National Audit Office: Managing the flow of patients through hospital from A&E (9 September 2026)

Summary

NHS England has made efforts and has targeted funding towards improving A&E waiting times and patient flow through hospitals, but this growth in spending has not been matched with proportionate improvements for patients, a new report from the National Audit Office (NAO) has found.

Content

Findings

• Crowding in A&E has increased in the last 14 years, making it harder for patients to flow through hospital as normal. The annual numbers of A&E attendances have increased by 6.5 million since 2011-12, and in May 2026, during any 24-hour period in England, there was an average of 2,241 patients waiting in corridors in A&E, and 669 patients waiting in corridors in hospital wards. Costs per A&E attendance have increased by a third to £280 per patient in 2024-25, compared with 2018-19.

• Although there has been an increase in A&E resources, including the number of staff, this has not correlated to a proportionate improvement in performance, suggesting that other factors such as bed occupancy may be limiting progress.

• The wider patient flow through a hospital can affect how quickly patients are admitted from A&E to a hospital bed, as when bottlenecks or blockages occur, patients can face delays. The number of patients requiring admission from A&E to a bed in a hospital ward has increased by over a million since 2011-12.

• Delayed discharge from hospital can also slow patient flow, with 14.2% of hospital stays involving a delayed discharge in 2025-26. These can be caused by delays from within the hospital such as arranging ‘take-home’ medicine or from outside the hospital, for example, capacity in care homes. Age UK has highlighted how delayed discharge disproportionately affects older people and patients living with frailty. NHSE estimates that delayed discharge has cost an estimated £2 billion between August 2025 and April 2026.

• The NHS constitution includes a maximum four-hour waiting time, aiming to have 95% of patients discharged, transferred or admitted within that time. This target has not been met since 2013-14, but there has been a gradual improvement since 2022-23.

• The percentage of people waiting 12 or more hours in A&E has tripled since before the COVID-19 pandemic, with ONS analysis suggesting that people who wait 12 or more hours in A&E are twice as likely to die within 30 days of leaving A&E , compared with those who wait two hours.

To help improve patient flow through hospital, and therefore A&E services, the NAO recommends that NHS England and the Department of Health and Social Care:

• Identify and spread successful approaches from high performing trusts, using oversight powers to support improvement in all hospitals.

• Support trusts to more consistently use end-to-end hospital flow management tools and reduce discharge delays caused from within hospitals, as well as improving coordination between hospitals, community services and social care.

• Include patient experience within routine performance monitoring, for example through patient feedback on timeliness and quality of care.

• Support trusts to better understand the relationship between costs, performance, patient numbers and acuity of cases.