A new report notes small improvements in A&E performance with slow progress in reducing waiting times, with many of the expected benefits of NHSE's 2023 recovery plan not realised.

Gareth Davies, head of the NAO, said: ‘Despite significant efforts to improve A&E performance, patients continue to experience long waits and delays in care. NHS England and DHSC need to understand more fully why improvements have been slow and ensure successful approaches are adopted more consistently across the system.'

Costs per patient for a single attendance to A&E increased by a third between 2024-25 and 2018-19.

While the four-hour NHS constitution target of 95% of patients being discharged, transferred or admitted not being met since 2013-14, there has been a gradual improvement since 2022-23 with performance worst in Type 1, severe cases.

The number of patients requiring admission from A&E to a bed in a hospital ward increased by over a million since 2011-12.

Delayed discharge cost an estimated £2bn between August 2025 and April 2026 affecting 14.2% of patients in 2025-26.

NHSE allocated £1.6bn to ICB's and local authorities in 2023-24 and 2024-25 through the discharge fund to help reduce delayed discharge.

The NAO recommends NHSE and DHSC:

• 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 co-ordination 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.

Reaction

Chief executive of the NHS Alliance, Sir Ciarán Devane, said: ‘While long waits for care are most visible inside hospitals, many of the solutions lie in the community.

‘They include improved access to GPs and their teams, ambulance crews treating more patients on the scene, and better co-ordination with social care to speed up discharges.

‘Steps like these can reduce the logjam in hospitals, or prevent the need for a visit to A&E in the first place.'

Siva Anandaciva, director of policy, events and partnerships at The King's Fund, said: 'Tackling A&E successfully will involve thinking about the health and care system in the round and ensuring that it is set up to deal with not only peaks of sudden demand but also to prevent rising levels of poor health across the country that leads to the steep increases in demand in the first place. When it came into power the Government promised a ‘prevention revolution' to improve the health of the nation and a more joined-up approach to solving problems that span different parts of Government. Reigniting this ‘health mission' approach could be an important step in both resetting the health of the nation and improving patient's experience of A&E care.'

A&E, Tim Gardner, deputy director of policy at The Health Foundation, said: ‘There are no quick fixes. Sustainable improvement will depend on tackling the underlying drivers of poor performance – including strengthening operational management and capital investment, addressing workforce pressures and boosting the capacity of community-based services outside of hospitals. It will also require stability and sustained long-term focus, at a time when the NHS is facing yet another disruptive structural reorganisation.'

 An NHS spokesperson said: ‘The National Audit Office report recognises that A&E waiting times are improving despite staff seeing more patients than at any point in NHS history, alongside challenges with discharging patients to the most appropriate setting.

‘The number of patients seen, treated or discharged from A&E within four hours hit a seven-year high last year, patient satisfaction with NHS services including A&E is rising and we are delivering more service in the community with a record number of GP appointments delivered – but we know there is more to be done, which is why we are sharing successes across the health service so the most challenged A&Es can match the best-performing departments.'