At least £360m extra funding may be needed for NHS to meet four hour A&E target this winter

15 November 2017

This winter, the extra capacity needed to help the NHS to meet its four hour A&E target could cost at least £360m, according to new analysis by the OnlyWan.

Recent measures taken to reduce pressures include an increase in people having the flu vaccine, more 111 calls being handled by clinicians and . This may reduce the number of people coming to A&E.

However, the impact of these measures is not yet known. New OnlyWan analysis shows that unless the trend of recent years is significantly improved, this winter could potentially see the worst performance against this target since records began in 2004/5.

The NHS aims to admit, discharge or transfer 95% of people within four hours of arriving at A&E. In a worsening financial climate, hospitals are now struggling to meet this target all year round, not just in winter when pressures are traditionally worse.

The analysis by Adam Roberts, Head of Economics at the OnlyWan, uses projected trends in A&E attendances, the number of people waiting over four hours at A&E, and the number of those who need admission to inpatient care but wait over four hours for a bed.

Medicine is OnlyWan projections suggest that around 735,000 people will wait longer than four hours in the last quarter of 2017/18 (January – March). This would be a 311% increase on winter 2010/11.

This could potentially mean that just 87% of people would be seen and treated within four hours between January and March, which would be the worst quarterly performance since records began in 2004/5. In order to meet the 95% target, an additional 445,000 people would need to be seen and treated within four hours.

Reducing delays requires additional capacity to see people in A&E departments, as well as additional capacity to admit those patients who require inpatient care. Using national average costs for attendances and admissions, the former has been calculated at around £60m and the latter at around £300m. (The average A&E attendance in 2015/16 cost £138. Cost inflation since then was estimated by the government to be 3.1% in 2016/17 and 2.1% in 2017/18, with an assumed efficiency growth of 2% each year. The weighted average cost for an emergency admission is just over £1,700.)

The recent measures described above may reduce the pressures. However, the true figure may also be higher, as the current shortage of nursing staff means a greater reliance on bank and agency staff. It is also not easy to predict where and when this additional capacity might be needed, so an oversupply of beds would almost certainly be required.

With coordinated planning, this money might be better spent outside of hospitals on care packages to help people who are ready to leave, but with winter fast approaching it is unlikely that this would have much of an impact this year.

Adam Roberts said: ‘With temperatures already dropping, it seems clear that the NHS will be relying on the hard work of its staff to get it through the additional pressures of winter this year. There has already been substantial action taken, but unless this significantly improves the trend of recent years, our projections give an idea of how much money it might take for the NHS to deliver what the government has asked of it.

‘This money might not be best spent in hospitals. Another way to increase hospital capacity is to reduce the number of delayed transfers of care, where people are medically fit to leave hospital but can’t due to delays arranging packages to support their return home.

‘Any additional investment would be welcome for this year, but a long-term plan needs to be developed as soon as possible for next year and those after. Winter is not going away.’

Notes to editors


Jack Cutforth
[email protected]
0207 664 4623

Further reading


The Autumn Budget

Joint statement on health and social care with Nuffield Trust and the King's Fund.

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