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New figures released for A&E attendances in 2020-21

Attendances at accident and emergency departments in England fell from 25.0m in 2019-20 to 17.4m in 2020-21, a drop of 30.3%1, new NHS Digital figures show.

This bucks the recent year-on-year trend of rising attendances for every year prior since at least 2011-12.

NHS Digital’s Hospital Accident and Emergency Activity 2020/21 also shows that the sharpest falls were seen in April-June 2020 and December 2020-February 20212, as well as in attendances at minor injury units and walk in centres3.

The report, created in partnership with NHS England and NHS Improvement, brings together data from three sources4:

  • newly published annual data for the first time from NHS Digital’s Emergency Care Dataset (ECDS)5
  • historical data from NHS Digital’s Hospital Episodes Statistics (HES), and
  • previously published data from NHS England and NHS Improvement’s A&E Attendances and Emergency Admissions Monthly Situation Reports (MSitAE).

It includes attendances from all types of accident and emergency departments ranging from major A&E departments and single specialty, consultant-led emergency departments to minor injury units and walk-in centres. 

The report also includes breakdowns by providers and demographics such as gender, ethnicity, age and deprivation, as well as a Home Nations comparison.

Other ECDS/HES data in the report also shows:

Age

In 2020-21, there was a drop in attendances for all age groups. In this, the sharpest drop was seen in those aged 24 years and under.

Within specific agebands, the proportion of overall attendances for those aged 0-24 years decreased by 5.2 percentage points from 32.1% in 2019-20 to 26.9% in 2020-21.  Conversely, the proportion for those aged 25 years and older increased from 66.0% in 2019-20 to 73.1% in 2020-21, even though the total number of attendances dropped for this age group6.

Deprivation

People residing in the most deprived 10% of areas7 accounted for 2.2m attendances, twice as many compared with those residing in the least deprived 10% of areas (1.1m attendances)8. This is in line with similar proportions reported in recent years.

Activity

Monday is the busiest day of the week, accounting for 16% of all attendances during 2020-21 (2.6m attendances). The most popular time of arrival on a Monday is between 11am and 1pm, accounting for 15% of attendances on this day (379,000 attendances)9.

The number of reattendances10 to A&E within 7 days was 1.4 million and accounted for 10.4% of all reported attendances, an increase of 1.7 percentage points on 2019-20 (8.7% of all reported attendances).

The number of attendances spending over 12 hours in A&E was 303,000 in 2020-21. This is a 42.1% decrease since 2019-20 (523,000) and an 8.2% decrease since 2018-19 (330,000 attendances). The proportion of total attendances spending over 12 hours in A&E in 2020-21 was 1.87%, (compared to 2.33% in 2019-20 and 1.49% in 2018-19). This measures the entire duration of stay in A&E11.

MSitAE data in the report shows:

From 2011-12 to 2019-20, the percentage of A&E attendances who are admitted to hospital rose steadily from 17.1% to 19.3%.  This percentage increased to 23.8% for 2020-21.

The percentage of attendances spending four hours or less in A&E rose from 84.2% in 2019-20 to 86.8% in 2020-2112.

The number of attendances fell for both major A&E departments and minor injury units/walk in centres13. Attendances at major A&E departments fell 22.8% from 16.4m in 2019-20 to 12.6m in 2020-21, and minor injury units/walk in centres fell 44.6% from 8.6m in 2019-20 to 4.8m in 2020-21.

Read the full report: Hospital Accident and Emergency Activity 2020/21

Notes for Editors

  1. While the main reason behind this fall is likely due to changes in both individual behaviours and service provision due to the coronavirus pandemic, it could also be influenced by the reconfiguration of existing type 3 & 4 A&E department types into Urgent Treatment Centres or changing their function to become other primary health care services. Activity related to the latter would not be reported within this data but would remain within historical data that has been reported in previous publications. This planned reclassification process started Autumn 2020.
  2. See Summary Report Tables file, Table 13
  3. See Summary Report Tables file, Summary Report 2. To respond to the challenges posed by the coronavirus pandemic, NHS hospitals in England were instructed to suspend all non-urgent activity for patients for parts of the 2020-21 reporting period, which may have impacted these figures. In addition, it is also possible that the challenges of the pandemic had an impact on the completion, return and processing of certain data when compared to earlier years. Therefore, at various points in the pandemic, fewer patients may have been recorded as attending A&E than in previous years, despite services being open.
  4. MSitAE data are received monthly by NHS England and ECDS data is received daily by NHS Digital. For ECDS both a monthly and an annual snapshot of the data are then taken on a specific date. MSitAE are submitted data and are used at aggregate level, to a quick timetable, to monitor performance and activity growth.  Coverage is more complete for MSitAE than ECDS, though ECDS holds the data at patient level from hospital systems. The gap between the two datasets is narrowing over time as the coverage in ECDS improves.  All data excludes planned attendances, unless otherwise stated.
  5. The ECDS dataset, which has replaced the predecessor HES A&E data source, has been designed to be better equipped to keep pace with the increasing complexity of delivering emergency care. It provides better support to healthcare planning and better-informed decision making on improvements to services. This improved data helps improve understanding of the complexity and acuity of attending patients, the causes of rising demand and the value added by emergency departments.
  6. See National Data Tables file, Table 6.  While the proportion of the overall attendance figures changed for both age groups, actual number of attendances fell for both.  The number of attendances for 0-24 year olds fell from 7.3m in 2019-20 to 4.4m in 2020-21.  The number of attendances for 25 year olds and over fell from 14.9m in 2019-20 to 11.9m in 2020-21.  This includes activity for both planned and unplanned attendances.
  7. See National Data Tables file, Table 22.  The Index of Multiple Deprivation 2019 is the official measure of relative deprivation for small areas (or neighbourhoods) in England.  The Index of Multiple Deprivation ranks every small area in England from 1 (most deprived area) to 32,844 (least deprived area). It is common to describe how relatively deprived a small area is by saying whether it falls among the most deprived 10%, 20% or 30% of small areas in England. To help with this, deprivation ‘deciles’ are published alongside ranks. Deciles are calculated by ranking the 32,844 small areas in England from most deprived to least deprived and dividing them into 10 equal groups. These range from the most deprived 10% of small areas nationally to the least deprived 10% of small areas nationally. The source data can be found here.
  8. Population rates are calculated using Office for National Statistics (ONS) data using population estimates for the 2011 Lower Layer Super Output Areas (LSOA) combined with the Index of Multiple Deprivation (IMD) to create a population estimate for each IMD decile group. The population estimates are the 2019 mid-year estimates mapped to 2011 LSOAs and IMD is using the 2019 version.

See Summary Report Tables file, Summary report 11.  This includes activity for both planned and unplanned A&E attendances.

See Summary Report Tables file, Summary report 16.  All reattendances are defined to be within seven days of the patient’s first attendance, either to the same or another A&E department, where more than four hours has elapsed from A&E for the initial attendance. The reason for the initial and reattendances have not been compared to assess whether they are related or not.

See Summary Report Tables file, Summary report 9.  This is defined as the ‘total time spent in A&E from arrival to discharge, transfer or admission’. The calculation excludes planned A&E attendances.  This is distinct from the official measure, which relates to the time between the point a clinician decides to admit the patient to the point the patient is admitted.

See Summary Report Tables file, Summary report 4.  Fourteen hospital trusts are excluded from the ‘Number and percentage attendances 4 hours or less / over 4 hours’ due to their involvement with testing new proposal standards for emergency care, which has made them exempt from this measure. More details can be found here.

As per footnote 1, while the main reason behind this fall is likely due to changes in both individual behaviour and service provision due to the coronavirus pandemic, it could also be influenced by the reconfiguration of existing type 3 & 4 A&E department types either into Urgent Treatment Centres or changing their function to become other primary health care services. Activity related to the latter would not be reported within this data but would remain within historical data that has been reported in previous publications. This planned reclassification process started Autumn 2020.

  1. See Summary Report Tables file, Summary report 11.  This includes activity for both planned and unplanned A&E attendances.
  2. See Summary Report Tables file, Summary report 16.  All reattendances are defined to be within seven days of the patient’s first attendance, either to the same or another A&E department, where more than four hours has elapsed from A&E for the initial attendance. The reason for the initial and reattendances have not been compared to assess whether they are related or not.
  3. See Summary Report Tables file, Summary report 9.  This is defined as the ‘total time spent in A&E from arrival to discharge, transfer or admission’. The calculation excludes planned A&E attendances.  This is distinct from the official measure, which relates to the time between the point a clinician decides to admit the patient to the point the patient is admitted.
  4. See Summary Report Tables file, Summary report 4.  Fourteen hospital trusts are excluded from the ‘Number and percentage attendances 4 hours or less / over 4 hours’ due to their involvement with testing new proposal standards for emergency care, which has made them exempt from this measure. More details can be found here.
  5. As per footnote 1, while the main reason behind this fall is likely due to changes in both individual behaviour and service provision due to the coronavirus pandemic, it could also be influenced by the reconfiguration of existing type 3 & 4 A&E department types either into Urgent Treatment Centres or changing their function to become other primary health care services. Activity related to the latter would not be reported within this data but would remain within historical data that has been reported in previous publications. This planned reclassification process started Autumn 2020.

 

Channel website: https://digital.nhs.uk

Original article link: https://digital.nhs.uk/news-and-events/latest-news/new-figures-released-for-ae-attendances-in-2020-21

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