• reduced length of stay in hospital 
• reduced incident severity
• reductions in anxiety and depression. 

The level of these improvements varied across hospitals, as did the type of interventions implemented. The hospitals also had different characteristics and populations which they served.

The study concluded that a negative experience at the initial ED visit may have dual conflicting impacts. It can contribute to patients' perceived need for a return visit because they are ill-equipped to manage their condition at home, and it can also contribute to their initial reluctance to return to the ED when symptoms persist. Nurses and other clinicians working in ED need to actively build patient's experiential trust through clear communication, timely consultation and shared decision-making at discharge, which in turn can increase patient's confidence and capability to self-manage their condition.

• Population changes are contributing to increasing demand for healthcare.
• Demand for unplanned or urgent care is increasing.
• The number of general and acute hospital beds has increased slightly following a downward trend before the Covid-19 pandemic, but occupancy rates have also risen and patients are now staying longer in hospital compared with previous years.
• The number of NHS staff has increased, including those working in unplanned or urgent care.
• he number of staff vacancies across the NHS rose from the start of 2021 but has recently fallen.
• Spending on the NHS continues to increase. The total budget for NHSE in 2022-23 was £152.6 billion, some £28.4 billion more than in 2016-17 at 2022-23 prices.
• Patients’ access to services for unplanned or urgent care has worsened.
• There is considerable variation in service performance and access, both between regions and between different providers.
• Covid-19 had, and continues to have, an adverse impact on the NHS’s capacity to meet healthcare needs.
• The NHS has not met key operational standards for unplanned or urgent care since before the pandemic.
• Performance against operational standards, and more widely, has deteriorated further since the onset of the pandemic.
• Overall performance of the unplanned and urgent care system has been worsened by delays transferring patients from one service to another.
• The NHS has not been able to secure the full benefits of increased spending and staff numbers and productivity has fallen since the onset of the Covid-19 pandemic.
• NHSE has a plan to reduce waiting times and improve patients’ experiences.

• In 2022, 1.65 million people waited 12 hours or more from their time of arrival (TOA) in an ED. This figure is 4.8 times the number of 12-hour Decision to Admit (DTA) waits reported, demonstrating the metric is misleading.
• From April 2023, NHS England will routinely publish 12-hour TOA data, a vital first step toward reducing long and unnecessary waiting times in EDs.
• We must have an accurate picture of these long waiting times, as they can have catastrophic consequences for patient safety and mortality. Using the Standard Mortality Ratio (SMR) and the 12-hour TOA figure, we estimate 23,003 excess patient deaths in 2022 in England were associated with long stays in EDs.
• While we welcome the Government publishing the data, we seek assurance that this data will be published on a monthly basis at ED level, so that hospitals can use this information to improve quality of care and ensure patient safety.