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Attendance rates at major A&E departments highest in London

January 28, 2014: New figures for 2012-13 show attendance rates per 1,000 population at major (Type 1) Accident and Emergency departments were highest in the London region and lowest in the South Central region.

*HSCIC must be quoted as the source of these figures

*Regional figures are available

*Attached: map showing rates of attendance at major A&E departments by Primary Care Trust of residence

This follows on from the 'Focus on A&E' report published by the Health and Social Care Information Centre (HSCIC) in December4, which gave a national picture of the patient journey through A&E. Today's report shows further information as well as regional figures.

The regions with the highest rates of major unit A&E attendance per 1,000 of the population5 were London Strategic Health Authority (SHA) with 312 A&E attendances per 1,000 (2.6 million attendances overall) and North West SHA with 307 per 1,000 (2.2 million attendances).

The lowest rates of attendance at major A&E departments were in South Central SHA (189 per 1,000 of the population or 790,200 attendances) and South West SHA (210 per 1,000 of the population or 1.1 million attendances).

Today's report also shows that GP referrals accounted for 5.8 per cent of attendances at major A&E departments overall (825,400). Regionally the highest percentage of GP referrals was for patients resident in the South West SHA (8.4 per cent or 94,000), while the lowest was for patients resident in the North West SHA (4.4 per cent or 96,400).

Finalised national information also shows shows that for A&E departments nationally in 2012-13:

  • There were 18.3 million attendances at A&E departments recorded in Hospital Episode Statistics (HES) data between April 2012 and March 2013, a 4.0 per cent increase on attendances in 2011-12 (17.6 million).8
  • Major A&E departments dealt with 14.3 million attendances, a rise of 340,500 attendances (2.4 per cent) on 14.0 million attendances in 2011-12.8
  • Almost three out of ten attendees at major departments arrived by ambulance (29.7 per cent). Elderly patients were much more likely to arrive by ambulance; this equated to six out of ten 65+ year olds (63.1 per cent or 1.9 million) and eight out of ten 85+ year olds (82.0 per cent or 664,900).

HSCIC Chair Kingsley Manning said: "The scale of the variation in A&E attendances reported in this publication is striking.  Policy makers and system managers will want to look at the implications of this analysis for the future management and disposition of A&E services."

pdf icon Rate of A&E type 1 attendance during 2012-13 by PCT of residence per 1,000 population [104kb]

Read the full report


Notes to editors

1. The Health and Social Care Information Centre (HSCIC) was established on April 1 2013 as an Executive Non Departmental Public Body (ENDPB). It is England's trusted data source, delivering high quality information and IT systems to drive better patient services, care and outcomes. Its work includes publishing more than 220 statistical publications annually; providing a range of specialist data services; managing informatics projects and programmes and developing and assuring national systems against appropriate contractual, clinical safety and information standards.

2. Hospital Episode Statistics (HES) are compiled from data sent by more than 300 NHS trusts and primary care trusts (PCTs) in England and from approximately 200 independent sector organisations for activity commissioned by the English NHS. The HSCIC liaises closely with these organisations to encourage submission of complete and valid data and seeks to minimise inaccuracies. While this brings about improvement over time, some shortcomings remain. Figures refer to recorded attendances and are reliant upon the accurate and complete recording of cause of attendance at Accident and Emergency. Submissions from the independent sector in particular have improved significantly in recent years.

3. Type 1 A&E department (Major A&E)
A consultant led 24 hour service with full resuscitation facilities and designated accommodation for the reception of accident and emergency patients

Type 2 A&E department (Single Specialty)
A consultant led single specialty accident and emergency service (e.g. ophthalmology, dental) with designated accommodation for the reception of patients

Type 3 A&E department (Other A&E / Minor Injury Unit)
Other type of A&E/minor injury units (MIUs)/Walk-in Centres (WiCs), primarily designed for the receiving of accident and emergency patients. A type 3 department may be doctor led or nurse led. It may be co-located with a major A&E or sited in the community. A defining characteristic of a service qualifying as a type 3 department is that it treats at least minor injuries and illnesses (sprains for example) and can be routinely accessed without appointment. An appointment based service (for example an outpatient clinic) or one mainly or entirely accessed via telephone or other referral (for example most out of hours services), or a dedicated primary care service (such as GP practice or GP-led health centre) is not a type 3 A&E service even though it may treat a number of patients with minor illness or injury.

4. 'Focus on Accident and Emergency' was published in December 2013 at:

5. Rates per 1,000 of the resident population have been rounded to the nearest whole number. Please note that owing to data availability 2011 mid-year population estimates have been used for Strategic Health Authorities rates and 2012 mid-year population esimates have been used for Primary Care Trusts rates.

6. Attendances at A&E that were recorded as 'unknown' refers to A&E attendances where the A&E department type was not known.

7. NHS England publish weekly aggregate A&E activity data and are the official source of A&E activity data in England - NHS England data does not include planned A&E attendances so these attendances are excluded from HES when comparing the activity reported to both.

8. The HES data for all attendances is known to be incomplete compared to NHS England's Weekly A&E aggregate data7 which recorded 21.7 million attendances in 2012-13. However, the recording of HES on attendances to major A&E departments is believed to be complete.

9. Figures over 1 million have been rounded to the nearest 100,000, figures over 10,000 have been rounded to the nearest 100, and figures under 10,000 have been rounded to the nearest 10.

10. For media enquiries please contact or 0300 303 3888

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