Overview

Why we carried out this assessment

1.1 The performance of the National Health Service in England (NHS England) is a hugely topical issue, often covered in public and political discourse. Individuals and organisations want to hold the UK Government to account against its commitments, understand what level of service can be expected in local areas and understand how performance compares against other countries.

1.2 At the Office for Statistics Regulation (OSR), we champion the effective communication of statistics which support society’s key information needs. Given the high public interest in NHS performance, we welcomed the request by NHS England to assess its statistics about accident and emergency (A&E) activity. We agreed with NHS England that the high profile nature of these statistics, as well as ongoing data developments, presented a good opportunity for OSR to provide feedback on the statistics and assess their compliance with the Code of Practice for Statistics. In requesting this assessment, the team has demonstrated its commitment to produce statistics that meet the standards required of accredited official statistics and the Code of Practice for Statistics.

A&E statistics in England

1.3 NHS England publishes statistics on A&E activity in England in three separate releases. This assessment considered all three outputs:

• A&E Attendances and Emergency Admissions
• Provisional Accident and Emergency Quality Indicators for England
• Hospital Accident and Emergency Activity

1.4 The first release (A&E Attendances and Emergency Admissions) is published monthly. It provides information at NHS Trust level in England on the number of attendances to A&E units and how many of these were discharged, admitted, or transferred within four hours (the operational standard for A&E waiting times in England is that 95% of patients should be admitted, transferred, or discharged within four hours of arrival). The statistics are produced from the Monthly Trust Situation Reports (MSitAE) – an aggregated data collection submitted to NHS England by NHS Trusts each month. In April 2023, NHS England started publishing monthly information on the number of attendances discharged, admitted, or transferred within 12 hours. These new statistics are produced using a different source – the Emergency Care Data Set (ECDS), which is a record-level data set.

1.5 The second release (Provisional A&E Quality Indicators) is also published monthly and provides information on total attendances, time to assessment, time to treatment and unplanned reattendances. The statistics are sourced from the ECDS.

1.6 The third release (Hospital A&E Activity) is published annually and provides analysis of attendances and waiting times by patient demographics, as well as comparisons of 4 and 12-hour waits between the four UK nations. The statistics are sourced from both the monthly aggregated data and the ECDS.

Our approach to the assessment

1.7 This assessment was conducted between June and September 2023. We reviewed published information about the statistics, as well as supplementary evidence provided to us by NHS England, such as internal work programmes and guidance.

1.8 An important part of the assessment process involved us talking to people who use the statistics, so that we could understand the current value of the statistics, and where there is the potential to increase this value. Users we engaged with included government analysts, health think tanks and unions, Royal Colleges, journalists, parliamentary researchers, and members of the public. We would like to thank everyone who gave their time to speak with us.

1.9 We have identified six actions for NHS England to fulfil in order for the statistics to become accredited official statistics (called National Statistics in the Statistics and Registration Service Act 2007). NHS England should aim to achieve this by July 2024. Once NHS England demonstrates that these steps have been undertaken, OSR will recommend that the UK Statistics Authority confirm the accredited official statistics status.