This was 1.3% of all elective activity - the highest proportion recorded since
488:
In
December 2019 there were 2,347 breaches, compared with 284 recorded in December 2018. In February 2022 there were 16,404 breaches and in March 2022 22,506. The NHS Standard Contract for 2022-23 requires hospitals to count 12-hour waits from time of patientsâ arrival in the Emergency Department to
199:
must be seen, treated, and admitted or discharged in under four hours. The target was further moved to 95% of patients within four hours in 2010 as a result of the coalition's claims that 98% was not clinically justified. Trusts which failed to meet the target could be fined. In July 2016 NHS trusts
119:
from April 2022. Performance is to be measured on the percentage of services delivered within two hours. Mental health targets are also planned, although no start date has been set, requiring require that urgent referrals to community crisis services should be seen within 24 hours, and âvery urgentâ
635:
proposed a two-hour standard for urgent community response services in
England. These include prescribing and reviewing medication, access to physiotherapy and occupational therapy, and help with nutrition and hydration. Data has been collected since July 2020 and was first published in June 2022.
528:
together with other medical groups fear patients are waiting longer in anxiety and pain for hospital procedures. The target was that 90% of patients admitted to hospital for treatment and 95% of those not admitted should receive consultant-led care within 18 weeks unless it is clinically appropriate
361:
In
England, the target is also for 95% of A&E patients to be treated, transferred, and discharged within four hours. However performance has fluctuated between 90 and 84% between 2015 and 2019, consistently putting it second in the United Kingdom. However performance against the target declined
335:
to be astonishing. Attendance at A&E departments has been increasingly steadily for many years, more so at âtype 3â departments, like urgent care centres (where waiting times are generally lower). In the first eight months of 2018, an average of 67,000 people attended each day. In
January 2019,
325:
By December 2014, the number of patients being treated within four hours had fallen to 91.8%. From December 2015, the 95% target over England as a whole was missed every month. From OctoberâDecember 2016, only 4 out of 139 hospitals with major type 1 A&E departments met the target. In November
300:
cycle. It is claimed that though A&E targets have resulted in significant improvements in completion times, the current target would not have been possible without some form of patient re-designation or re-labelling taking place, so true improvements are somewhat less than headline figures might
480:
led to more than 1,000 cases of patients waiting over 12 hours for admission in 2018â19. This was about a third of all the 12 hour breaches, which were mostly mental health cases - where admission to a ward is not within the control of the trust running the A&E department. A review found that
471:
At the same time as the four target was introduced a target that no patient should wait longer than 12 hours before they are admitted to a ward, if that is required, was introduced. In England time was measured from the point a decision to admit is made and not from the moment the patient arrives.
352:
In Scotland, the target is for 95% of A&E patients to be either admitted, transferred or discharged in four hours. It was last met in July 2017. Scotland has performed best on this measure out of the four UK nations, a position it has held since September 2015. However like all other UK nations
378:
In Wales, the target is also for 95% of A&E patients to be treated, transferred, and discharged within four hours. While higher than the performance in Northern Ireland (60%), the Welsh NHS is third in the United Kingdom, putting it 7 percent behind NHS England and 8% behind NHS Scotland. The
365:
In March 2022 average waits for an ambulance for stroke and heart attack patients (category 2) reached as long as two hours in some regions. The national target for reaching them is 18 minutes. According to the Association of Ambulance Chief Executives more than 3,000 patients may have suffered
62:
introduced far more targets and managed performance far more aggressively - a management regime sometimes referred to as 'targets and terror'. Targets were blamed for distorting clinical priorities, and in particular for one organisation achieving a target at the expense of another. For example,
330:
reported that performance on emergency admissions, trolley waits for more than four hours and A&E patients seen within four hours in the summer of 2017 was worse than in the winters of 2011â15. Performance against the four-hour wait target in the summer of 2018 was the worst second quarter
497:
The Welsh NHS sets a measure of patients waiting more than 12 hours to be treated, transferred, and discharged by A&E. In January 2019, the Welsh NHS has recorded a record 6,882 patients waiting more than 12 hours in A&E, and Morriston Hospital in Swansea represented 15% of all A&E
331:
performance recorded. Only 88.9% of patients were seen within four hours in September. The number of people admitted, transferred or discharged within four hours in emergency departments in September was up more than 3% compared to September 2017 with a 7% rise in emergency admissions said by
152:
Targets in Wales are set by the Welsh Government and set out in the NHS Wales Delivery Framework. The Welsh Government has taken a different approach to some areas of care, such as becoming the first nation in the UK to have a single waiting times target for cancer treatment. The Welsh NHS has
604:
In July 2021 it was reported that there was a 46% increase in patients waiting more than 104 weeks for treatment, from 2,597 to 3,802 from April to May. There were 5.45 million people waiting for hospital treatment in England in JUne 2021 with very large differences in the numbers waiting in
204:
announced that the target would in future only apply to "urgent health problems". In January 2018 only 77.1% of patients were admitted or discharged within four hours, the worst ever performance for type one A&E departments. In December 2018 it was reported that patients with only minor
69:
under the Conservative governments reduced the number of targets, in particular removing most of those relating to health inequality, and encouraged a system wide approach. However shortage of staff and funding meant that performance against targets nonetheless declined. Guidance published in
457:
Even though exceptions are allowed to the targets, concerns have been raised that the target has put pressure on A&E staff to compromise patient care. A significant proportion (90%) of A&E consultants welcomed the four hour target in a study but felt that 98% was too high a target.
308:
and top-down reorganisation of the NHS) hospitals in England struggled to stick to it, prompting suggestions that A&E departments may be reaching a limit in terms of what can be achieved within the available resources. The announcement of the reduction of the target from 98% to 95% was
288:
48% of departments said they did not meet the target for the period ending 31 December 2004. Government figures show that in 2005â06, 98.2% of patients were seen, diagnosed and treated within four hours of their arrival at A&E, the first full financial year in which this has happened.
391:
and are less demanding than in the rest of the UK. None have been met since 2015, and some for considerably longer. A&E waits when considered using the NHS measure of 4 hours to discharge show that performance in Northern Ireland has dropped 13% between May 2018 and September 2019.
366:âsevere harmâ from ambulance delays in February 2022. In June 2022 ambulance response times for the most serious category one incidents, including cardiac arrests, sank to an average of 9 minutes and 6 seconds, half a minute slower than in May. The target time is 7 minutes.
805:"Funding and performance of healthcare systems in the four countries of the UK before and after devolution: a longitudinal analysis of the four countries, 1996/97, 2002/03 and 2006/07, supplemented by cross-sectional regional analysis of England, 2006/07. Technical Report"
512:
In England 93% of patients referred for investigation of breast symptoms, even if cancer is not initially suspected, should be seen by a specialist within two weeks. Only 77.5% of patients referred for breast symptoms between April and June 2019 were seen within 2 weeks.
472:
Between January and March 2012 only 15 patients in England waited more than 12 hours, but in the same months in 2017 1,597 patients breached the target. In January 2018 1,043 patients waited over 12 hours for a bed, the worst figure ever recorded. 272 were at
208:
The effect of the target can be that patients waiting just below 4 hours get a lot of attention, but once the target is breached there is no further consequence. The average time spent by a patient in A&E who has breached four hours is around eight hours.
89:
famously put it - "hitting the target and missing the point". But they are alluring to politicians. Hunt says the effectiveness of targets is in inverse proportion to their quantity and points out that no other country runs its healthcare system by targets.
212:
In January 2022 research published in the Emergency Medicine Journal found that there was one extra death For every 82 admitted patients whose time to inpatient bed transfer is delayed more than 6 to 8 hours from time of arrival at the emergency department.
35:. These vary by country but assess the performance of each health service against measures such as 4 hour waiting times in Accident and Emergency departments, weeks to receive an appointment and/or treatment, and performance in specific departments such as
600:
said it was âcompletely shamefulâ that patients were being forced to resort to paying for operations the NHS should provide as these waiting times led to an increase of 53% between 2012 and 2016 in the numbers paying personally for private operations.
280:
government (1997-2010) had identified a requirement to promote improvements in A&E departments, which had suffered under-funding for a number of years. The target, accompanied by extra financial support, was a key plan to achieve the improvements.
485:, which only provides that patients can be lawfully detained for 24 hours, with a possible 12-hour extension. In December 2019 trusts in London were told to set up dedicated spaces to care for three mental health patients in every A&E department.
195:. The original target was set at 100%, but lowered to reflect clinical concerns that there will always be patients who need to spend slightly longer in A&E, under observation. Setting a target that, by 2004, at least 98% of patients attending an
84:
showed that concentrating on national targets led to managers deprioritising the safety and well-being of patients. Targets can benefit patients but they can also lead to bureaucracy, gaming and poor patient care, or as
2236:
1033:
815:
613:
In Wales, as of January 2020 83.5% of patients were waiting less than six months to start hospital treatment. This is the lowest figure since December 2015 and was below the Welsh Government's 95% target.
554:
506:
All across the UK the target is that patients should be treated within 62 days of an urgent referral, but the way this is measured varies. In Northern Ireland the target has not been met since 2015.
481:
some patients in Lancashire were âpotentially being held against their will without appropriate legal provisionâ. Some were detained in seclusion rooms for more than a week under section 136 of the
285:
felt the targets had been successful in achieving their aim. "We feel, and maybe we are wrong, that one way we've managed to do that promote improvements in A&E is by setting a clear target".
200:
were set new "performance improvement trajectories". For 47 of the 140 trusts with "type one" major A&E facilities this meant a target of less than 95% waiting under 4 hours. In January 2017
336:
only 84.4% of patients were seen within four hours, the worst figure since the target was introduced in 2004. In November 2019 not a single A&E department hit the four-hour wait time target.
161:
acknowledges that the two nations targets are not directly comparable because "the Welsh population is older, sicker and more deprived than the English populationâso its NHS has to work harder".
516:
Only 38% of hospitals met the target in 2019 and 22.5% of people waited longer than two months for their first treatment. In February 2022 10.7% of patients treated waited more than 104 days.
2520:
1825:
1000:
70:
February 2018 conceded that most of the targets would not be met before April 2019. The hospital care and A&E performance measures for October 2019 were the worst ever recorded.
111:
specifies waiting times in the accompanying Handbook, but does not provide a remedy should they be breached. Non-acute crisis response waiting time targets are to be introduced by
1428:
Woodcock, Thomas; Poots, Alan J; Bell, Derek (March 2013). "The impact of changing the 4 h emergency access standard on patient waiting times in emergency departments in England".
583:
In Wales a year target is not measured but a nine month target is monitored. As of January 2020 25,549 patients (5.5%) had been waiting more than nine months to receive treatment.
2050:
1918:
2226:
2028:
570:
2160:
1022:
804:
1940:
473:
120:
referrals should be seen within four hours. Mental health patients referred from emergency departments should be seen face-to-face by liaison teams within one hour.
562:
370:
told the House of Commons on 10 July 2022 that ambulance service response time performance had improved month on month, but in fact it had deteriorated in June.
2492:
1232:
1874:
2470:
1280:
2525:
1733:
1544:
576:
In Northern Ireland more than a third of patients, 94,222 people, had waited more than a year for their first appointment in October 2018. According to the
1632:
2530:
2360:
32:
2338:
2294:
953:
2250:
1302:
1141:
748:
2204:
2094:
533:
joint committee for mid and south Essex in December 2019 reported that local hospitals were ânow workingâ to a 40-week referral to treatment target.
2426:
2138:
1777:
304:
Although the four-hour target helped to bring down waiting times when it was first introduced, since September 2012 (after the introduction of the
1755:
1610:
2448:
2382:
55:
in the 1990s â for example, guaranteeing a maximum two-year wait for non-emergency surgery and reducing rates of death from specific diseases.
2072:
1962:
1210:
296:(also known as the medical assessment unit), which works alongside the emergency department but is outside it for statistical purposes in the
2272:
1378:
558:
546:
542:
2404:
577:
477:
906:
596:
445,360 in England had been waiting six months or more by the end of December 2017 - three times more than in 2013. The President of the
449:
produced a report saying that the NHS needed at least 5,000 more beds to achieve safe bed occupancy levels and hit the four-hour target.
446:
566:
550:
129:
2316:
1497:
937:
1984:
1366:
Using queuing theory to analyse completion times in accident and emergency departments in the light of the Government 4-hour target
1654:
1188:
553:. 11.8% of those waiting for a procedure had waited 18 weeks or more. By March 2018 there were 2,647. The largest numbers were at
305:
205:
ailments could be excluded from the target and a new target introduced so the most urgent cases should be seen within an hour.
86:
1091:
605:
different areas, with 25 times more patients waiting for heart operations in Birmingham and Solihull than in West Lancashire.
1896:
862:
1163:
509:
The Welsh Government in 2019 became the first nation in the UK to have a single waiting times target for cancer treatment.
225:
announced that the 4 hour target was to be replaced by a new set of 10 metrics. The new âbundle of ten standardsâ includes
153:
broadly under-performed compared to the English NHS, with higher waiting times for both urgent and routine care. However a
254:
Clinically ready to proceed (time from when decision is made to admit or discharge, and patient is admitted or discharged)
260:
Critical time standards â aimed at ensuring the highest priority patients get care within a set timeframe such as an hour
2182:
1799:
530:
388:
141:
108:
327:
2006:
541:
In December 2017 there were 1,750 patients waiting a year or more, the highest total since August 2012. 242 were at
353:
this performance has recently declined. In Scotland this target has dropped 5% between May 2018 and September 2019.
144:
and are less demanding than in the rest of the UK. None have been met since 2015, and some for considerably longer.
1062:
636:
The 70% two-hour response target was met at an all-England level but there were enormous variations between areas.
1519:
781:
722:
597:
525:
81:
59:
332:
1256:"Association between delays to patient admission from the emergency department and all-cause 30-day mortality"
1127:
1566:
182:
301:
suggest and it is doubtful that a single target (fitting all A&E and related services) is sustainable.
645:
482:
158:
116:
2535:
293:
1402:
1364:
1370:
265:
196:
178:
268:
said: âI can absolutely say there will be no changes to the target for four-hour waits in A&E.â
1255:
132:
establishes the treatment time guarantee, but also does not specify a remedy should it not be met.
431:
1453:
632:
1115:
1445:
1374:
933:
756:
704:
686:
439:
277:
91:
1471:
1437:
694:
678:
339:
Performance in the first three months of 2019-20 was the worst since records began in 2011.
185:
173:
Percent of patients in English A&E departments waiting over 4 hours, monthly, 2011-2018
524:
Over four million patients were waiting for non urgent hospital care as of July 2017. The
367:
1848:
1611:"NHS waiting list hits record high as every A&E in country missed four-hour target"
699:
666:
435:
297:
169:
2051:"Exclusive: 'Outrageous' long A&E waits for mental health patients increase 150pc"
232:
Reducing avoidable trips (conveyance rates) to emergency departments by 999 ambulances
2514:
1826:"Northern Ireland NHS 'simply unable to cope with the demands placed on it': report"
1457:
1340:
1001:"Northern Ireland NHS 'simply unable to cope with the demands placed on it': report"
2231:
24:
2029:"Revealed: Secret stats show A&E crisis four times as bad as official numbers"
975:
1441:
1351:
1326:
317:
222:
201:
112:
77:
66:
20:
242:
Percentage of ambulance handovers (from ambulance to A&E) within 15 minutes
282:
48:
2116:
1707:
1588:
884:
840:
760:
690:
682:
1941:"Trusts told to create 'dedicated A&E space' for mental health patients"
1092:"Fact or Fiction? The Welsh NHS performs poorly compared to the English NHS"
405:
188:
154:
94:
applies: "When a measure becomes a target, it ceases to be a good measure".
28:
2183:"Cancer patients forced to wait 'unacceptably' long time for NHS treatment"
2161:"Pensions crisis and staff shortages trigger record low cancer performance"
1449:
1233:"Performance Watch: A sneak preview of a keenly awaited review of A&Es"
749:"Don't leave patients in ambulances to hit A&E targets, hospitals told"
708:
73:
Sajid Javid called for a âproper review of NHS targetsâ in September 2021.
2227:"NHS patients waiting for hospital care top 4m for first time in a decade"
1090:
Edwards, Nigel; Trust, Chief Executive of the Nuffield (6 February 2015).
36:
580:
the 52-week target had "not been completely achieved in over 11 years".
400:
According to the BMA the main reasons for not reaching this target are:
2117:"Check NHS cancer, A&E, ops and mental health targets in your area"
236:
192:
2405:"Numbers 'going private' for surgery soaring as NHS rationing deepens"
1919:"Revealed: Why one county saw a third of all 12-hour A&E breaches"
309:
immediately followed by a reduction in attainment to the lower level.
2449:"Huge discrepancy in NHS England waiting times for common procedures"
1897:"12-hour patient waits in A&E increase by 10,000% in five years"
1341:
BMA - BMA survey of accident and emergency waiting times, March 2005
1183:
1181:
2493:"Huge variation in referrals to flagship 'urgent response' service"
2427:"Two-year waiters for elective care up by half to just under 4,000"
1128:"NHS failed to meet four-hour A&E targets for past two months"
1063:"Wales introduces single waiting times target for cancer patients"
316:
177:
A four-hour target in emergency departments was introduced by the
168:
1142:"Third of providers will still miss A&E target in March 2017"
1281:"NHS England gives green light to drop four-hour A&E target"
1164:"Jeremy Hunt ditches four-hour target as A&E crisis deepens"
2471:"Last minute cancelled operations hits highest rate since 2005"
1303:"Recovery Watch: Will NHSE ever kill off the four-hour target?"
1023:"NHS Wales Delivery Framework and Reporting Guidance 2019-2020"
841:"Check NHS cancer, A&E and operations targets in your area"
803:
Connolly, Sheelah; Bevan, Gwyn; Mays, Nicholas (January 2010).
1545:"A&Es miss national objective with record low performance"
555:
Northern Lincolnshire and Goole Hospitals NHS Foundation Trust
52:
1734:"Ambulance waits hit two hours for heart attacks and strokes"
1633:"First quarter A&E performance worst since records began"
2361:"Trusts with the most two-year elective breaches revealed"
2339:"New fines for leaving patients waiting more than a year"
2295:"Year-plus elective waiters at highest number since 2012"
1875:"NHS needs 5,000 more beds, warn leading A&E doctors"
1539:
1537:
1327:
BBC NEWS | Health | Target 'putting A&E care at risk'
1211:"NHS chiefs look to scrap four-hour A&E maximum wait"
954:"Community services given first ever waiting time target"
245:
Time to initial assessment â percentage within 15 minutes
51:
Conservative government first set public targets for the
1498:"What's going on in A&E? The key questions answered"
2383:"Lengthy waiting time figures are 'deeply distressing'"
2251:"Majority of local services are now breaching 18 weeks"
667:"Have targets improved performance in the English NHS?"
292:
The four-hour target triggered the introduction of the
2205:"Long cancer waits at highest rate since pandemic hit"
1778:"Exclusive: Minister misled MPs over ambulance crisis"
1589:"A&E waits at worst level for 15 years in England"
248:
Average time in department â for non-admitted patients
2139:"Trust hits waiting time target in just 8pc of cases"
2095:"Summer crisis deepens as trolley waits hit new high"
1352:
BBC NEWS | Health | A&E success 'not sustainable'
863:"NHS allowed to miss A&E target for another year"
995:
993:
157:
report by the Chief Executive of the Nuffield Trust
665:Bevan, Gwyn; Hood, Christopher (16 February 2006).
571:
East Kent Hospitals University NHS Foundation Trust
2273:"Region 'working to 40-week target' for treatment"
1756:"Emergency performance slumps again as covid hits"
362:almost 10% between May 2018 and September 2019.
251:Average time in department â for admitted patients
33:Health and Social Care service in Northern Ireland
1336:
1334:
1322:
1320:
2521:Emergency medical services in the United Kingdom
1708:"Longest A&E waiting times hit a new record"
474:University Hospitals of North Midlands NHS Trust
1963:"Record collapse in emergency care performance"
257:Patients spending more than 12 hours in A&E
2073:"Trusts reveal thousands of new 12-hour waits"
1655:"SNP attacked over year of missed NHS targets"
1116:The Four Hour Target in Accident and Emergency
907:"Javid wants review of 'nonsense' NHS targets"
1800:"The challenge of change in the NHS in Wales"
1520:"NHS emergency care in crisis all year round"
8:
885:"Hospital waiting times at worst-ever level"
563:King's College Hospital NHS Foundation Trust
2253:. Health Service Journal. 12 September 2019
1567:"NHS Key Statistics: England, October 2018"
1403:"Why are people waiting longer in A&E?"
1363:Mayhew, Les; Smith, David (December 2006).
1305:. Health Service Journal. 28 September 2022
909:. Health Service Journal. 12 September 2021
387:Targets in Northern Ireland are set by the
140:Targets in Northern Ireland are set by the
1943:. Health Service Journal. 19 December 2019
1569:. House of Commons Library. 1 October 2018
221:In May 2021, after prolonged consultation
2341:. Health Service Journal. 10 January 2019
2297:. Health Service Journal. 8 February 2018
2275:. Health Service Journal. 6 December 2019
2163:. Health Service Journal. 1 November 2019
1547:. Health Service Journal. 11 October 2018
1191:. Health Service Journal. 8 February 2018
865:. Health Service Journal. 2 February 2018
698:
2097:. Health Service Journal. 11 August 2022
1965:. Health Service Journal. 9 January 2020
1855:. Nuffield Trust & Health Foundation
1478:. Nuffield Trust & Health Foundation
1409:. Nuffield Trust & Health Foundation
782:"Have targets improved NHS performance?"
723:"Have targets improved NHS performance?"
2363:. Health Service Journal. 14 April 2022
2207:. Health Service Journal. 19 April 2022
2075:. Health Service Journal. 2 August 2022
1987:. Health Service Journal. 14 April 2022
932:. London: Swift Press. p. 82, 87.
657:
2495:. Health Service Journal. 21 June 2022
2141:. Health Service Journal. 9 April 2019
2053:. Health Service Journal. 19 July 2022
2009:. Health Service Journal. 4 March 2022
1899:. Healthcare Leader. 25 September 2017
1780:. Health Service Journal. 14 July 2022
1758:. Health Service Journal. 14 July 2022
1736:. Health Service Journal. 1 April 2022
1702:
1700:
1698:
1696:
1694:
1692:
1635:. Health Service Journal. 11 July 2019
1144:. Health Service Journal. 21 July 2016
956:. Health Service Journal. 22 July 2021
426:Delay in accessing diagnostic services
2473:. Health Service Journal. 10 May 2018
2429:. Health Service Journal. 9 July 2021
2319:. Health Service Journal. 31 May 2018
2031:. Health Service Journal. 13 May 2022
1921:. Health Service Journal. 17 May 2019
1877:. Health Service Journal. 7 July 2017
1828:. Belfast Telegraph. 18 December 2018
1690:
1688:
1686:
1684:
1682:
1680:
1678:
1676:
1674:
1672:
1283:. Health Service Journal. 26 May 2021
1235:. Health Service Journal. 22 May 2019
1085:
1083:
1056:
1054:
1003:. Belfast Telegraph. 18 December 2018
821:from the original on 29 February 2020
559:Imperial College Healthcare NHS Trust
547:Mid Essex Hospital Services NHS Trust
543:Imperial College Healthcare NHS Trust
414:Delay in accessing specialist opinion
7:
2317:"Year-plus waiters rise 75 per cent"
1985:"Biggest ever rise in 12-hour waits"
1613:. Evening Standard. 13 December 2019
976:"The NHS paid for my new French hip"
578:Royal College of Surgeons in Ireland
478:Lancashire Care NHS Foundation Trust
2526:Health policy in the United Kingdom
1189:"Trolley waits soar to record high"
447:Royal College of Emergency Medicine
1472:"Indicator: A&E waiting times"
1039:from the original on 19 April 2020
567:Royal Cornwall Hospitals NHS Trust
551:Royal Cornwall Hospitals NHS Trust
165:Accident and emergency departments
130:Patient Rights (Scotland) Act 2011
14:
2531:National Health Service (England)
2239:from the original on 1 July 2023.
747:Watts, Robert (27 October 2012).
19:are performance measures used by
2007:"Daily Insight: Unto the breach"
1657:. Scottish Express. 29 July 2018
1254:Jones, Simon (18 January 2022).
1849:"Focus on: A&E attendances"
430:In 2014, research conducted by
420:Not enough middle grade doctors
306:Health and Social Care Act 2012
2385:. Irish News. 29 November 2018
1061:Smith, Mark (27 August 2019).
646:NHS ambulance services targets
1:
434:, a joint programme from the
229:Response times for ambulances
2451:. Guardian. 1 September 2021
531:clinical commissioning group
389:Health and Social Care Board
343:National A&E performance
142:Health and Social Care Board
109:NHS Constitution for England
2407:. Telegraph. 11 August 2018
1522:. Sky News. 7 November 2018
1500:. King's Fund. 6 March 2017
1442:10.1136/emermed-2012-201175
1213:. Guardian. 2 December 2018
843:. BBC News. 7 December 2017
328:British Medical Association
239:that receive clinical input
235:Proportion of contacts via
2552:
1430:Emergency Medicine Journal
1260:Emergency Medicine Journal
1166:. Guardian. 9 January 2017
598:Royal College of Surgeons
526:Royal College of Surgeons
82:Stafford Hospital scandal
2185:. ITV News. 11 July 2019
683:10.1136/bmj.332.7538.419
2119:. BBC. 13 December 2018
1591:. BBC. 14 February 2019
887:. BBC. 14 November 2019
183:National Health Service
117:integrated care systems
978:. BBC. 3 December 2018
483:Mental Health Act 1983
322:
174:
928:Hunt, Jeremy (2022).
320:
294:acute assessment unit
172:
1371:Cass Business School
423:Department too small
283:Prime Minister Blair
179:Department of Health
321:A&E Attendances
98:National approaches
2235:. 10 August 2017.
1804:The Nuffield Trust
1714:. 20 February 2020
1373:. pp. 2, 34.
784:. Kings Fund. 2010
633:NHS Long Term Plan
627:Community services
462:Twelve hour target
411:Delayed discharges
396:Missing the target
323:
264:In September 2022
197:A&E department
175:
1806:. 18 January 2017
1380:978-1-905752-06-5
677:(7538): 419â422.
520:Planned treatment
445:In July 2017 the
440:Health Foundation
417:Not enough nurses
60:Labour government
2543:
2505:
2504:
2502:
2500:
2489:
2483:
2482:
2480:
2478:
2467:
2461:
2460:
2458:
2456:
2445:
2439:
2438:
2436:
2434:
2423:
2417:
2416:
2414:
2412:
2401:
2395:
2394:
2392:
2390:
2379:
2373:
2372:
2370:
2368:
2357:
2351:
2350:
2348:
2346:
2335:
2329:
2328:
2326:
2324:
2313:
2307:
2306:
2304:
2302:
2291:
2285:
2284:
2282:
2280:
2269:
2263:
2262:
2260:
2258:
2247:
2241:
2240:
2223:
2217:
2216:
2214:
2212:
2201:
2195:
2194:
2192:
2190:
2179:
2173:
2172:
2170:
2168:
2157:
2151:
2150:
2148:
2146:
2135:
2129:
2128:
2126:
2124:
2113:
2107:
2106:
2104:
2102:
2091:
2085:
2084:
2082:
2080:
2069:
2063:
2062:
2060:
2058:
2047:
2041:
2040:
2038:
2036:
2025:
2019:
2018:
2016:
2014:
2003:
1997:
1996:
1994:
1992:
1981:
1975:
1974:
1972:
1970:
1959:
1953:
1952:
1950:
1948:
1937:
1931:
1930:
1928:
1926:
1915:
1909:
1908:
1906:
1904:
1893:
1887:
1886:
1884:
1882:
1871:
1865:
1864:
1862:
1860:
1844:
1838:
1837:
1835:
1833:
1822:
1816:
1815:
1813:
1811:
1796:
1790:
1789:
1787:
1785:
1774:
1768:
1767:
1765:
1763:
1752:
1746:
1745:
1743:
1741:
1730:
1724:
1723:
1721:
1719:
1704:
1667:
1666:
1664:
1662:
1651:
1645:
1644:
1642:
1640:
1629:
1623:
1622:
1620:
1618:
1607:
1601:
1600:
1598:
1596:
1585:
1579:
1578:
1576:
1574:
1563:
1557:
1556:
1554:
1552:
1541:
1532:
1531:
1529:
1527:
1516:
1510:
1509:
1507:
1505:
1494:
1488:
1487:
1485:
1483:
1468:
1462:
1461:
1425:
1419:
1418:
1416:
1414:
1398:
1392:
1391:
1389:
1387:
1360:
1354:
1349:
1343:
1338:
1329:
1324:
1315:
1314:
1312:
1310:
1299:
1293:
1292:
1290:
1288:
1277:
1271:
1270:
1268:
1266:
1251:
1245:
1244:
1242:
1240:
1229:
1223:
1222:
1220:
1218:
1207:
1201:
1200:
1198:
1196:
1185:
1176:
1175:
1173:
1171:
1160:
1154:
1153:
1151:
1149:
1138:
1132:
1131:
1124:
1118:
1113:
1107:
1106:
1104:
1102:
1087:
1078:
1077:
1075:
1073:
1058:
1049:
1048:
1046:
1044:
1038:
1030:Welsh Government
1027:
1019:
1013:
1012:
1010:
1008:
997:
988:
987:
985:
983:
972:
966:
965:
963:
961:
950:
944:
943:
925:
919:
918:
916:
914:
903:
897:
896:
894:
892:
881:
875:
874:
872:
870:
859:
853:
852:
850:
848:
837:
831:
830:
828:
826:
820:
809:
800:
794:
793:
791:
789:
778:
772:
771:
769:
767:
744:
738:
737:
735:
733:
719:
713:
712:
702:
662:
383:Northern Ireland
136:Northern Ireland
2551:
2550:
2546:
2545:
2544:
2542:
2541:
2540:
2511:
2510:
2509:
2508:
2498:
2496:
2491:
2490:
2486:
2476:
2474:
2469:
2468:
2464:
2454:
2452:
2447:
2446:
2442:
2432:
2430:
2425:
2424:
2420:
2410:
2408:
2403:
2402:
2398:
2388:
2386:
2381:
2380:
2376:
2366:
2364:
2359:
2358:
2354:
2344:
2342:
2337:
2336:
2332:
2322:
2320:
2315:
2314:
2310:
2300:
2298:
2293:
2292:
2288:
2278:
2276:
2271:
2270:
2266:
2256:
2254:
2249:
2248:
2244:
2225:
2224:
2220:
2210:
2208:
2203:
2202:
2198:
2188:
2186:
2181:
2180:
2176:
2166:
2164:
2159:
2158:
2154:
2144:
2142:
2137:
2136:
2132:
2122:
2120:
2115:
2114:
2110:
2100:
2098:
2093:
2092:
2088:
2078:
2076:
2071:
2070:
2066:
2056:
2054:
2049:
2048:
2044:
2034:
2032:
2027:
2026:
2022:
2012:
2010:
2005:
2004:
2000:
1990:
1988:
1983:
1982:
1978:
1968:
1966:
1961:
1960:
1956:
1946:
1944:
1939:
1938:
1934:
1924:
1922:
1917:
1916:
1912:
1902:
1900:
1895:
1894:
1890:
1880:
1878:
1873:
1872:
1868:
1858:
1856:
1846:
1845:
1841:
1831:
1829:
1824:
1823:
1819:
1809:
1807:
1798:
1797:
1793:
1783:
1781:
1776:
1775:
1771:
1761:
1759:
1754:
1753:
1749:
1739:
1737:
1732:
1731:
1727:
1717:
1715:
1706:
1705:
1670:
1660:
1658:
1653:
1652:
1648:
1638:
1636:
1631:
1630:
1626:
1616:
1614:
1609:
1608:
1604:
1594:
1592:
1587:
1586:
1582:
1572:
1570:
1565:
1564:
1560:
1550:
1548:
1543:
1542:
1535:
1525:
1523:
1518:
1517:
1513:
1503:
1501:
1496:
1495:
1491:
1481:
1479:
1470:
1469:
1465:
1427:
1426:
1422:
1412:
1410:
1400:
1399:
1395:
1385:
1383:
1381:
1362:
1361:
1357:
1350:
1346:
1339:
1332:
1325:
1318:
1308:
1306:
1301:
1300:
1296:
1286:
1284:
1279:
1278:
1274:
1264:
1262:
1253:
1252:
1248:
1238:
1236:
1231:
1230:
1226:
1216:
1214:
1209:
1208:
1204:
1194:
1192:
1187:
1186:
1179:
1169:
1167:
1162:
1161:
1157:
1147:
1145:
1140:
1139:
1135:
1130:. 2 April 2013.
1126:
1125:
1121:
1114:
1110:
1100:
1098:
1089:
1088:
1081:
1071:
1069:
1060:
1059:
1052:
1042:
1040:
1036:
1025:
1021:
1020:
1016:
1006:
1004:
999:
998:
991:
981:
979:
974:
973:
969:
959:
957:
952:
951:
947:
940:
927:
926:
922:
912:
910:
905:
904:
900:
890:
888:
883:
882:
878:
868:
866:
861:
860:
856:
846:
844:
839:
838:
834:
824:
822:
818:
807:
802:
801:
797:
787:
785:
780:
779:
775:
765:
763:
753:Daily Telegraph
746:
745:
741:
731:
729:
727:The King's Fund
721:
720:
716:
664:
663:
659:
654:
642:
629:
620:
611:
594:
589:
539:
522:
504:
495:
476:. Problems at
469:
464:
455:
398:
385:
376:
368:Maria Caulfield
359:
350:
345:
315:
274:
219:
167:
150:
138:
126:
105:
100:
87:David Nicholson
58:The subsequent
45:
12:
11:
5:
2549:
2547:
2539:
2538:
2533:
2528:
2523:
2513:
2512:
2507:
2506:
2484:
2462:
2440:
2418:
2396:
2374:
2352:
2330:
2308:
2286:
2264:
2242:
2218:
2196:
2174:
2152:
2130:
2108:
2086:
2064:
2042:
2020:
1998:
1976:
1954:
1932:
1910:
1888:
1866:
1839:
1817:
1791:
1769:
1747:
1725:
1668:
1646:
1624:
1602:
1580:
1558:
1533:
1511:
1489:
1463:
1420:
1393:
1379:
1355:
1344:
1330:
1316:
1294:
1272:
1246:
1224:
1202:
1177:
1155:
1133:
1119:
1108:
1079:
1050:
1032:. March 2019.
1014:
989:
967:
945:
938:
920:
898:
876:
854:
832:
812:Nuffield Trust
795:
773:
739:
714:
656:
655:
653:
650:
649:
648:
641:
638:
628:
625:
619:
616:
610:
607:
593:
590:
588:
587:Six month wait
585:
538:
535:
521:
518:
503:
500:
494:
491:
468:
465:
463:
460:
454:
451:
436:Nuffield Trust
428:
427:
424:
421:
418:
415:
412:
409:
397:
394:
384:
381:
375:
372:
358:
355:
349:
346:
344:
341:
314:
311:
298:bed management
273:
270:
266:ThÊrèse Coffey
262:
261:
258:
255:
252:
249:
246:
243:
240:
233:
230:
218:
215:
166:
163:
149:
146:
137:
134:
125:
122:
104:
101:
99:
96:
92:Goodhart's law
44:
41:
13:
10:
9:
6:
4:
3:
2:
2548:
2537:
2534:
2532:
2529:
2527:
2524:
2522:
2519:
2518:
2516:
2494:
2488:
2485:
2472:
2466:
2463:
2450:
2444:
2441:
2428:
2422:
2419:
2406:
2400:
2397:
2384:
2378:
2375:
2362:
2356:
2353:
2340:
2334:
2331:
2318:
2312:
2309:
2296:
2290:
2287:
2274:
2268:
2265:
2252:
2246:
2243:
2238:
2234:
2233:
2228:
2222:
2219:
2206:
2200:
2197:
2184:
2178:
2175:
2162:
2156:
2153:
2140:
2134:
2131:
2118:
2112:
2109:
2096:
2090:
2087:
2074:
2068:
2065:
2052:
2046:
2043:
2030:
2024:
2021:
2008:
2002:
1999:
1986:
1980:
1977:
1964:
1958:
1955:
1942:
1936:
1933:
1920:
1914:
1911:
1898:
1892:
1889:
1876:
1870:
1867:
1854:
1850:
1843:
1840:
1827:
1821:
1818:
1805:
1801:
1795:
1792:
1779:
1773:
1770:
1757:
1751:
1748:
1735:
1729:
1726:
1713:
1709:
1703:
1701:
1699:
1697:
1695:
1693:
1691:
1689:
1687:
1685:
1683:
1681:
1679:
1677:
1675:
1673:
1669:
1656:
1650:
1647:
1634:
1628:
1625:
1612:
1606:
1603:
1590:
1584:
1581:
1568:
1562:
1559:
1546:
1540:
1538:
1534:
1521:
1515:
1512:
1499:
1493:
1490:
1477:
1473:
1467:
1464:
1459:
1455:
1451:
1447:
1443:
1439:
1435:
1431:
1424:
1421:
1408:
1404:
1397:
1394:
1382:
1376:
1372:
1368:
1367:
1359:
1356:
1353:
1348:
1345:
1342:
1337:
1335:
1331:
1328:
1323:
1321:
1317:
1304:
1298:
1295:
1282:
1276:
1273:
1261:
1257:
1250:
1247:
1234:
1228:
1225:
1212:
1206:
1203:
1190:
1184:
1182:
1178:
1165:
1159:
1156:
1143:
1137:
1134:
1129:
1123:
1120:
1117:
1112:
1109:
1097:
1093:
1086:
1084:
1080:
1068:
1064:
1057:
1055:
1051:
1035:
1031:
1024:
1018:
1015:
1002:
996:
994:
990:
977:
971:
968:
955:
949:
946:
941:
939:9781800751224
935:
931:
924:
921:
908:
902:
899:
886:
880:
877:
864:
858:
855:
842:
836:
833:
817:
813:
806:
799:
796:
783:
777:
774:
762:
758:
754:
750:
743:
740:
728:
724:
718:
715:
710:
706:
701:
696:
692:
688:
684:
680:
676:
672:
668:
661:
658:
651:
647:
644:
643:
639:
637:
634:
626:
624:
618:Cancellations
617:
615:
608:
606:
602:
599:
591:
586:
584:
581:
579:
574:
572:
568:
564:
560:
556:
552:
548:
544:
537:One year wait
536:
534:
532:
527:
519:
517:
514:
510:
507:
501:
499:
492:
490:
486:
484:
479:
475:
466:
461:
459:
452:
450:
448:
443:
441:
437:
433:
425:
422:
419:
416:
413:
410:
407:
403:
402:
401:
395:
393:
390:
382:
380:
373:
371:
369:
363:
356:
354:
347:
342:
340:
337:
334:
329:
319:
312:
310:
307:
302:
299:
295:
290:
286:
284:
279:
271:
269:
267:
259:
256:
253:
250:
247:
244:
241:
238:
234:
231:
228:
227:
226:
224:
217:New standards
216:
214:
210:
206:
203:
198:
194:
190:
187:
184:
180:
171:
164:
162:
160:
159:Nigel Edwards
156:
147:
145:
143:
135:
133:
131:
123:
121:
118:
114:
110:
102:
97:
95:
93:
88:
83:
79:
76:According to
74:
71:
68:
64:
61:
56:
54:
50:
42:
40:
38:
34:
30:
26:
22:
18:
2536:NHS Scotland
2497:. Retrieved
2487:
2475:. Retrieved
2465:
2453:. Retrieved
2443:
2431:. Retrieved
2421:
2409:. Retrieved
2399:
2387:. Retrieved
2377:
2365:. Retrieved
2355:
2343:. Retrieved
2333:
2321:. Retrieved
2311:
2299:. Retrieved
2289:
2277:. Retrieved
2267:
2255:. Retrieved
2245:
2232:The Guardian
2230:
2221:
2209:. Retrieved
2199:
2187:. Retrieved
2177:
2165:. Retrieved
2155:
2143:. Retrieved
2133:
2121:. Retrieved
2111:
2101:29 September
2099:. Retrieved
2089:
2079:29 September
2077:. Retrieved
2067:
2055:. Retrieved
2045:
2033:. Retrieved
2023:
2011:. Retrieved
2001:
1989:. Retrieved
1979:
1967:. Retrieved
1957:
1945:. Retrieved
1935:
1923:. Retrieved
1913:
1901:. Retrieved
1891:
1879:. Retrieved
1869:
1857:. Retrieved
1853:QualityWatch
1852:
1847:Blunt, Ian.
1842:
1830:. Retrieved
1820:
1808:. Retrieved
1803:
1794:
1782:. Retrieved
1772:
1760:. Retrieved
1750:
1738:. Retrieved
1728:
1716:. Retrieved
1711:
1659:. Retrieved
1649:
1637:. Retrieved
1627:
1615:. Retrieved
1605:
1593:. Retrieved
1583:
1571:. Retrieved
1561:
1549:. Retrieved
1524:. Retrieved
1514:
1502:. Retrieved
1492:
1480:. Retrieved
1476:QualityWatch
1475:
1466:
1433:
1429:
1423:
1411:. Retrieved
1407:QualityWatch
1406:
1401:Blunt, Ian.
1396:
1384:. Retrieved
1365:
1358:
1347:
1307:. Retrieved
1297:
1285:. Retrieved
1275:
1263:. Retrieved
1259:
1249:
1237:. Retrieved
1227:
1215:. Retrieved
1205:
1193:. Retrieved
1168:. Retrieved
1158:
1146:. Retrieved
1136:
1122:
1111:
1099:. Retrieved
1095:
1070:. Retrieved
1066:
1041:. Retrieved
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