A&E Activity · NHS England annual data · 2025/26

A&E is busier than ever, and slowly getting quicker. One in fourteen still waits twelve hours.

Every year NHS England publishes a record of every A&E visit in the country. The 2025/26 edition came out this week. It shows more visits than ever before, waits that are shortening for the third year running but are still far off target, and 1.8 million visits that lasted more than twelve hours. This is what it says, written for GPs rather than analysts.

By Dr Yogasakaran Arjuna · 27 September 2026 · NHS England Hospital A&E Activity, 2020/21 to 2025/26 · 182 providers · 36 ICBs

01More visits every year

A&E visits have gone up every year since the pandemic. Almost all of the growth is in the smaller urgent care units, not the big emergency departments.

There were 26.6 million A&E visits in the year to March 2026. That is roughly one for every two people in England, though in reality a small number of people make many visits. The rise on the previous year was 3.2%, a little slower than the year before, but the direction has not changed. Split the visits by the kind of department and the story becomes clearer:

Visits to major emergency departments have grown by 6% in four years, from 16.3 million to 17.3 million. Visits to the smaller units have grown by 49% in the same time, from 5.9 million to 8.8 million, and are now a third of all A&E activity. Some of that is new demand. A lot of it is deliberate: many hospitals now put an urgent treatment centre at the front door of the emergency department and count the two separately. Either way, when a patient tells you they “went to A&E”, one time in three they mean a minor injury or urgent treatment unit.

Two slower changes are worth knowing about. The share of visits ending in a hospital admission has fallen from 15.3% to 14.3% in three years, while the share sent to a short-stay or same-day unit instead of a ward rose from 4.1% to 5.1% last year alone. That is hospitals treating more emergencies without admitting anyone overnight. And the share of patients who come back to A&E within a week has crept up every year, from 10.4% in 2020/21 to 11.6% now.

02Waits: better for three years, still far off target

The NHS target is that 95% of patients should be out of A&E within four hours. In 2025/26, 72.5% were.

The share of patients spending more than four hours in A&E peaked at a third in 2022/23 and has fallen every year since, to 27.5%. That is genuine progress, and it has happened everywhere in the country. The interim target for 2025/26 was 78% within four hours; the year as a whole came in about five points short.

The twelve-hour number is the one to worry about. In 2020/21, one visit in fifty lasted more than twelve hours. In 2025/26 it was one in fourteen: 1,835,378 visits, or about 5,000 people a day, spending half a day or more in the department. It has come down slightly from the worst year, but because visits keep rising the actual number of people affected has hardly changed in four years.

The monthly figures show who is and is not benefiting from the improvement. The typical patient (the middle of the range) is being dealt with faster: 177 minutes in 2023/24, 163 minutes in 2025/26, and for patients who end up admitted, down from 332 minutes to 263. But the one-in-twenty longest waits have not improved at all, and every January they get worse:

In March 2026 the typical patient was out in 159 minutes, about two and a half hours. One patient in twenty was still there after 840 minutes, fourteen hours. The January peaks get higher every winter: 1,055 minutes in January 2024, 1,078 in January 2025 and 1,121 in January 2026, which is nearly nineteen hours. A&E is getting quicker for the walking wounded and no quicker at all for the frail, the sick and the stuck, and those are the people on trolleys in corridors.

03The four-hour cliff

The target still shapes what departments do, even where they miss it.

Between two and four hours, each ten-minute block holds a fairly steady 2.5% to 2.9% of patients. The block from three hours fifty-one to four hours holds 4.7%, nearly double. That is 1.25 million patients a year who were discharged, admitted or moved in the ten minutes before the clock ran out. Then more than a quarter of everyone, 7.3 million people, falls off the cliff into the red bar, where the published data no longer tells us whether they waited four hours and one minute or a day and a half.

04Who goes: deprivation doubles the rate

People from the poorest tenth of neighbourhoods make nearly twice as many A&E visits as people from the richest tenth.

The bars fall steadily from 13.4% of visits in the most deprived tenth to 6.9% in the least deprived, and the pattern was identical the year before. Because each group holds a tenth of the population, that is a straight rate ratio of about 1.9 to one. It varies hugely by place: over half of the Black Country’s A&E visits and of Birmingham and Solihull’s come from the poorest fifth of England, and nearly half of Greater Manchester’s; in Thames Valley it is 4%. Any comparison of A&E use between practices that does not start with deprivation is not worth having.

By age there are fewer surprises. Children under 15 make 19.4% of visits and people aged 70 and over 18.2%, both roughly their share of the population, though the over-70s are far more likely to arrive by ambulance and to be admitted. One trend is going the wrong way: the share of patients triaged as “non-urgent” rose from 7.9% to 8.9% in a single year, while the sickest patients (resuscitation and very urgent) stayed flat at 9.1%.

05How they get there: two in three just turn up

Only one visit in ten came via a GP, an out-of-hours service or NHS 111.

Of the 26.6 million visits, 66.1% were recorded as people turning up on their own, down a fraction from 66.8%. The ambulance service referred 9.6%, and 17.3% of patients actually arrived in an ambulance. NHS 111 sent 5.9% and GPs or other members of the practice team 5.1%, both up a tenth of a point on the year. Out-of-hours services sent 0.5%, and pharmacists, dentists and opticians together 0.3%. Whatever the policy says about steering urgent demand through 111 and general practice, the front door is still where most people go first.

The timing is as predictable as it has always been. The busiest hour of the day is 11am, Monday is the busiest day (16.0% of the week’s visits, against 13.1% on a Saturday), and 32% of visits arrive outside 8am to 6.30pm. Put the other way round, two in three arrive during hours when a practice could in principle have seen the patient. Whether it could have done in practice is a different question.

06What they come with, and what they leave with

Tummy pain and chest pain top the list. The commonest diagnosis on leaving is that nothing was found.

Where a presenting complaint was recorded, the top five were abdominal pain (6.4% of all visits), chest pain (5.6%), breathlessness (about 5% counting both ways it is coded), head injury (2.9%) and fever (2.6%). Cough fell from 1.7% to 1.2% of visits, which is last winter’s viruses dropping out. The single commonest diagnosis on leaving, one visit in eleven (8.8%), is “no abnormality detected”, and another 2.0% is “patient walked out”. Upper and lower respiratory infections, sprained ankles, urine infections, cellulitis and tonsillitis fill out the top ten. Much of that could be seen in general practice, if general practice were open and reachable at the moment it was needed.

07Your area versus the rest: a twenty-point gap

England is divided into 36 integrated care boards (ICBs), the NHS bodies that plan and pay for care in each area. Twenty percentage points separate the best from the worst on the four-hour measure.

Kent and Medway (19.7%), Cornwall and the Isles of Scilly (21.2%) and West and North London (21.5%) do best. Kent and Medway admits only 9.5% of its patients, which suggests a lot of its activity is minor-injury work, but it also has the shortest typical time in the country at 142 minutes. At the bottom, Shropshire, Telford and Wrekin (39.5%), Herefordshire and Worcestershire (38.3%) and Bath and North East Somerset, Swindon and Wiltshire (35.5%) keep more than a third of patients over four hours. The twelve-hour figures pull the areas even further apart:

In Shropshire, Telford and Wrekin, 15.0% of visits, one in seven, lasted more than twelve hours. In Somerset it was 2.4% and in North East and North Cumbria 2.9%. That is not a difference in patients. It is a difference in how quickly patients can leave the department, which means beds, discharges and social care. The share of patients who give up and leave before being seen tells the same story from the waiting room: 10.8% in Leicester, Leicestershire and Rutland and around 7.6% in Lincolnshire and Shropshire, against 1.8% in Somerset.

The good news is that the areas that were furthest behind two years ago have improved the most:

Leicester, Leicestershire and Rutland has cut its over-four-hour share by sixteen points in two years, North East London by fourteen and Thames Valley by eleven. (A few areas, Dorset and Nottinghamshire among them, look as if they have got much worse since 2023/24. Their 2023/24 figures were implausibly low because some hospitals were not reporting properly then, so those are reporting changes rather than real deteriorations, and one reason this analysis leans on the latest year.) For local readers: West and North London is third best of the 36 on the four-hour measure, with 2.07 million visits, 5.1% over twelve hours and a typical stay of 162 minutes.

08Individual hospitals: the same story, wider still

Of the 123 hospital trusts with a major emergency department and at least 20,000 visits a year, thirty kept more than one patient in ten for over twelve hours.

At the top of the table, Northumbria Healthcare had 10.7% of patients over four hours and just 0.3% over twelve, on 282,000 visits; Calderdale and Huddersfield and North Tees and Hartlepool were both at 16.9% over four hours. At the bottom, Blackpool Teaching Hospitals had 63.6% of patients over four hours and 26.7% over twelve; Wirral University Teaching Hospital 53.7% and 22.1%; Hull University Teaching Hospitals 50.8% and 12.4%. Those are not small differences. A patient walking into Blackpool’s emergency department last year had a one-in-four chance of still being there twelve hours later. The biggest trusts sit in the middle of the table: Manchester University (536,000 visits), Royal Free London (507,000, which now includes North Middlesex) and University Hospitals Birmingham (437,000).

09What this means for your practice