NHS winter crisis: Number of A&E patients treated in four hours falls to record low in December

By | January 13, 2020

Worst ever NHS A&E performance figures for December show 400,000 patients faced four-hour waits as record-low 79.8% were treated in the target time

  • More than one in five people in A&E December spent more than four hours there
  • Last week 18,251 ambulance patients waited 30 mins or more to be handed over
  • Doctors said hospitals are under ‘pressures the like of which we have never seen’
  • There were almost 2.2million visits to A&E departments in England in December 

Almost 400,000 A&E patients waited more than four hours to be treated in casualty units England last month, shock figures show.

In the worst ever performance of its kind in the NHS, just 79.8 per cent of all patients were cared for in December within the target time. 

This worked out as 396,762 people waiting longer, 40,000 more than in November, the previous worst month when just 81.4 per cent were seen in four hours.  

Other statistics laying bare the immense pressure on A&E units revealed ambulance delays were last week the worst they have been in at least two years.

The first week of 2020 saw almost one in five ambulance patients (18 per cent, equal to 18,000 people) wait more than half an hour to be handed over to hospital staff.

Doctors’ organisations said the NHS is stuck in a ‘spiral of decline’ and staff are dealing with ‘pressures the like of which we have never seen’.

December data for the past nine years reveals the number of people waiting more than four hours in A&E has soared from a low of 66,661 in 2011 to a record high of 396,762 in 2019

December data for the past nine years reveals the number of people waiting more than four hours in A&E has soared from a low of 66,661 in 2011 to a record high of 396,762 in 2019

NHS statistics published this morning showed there were a total of 2.1million visits to A&E departments in December, the highest in five months.

The NHS rules 95 per cent patients must be seen within four hours of arriving, but this was only the case for 1.56million of those patients.

Data also showed last week a total of 12,824 people arriving at A&E by ambulance had to wait between 30 minutes and an hour to be handed over to hospital staff, while another 5,247 waited for more than an hour.

Patients should be taken away from ambulance crews within a quarter of an hour but overloaded A&E departments mean they must stay with them until a bed is free.

Last week’s statistic is significantly higher than in any other single week during the winters of 2017 and 2018, and the third week of December was almost as bad. 

Patients who needed admitting to hospital after their visits also faced record-breakingly long waits before they could get onto a ward.

Almost 100,000 seriously ill people (98,452) waited more than four hours for a bed after a doctor had decided to keep them in the hospital.

And a staggering 2,347 people waited for 12 hours or more. This was more than double the 1,112 in November and 10 times as many as in December 2018 (284).

The Acute Society of Medicine, which represents hospital staff across the country, said the health service is facing an unprecedented challenge.

Its president, Dr Susan Crossland, said: ‘We can honestly say that acute care is facing pressures the like of which we have never seen.

‘And the huge jump in patients waiting more than 12 hours should be of serious concern to the government.


The NHS’s four-hour A&E target is one set out in the NHS constitution which dictates 95 per cent of all emergency patients in England should be admitted to hospital or discharged within four hours of arriving.

Hospitals’ performance against this measure has been tracked for more than a decade.

At a national level the NHS hasn’t hit the 95 per cent target since July 2015, when it was 95.2 per cent.

Since then there has been a steady decline to October 2019’s record low of 83.6 per cent.

That low meant that one out of every six people who went to A&E in that month waited there for more than four hours – more than 320,000 people. 

The woeful figures come at a time when the NHS is trying to scrap the four-hour target completely.

Unable to meet the ambitious 95 per cent, the health service is now trying to switch to a system which doesn’t measure waiting times against a set benchmark but simply tries to treat the more urgent cases faster and loosens the limit for less serious patients.

‘Almost 100,000 patients waited more than four hours [before being admitted to hospital] – almost double that of last month.’

Dr Simon Walsh, spokesperson for the British Medical Association, said: ‘How many wake-up calls does the Government need?

‘These figures are truly alarming and serve as yet further evidence that our NHS simply doesn’t have the resources, staff, or capacity to cope with rocketing demand. 

‘This is totally unacceptable and demands urgent action.’  

December saw a record high number of category 1 ambulance call-outs – the most serious emergency – with almost 10,000 people needing urgent help.

And the number of ambulance arrivals at emergency departments was also at its highest level ever at an average of 14,480 every day across England. 

One expert warned that proper winter weather, which is known to make people more ill, hasn’t even started yet.

Professor John Appleby, economist at the think-tank the Nuffield Trust, said: ‘These would be dire performance figures for any December but what’s worrying is that we are still awaiting the truly cold winter weather that we know will plunge the NHS into further problems.

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‘Once a rare and almost unthinkable event, in December over two thousand people waited more than 12 hours on a trolley to be admitted to a bed on a hospital ward. 

‘Missed targets are now the norm… this pressure is spreading out across the entire system.’ 

Katherine Henderson, president of the Royal College of Emergency Medicine, added: ‘The NHS is struggling to escape its spiral of decline. With a record low in terms of four-hour performance and highest ever number of 12-hour waits, this will have been a miserable Christmas period for many patients and staff alike.’

Experts say 'missed targets are now the norm' as thousands of people every week are forced to wait hours on beds in corridors because there is no room in A&E bays or inpatient wards (stock image)

Experts say ‘missed targets are now the norm’ as thousands of people every week are forced to wait hours on beds in corridors because there is no room in A&E bays or inpatient wards (stock image)


The NHS surgery waiting list had in November shrunk slightly since the month before – down from 4.45million to 4.42m.

But the number of patients in England who had been waiting for more than 18 weeks – four-and-a-half months – for their treatment, was at its highest level since May 2008.

A total of 690,096 people had been waiting for longer. The NHS constitution says patients should have their op within 18 weeks of being referred by a consultant.

In May 2008, almost 12 years, ago the number of people who had waited longer was 768,383.

People on the waiting list may be expecting routine surgeries such as hip or knee replacements or cataracts, but may also be cancer patients who need tumours removed. 

Around 220,000 patients’ waiting times are unknown because they went to hospitals which are trialling a new way of running A&E departments.

As hospitals all over the country consistently fail to see 95 per cent of their patients within four hours of them arriving, the NHS is testing a way of scrapping the target. 

Instead, 14 hospitals around England now triage patients based purely on the severity of their condition without prioritising hitting targets on paper.

If this was adopted nationally it could be harder to keep track of hospitals’ performance because they would report average waiting times rather than measuring themselves against a benchmark. 

Professor Stephen Powis, the NHS’s medical director, said: ‘A&Es across the country are currently very busy – in 2019 we treated over a million more patients in our A&Es than the previous year.

‘We have got more hospital beds open than last winter, but flu has come early and is around twice as high as this time last year.

‘For the public there is still time to get your flu jab, and remember to use the free NHS 111 phone and online service and your local pharmacist.’

How many patients get seen within four hours of arriving at A&E varies hugely across the country.  

In Norfolk & Norwich University Hospitals, the worst performing in December, only around half of patients got seen within that time (54.7 per cent).

At Stockport NHS Trust the figure was 59.1 per cent and it was 59.6 per cent at Shrewsbury and Telford Hospital.

Whereas at Homerton University Hospital in London and Northumbria Healthcare, which saw comparable numbers of patients, more than 90 per cent of patients were seen in time.

Some smaller trusts and community care providers were able to see 100 per cent of their patients in the target time. 


The Royal College of Surgeons today revealed eight out 10 surgeons had to cancel operations in November because hospitals didn’t have enough beds to put their patients in.

There are currently 4.42million people in England waiting to have routine surgery, of whom 690,000 had already been waiting for longer than four-and-a-half months in November.

When hospitals are busy they may not have the capacity to take in non-urgent patients, so operations get cancelled.  

These surgeries include standard procedures such as hip and knee replacements or cataracts, but also include cancer patients.

Almost four out of 10 surgeons said the surgery they had planned ended up being more complicated by the time they got to it because the patient’s condition had got worse during the wait, the Royal College revealed.

Surgeons say the procedures they plan for people often become more complicated by the time they finally get to do it because the patient's condition has got worse while they were waiting for the operation (stock image)

Surgeons say the procedures they plan for people often become more complicated by the time they finally get to do it because the patient’s condition has got worse while they were waiting for the operation (stock image)

And nearly 60 per cent of surgeons said they had had to cancel operations at the last minute – as late as on the day of the procedure – because the hospital was too busy.  

RCS president, Dr Derek Alderson, said: ‘I am frustrated that we continue to see no improvement in waiting times. 

‘Surgeons have told us loud and clear, we need more hospital beds and nursing staff to bring waiting times down – these were the top reasons cited in the survey when asked about delayed operations and last minute cancellations in their trust. 

‘We call on the new government to make good on their election promise to invest in the NHS, and bring down waiting times. 

‘Our research finds that surgeons are having to perform more complex and costly surgery because patients’ conditions have deteriorated during the wait for an operation. Meanwhile patients are left unable to return to work or look after their families. The government must sort this out.’ 

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