• NHS England has increased resources and made small improvements, but while there has been progress on reducing waiting times, this has been slow and many of the expected benefits from its 2023 recovery plan have not yet been realised.
  • Costs per patient for a single attendance to A&E have increased by a third between 2024-25 and 2018-19.
  • NHSE estimates that delays to discharges from hospital beds are costing billions. These delays are also affecting patient flow through hospitals, worsening pressure across the urgent and emergency care system.

NHSE 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.1

Crowding in A&E has increased in the last 14 years, making it harder for patients to flow through hospital as normal. The annual numbers of A&E attendances have increased by 6.5 million since 2011-12, and in May 2026, 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 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, but there has been a gradual improvement since 2022-23.2 Type 1 A&Es, which deal with the most complex and severe cases, have a much worse wait-time performance than Type 2 and Type 3 A&Es who tend to deal with less severe injuries.3

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.

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.

The wider patient flow through a hospital can affect how quickly patients are admitted from A&E to a hospital bed, as when bottlenecks or blockages occur, patients can face delays. The number of patients requiring admission from A&E to a bed in a hospital ward has increased by over a million since 2011-12.4

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. NHSE estimates that delayed discharge has cost an estimated £2 billion between August 2025 and April 2026.

NHSE published a plan in 2023 to improve A&E care, with the main objective being dealing with reduced patient flow through hospitals resulting from increased bed occupancy rates, which NHSE saw as the “key driver” of falling A&E performance.5 NHSE allocated £1.6 billion to ICB’s and local authorities in 2023-24 and 2024-25 through the discharge fund to help reduce delayed discharge.6

However, despite achieving many of the aims in this plan, NHSE has evaluated that many of the desired outcomes have not materialised. NHSE 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.

To help improve patient flow through hospital, and therefore A&E services, the NAO recommends that NHSE and DHSC should:

  • Identify and spread successful approaches from high performing trusts, using oversight powers to support improvement in all hospitals.
  • Support trusts to more consistently use end-to-end hospital flow management tools and reduce discharge delays caused from within hospitals, as well as improving coordination between hospitals, community services and social care.
  • Include patient experience within routine performance monitoring, for example through patient feedback on timeliness and quality of care.
  • Support trusts to better understand the relationship between costs, performance, patient numbers and acuity of cases.

“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.

“A stronger focus on patient flow, timely discharge and patient experience will be vital to improving outcomes for patients.”

Gareth Davies, head of the NAO

Read the full report

Managing the flow of patients through hospital from A&E 

Notes for editors

  1. The report will be available on the following link from 00:01 on Wednesday 9th September: https://www.nao.org.uk/reports/managing-the-flow-of-patients-through-hospital-from-ae/
  2. In 2013-14, performance against the four-hour metric was, on average, 95.7%, which then declined to a low of 70.8% in 2022-23. Performance has improved gradually since, and in 2025-26 the NHS met the four-hour target for 74.9% of attendances.
  3. Type 1 A&E departments are 24/7 consultant led-ED. Type 2 A&E departments are single speciality consultant-led ED. Types 3 and 4 are all other A&E types, including UTC’s, UCC, WiCs, MIUs.Type 1 A&E departments had a performance rate of 60.9% on the four-hour metric in 2025-26, but Type 2 and 3 departments perform consistently at 96% or above.
  4. There have been increasing numbers of people who require an admission from A&E to a bed in a hospital ward (from 3.7 million patients in 2011-12 to 4.8 million patients in 2025-26). In addition, average bed occupancy in hospitals increased from 87% to 92% nationally, which means fewer beds were available in the right places at the right time. On average someone admitted to hospital from A&E spends 8.1 days in a hospital bed, up from 7.3 days in 2019-20 (an 11% increase)
  5. In January 2023, NHSE and Department of Health & Social Care (DHSC) published the “Delivery plan for recovering urgent and emergency services” (the 2023 plan). NHS England » Delivery plan for recovering urgent and emergency care services
  6. To aid with the goal of improving discharge, £1.6 billion of additional social care discharge funding was distributed over 2023-24 and 2024-25. Impact on improving discharge is less clear. In September 2023, 13.5% of discharges were delayed. In March 2025, this figure was 13.7%.