Trends in NHS urgent and emergency care activity: as at March 2023
Report summarising data on activity and performance in NHS urgent and emergency care, including ambulance services, emergency departments and the NHS 111 service, as at March 2023.
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In this page
Introduction
This statistical release provides a summary of unscheduled care activity carried out by the NHS in Wales. The statistics presented within this release cover calls made to the 111 service, ambulance service activity and attendances at emergency departments. Unscheduled care covers the services offered for conditions/ailments which cannot reasonably be foreseen or planned for. These services are available 24 hours a day.
Performance targets associated with urgent and emergency care are monitored in the monthly NHS activity and performance summary and are not reported here. This publication focuses on longer term trends. A similar report on planned care – NHS waiting lists, inpatient activity, outpatient referrals & activity, diagnostic and therapy waits, NHS beds and cancer services – has also been produced and is published separately.
The data sources used in this release cover different time periods and in all cases the full available time series has been used.
Data for each topic area are also available in more detail on our StatsWales website.
Main points
- Over the long term, ambulance and emergency department activity has increased significantly and at a far greater rate than the corresponding increase in Wales’ population.
- Calls to the ambulance service more than doubled between 1991/92 and 2017/18 and have since fluctuated. The last two years have seen the highest figure on record followed by the lowest since 2013-14.
- The number of urgent ‘red’ calls has more than doubled in the last five years partly reflecting changes in how some calls are categorised and a large increase in respiratory conditions in the latest winter.
- There is a clear relationship between the volume of red calls and response times, with both increasing in recent years.
- At a Local Health Board level, the highest number of red calls per 10,000 population in the last few years are seen in Swansea Bay and Cwm Taf Morgannwg, and the longest median response times are generally in Powys and Hywel Dda.
- Ambulance handover delays have increased significantly in the last two years. In 2022-23, almost 300,000 hours were lost to handover delays at emergency departments.
- There were over one million attendances at emergency departments in the latest year, more than five times as many as in 1951. Attendances have levelled off somewhat in the last 15 years after a consistent increase over the previous 50 years.
- Emergency department attendances are higher in the summer than in winter, with more occurring on Mondays than any other day of the week. There are many more attendances during daylight hours than at night, though waits are shortest during the day.
- Median waiting times in emergency departments have increased slowly over the past decade. After reaching record highs following the COVID-19 pandemic they have since fallen back towards pre-pandemic levels.
- Patients over age 85 are the most likely to attend emergency departments and they also experience the longest waits on average.
Calls to the ambulance service
Historically, there have been different emergency services call classifications. Figure 2 is based on:
- Emergency calls and GP urgent patient journeys from 1991-92 to 1998-99
- Category A, Category B and GP urgent journeys from 1999-2000 until November 2011
- Category A, Category C and Category C (HCP) from December 2011 until September 2015
- Red, amber and green calls from October 2015 to date
Figure 1: Calls to the ambulance service, 1991-92 onwards
Description of Figure 1: A line chart showing the number of calls made to the ambulance service from 1991-92 to 2022-23. There was a consistent upwards trend until around 2017-18, and a fluctuating but broadly flat series since.
Source: Welsh Ambulance Services NHS Trust
Emergency ambulance calls and responses, by local health board and month, on StatsWales
The data in Figure 2 have been combined to present a time series on as comparable a basis as possible.
The number of calls made to the ambulance service increased over the long term to a record high of 481,000 in 2021-22, more than twice the amount received in 1991-92. The trend levelled off from 2017-18 and there was significant fall in 2020-21 during the height of the COVID-19 pandemic. The last two years have seen the highest figure on record (481,000) followed by the lowest since 2013-14 (432,000).
Figure 2: Average daily ambulance calls, by call type and month, April 2016 onwards, [Note 1]
Description of Figure 2: A line chart showing the number of red emergency calls has doubled in the last few years, while green calls have halved. Amber calls account for the majority of all calls and have been relatively stable.
Source: Welsh Ambulance Services NHS Trust
Emergency ambulance calls and responses, by local health board and month, on StatsWales
[Note 1]: An update to call handling in May 2019 resulted in a change to red incident volume. Direct comparisons should not be made before and after this date. Further details are available in our NHS activity and performance summary quality report.
Since 2015 calls to the ambulance service have been categorised as red (immediately life-threatening), amber (serious but not life-threatening) or green (non-urgent).
The number of red calls has increased significantly in the last few years, while amber calls have fluctuated. Green calls have fallen from over 400 per day in 2016-17 to less than 200 recently.
Red calls have accounted for an increasing proportion of all calls over recent years, 11.3% in the latest year compared with 4.5% in 2016-17. The increase at least partially reflects two things: changes in how some calls are handled, as some calls that used to be categorised as amber are now categorised as red; and a large increase in respiratory conditions in the latest winter. The ageing population may also be relevant to a longer term increase in demand for emergency care.
Figure 3: Average red calls per day and median red call response times, 2016-17 to 2022-23
Description of Figure 3: A line chart showing similar trends in the number of red emergency calls received and the median response time, with increases in both in recent years
Source: Welsh Ambulance Services NHS Trust
Emergency ambulance calls and responses, by local health board and month, on StatsWales
The average number of red calls per day and median response time for red calls have increased since 2016-17, with a clear relationship between call volume and response times. In December 2022 a record high was reached for both the number of average red calls per day (192) and median waiting time for red calls (10 minutes). In the latest year there were an average of 134 red calls per day, an increase of 139% since 2017-18 (56 per day).
In the latest year the overall median response time for red calls was 8 minutes and 9 seconds, an increase of 66.2% since 2016-17 (4 minutes and 54 seconds).
Figure 4: Lost hours for the ambulance service following notification to handover at emergency departments, 2017-18 to 2022-23 [Note 1]
Description of Figure 4: A line chart showing the number of lost hours for the ambulance service following notification to handover at emergency departments. The chart shows an increase in the trend for lost hours following the pandemic, when they had fallen to their lowest.
Source: Welsh Ambulance Services NHS Trust (WAST)
[Note 1] Only waits longer than 15 minutes are counted within the lost hours.
Other than the increased demand, ambulance response can also be affected by handover delays at hospitals, when ambulance crews are unable to respond to new calls while waiting to handover patients to emergency departments.
There has been a significant increase in handover delays in recent years, with more than five times as many hours lost in 2022-23 compared with 2016-17. Further data on handover delays can be found on the Emergency Ambulance Services Committee’s (EASC) Ambulance Service Indicators dashboard.
In 2022-23, almost 300,000 hours were lost by the ambulance service following notification to handover at emergency departments, the highest per year on record.
December 2022-23, saw the highest monthly hours lost (32,000), May 2020 saw the fewest (1,900).
Figure 5: Average amber calls per day and median amber call response times, 2016-17 to 2022-23
Description of Figure 5: A line chart showing the average number of amber (serious but not life-threatening) emergency calls received by the ambulance services per day and the median response time. The chart shows an increasing trend for amber median waiting times but a decreasing trend for the average number of amber calls per day.
Source: Welsh Ambulance Services NHS Trust
Emergency ambulance calls and responses, by local health board and month, on StatsWales
In December 2022 the amber median waiting time calls reached a record high of 3 hours 29 minutes, though the number of amber calls did not greatly increase. This reflects the fact that red calls reached a record high, and since they are prioritised for ambulance response, this reduced the resources available to respond to amber calls. In January 2023 the average number of amber calls per day fell to the lowest on record (713 calls) and the median waiting time also fell to 53 minutes and 28 seconds, the lowest since May 2021.
Figure 6: Red calls per 10,000 population by local health board, 2016-17 to 2022-23
Description of Figure 6: line charts showing yearly increases in red calls per 10,000 population in local health boards since 2016-17, with the exception of 2020-21.
Source: Welsh Ambulance Services NHS Trust
Emergency ambulance calls and responses, by local health board and month, on StatsWales
There was a step change between 2021-22 and 2022-23, with record numbers of red calls per 10,000 population set across all health boards in 2022-23. At the Wales level, this meant there were 196 calls per 10,000 population, almost three times as high as 2016-17 (65.9). As described above, this at least partially reflects changes in how calls are handled, with some calls that used to be categorised as amber now categorised as red. The highest rates of red calls per 10,000 in recent years have been in Swansea Bay and Cwm Taf Morgannwg. These are known to have at least slightly higher levels of deprivation than the Wales average, and deprivation is known to be linked to health in general and the likelihood of requiring emergency care. In the latest year Swansea Bay had the highest number of red calls per 10,000 population (210.4) and Powys had the fewest (169.7).
For amber calls, record numbers per 10,000 population were set across most health boards in 2022-23. There were 1,233 calls per 10,000 population across Wales, 25 per cent higher than in 2016-17. Betsi Cadwaladr had the highest number of amber calls per 10,000 population with 1,434 calls and Cwm Taf Morgannwg had the fewest with 1,095.
Ambulance calls categorised as green are assessed as being non-urgent. For Wales as a whole the lowest number of green calls per 10,000 population was in the latest year, with 295 calls, 38.1% lower than in 2016-17. Aneurin Bevan had the highest number of green calls per 10,000 population (362 calls) in 2022-23 and Cwm Taf Morgannwg had the fewest, at 233 calls.
Figure 7: Median response time to red calls by local health board, 2016-17 to 2022-23
Description of Figure 7: line charts showing increasing trends in median waiting times for red calls across all health boards in Wales.
Source: Welsh Ambulance Services NHS Trust (WAST)
Emergency ambulance calls and responses, by local health board and month, on StatsWales
For Wales as a whole, the longest median waiting time was set in December 2022 at 10 minutes. This was 5 minutes and 45 seconds longer than the shortest median waiting time in May 2017. At health board level, the longest median waits in recent years have generally been seen in Powys and Hywel Dda, and the lowest in Cardiff and Vale and Aneurin Bevan.
Emergency departments
Figure 8: Attendances at emergency departments, 1959 onwards [Note 1]
Description of Figure 8: A line chart showing an upward trend in attendances to emergency departments in Wales from 1959 to 2022-23. There was a sharp drop in 2020-21, corresponding with the COVID-19 pandemic. The trend has levelled off slightly since 2005-06 , climbing at a slower rate than in previous decades.
Source: QueSt 1 (QS1) and Emergency Department Data Set (EDDS), DHCW
Attendances in NHS Wales emergency departments, on StatsWales
[Note 1] these figures are based on different data sources from 1959 to 2009-10 and 2007-08 to 2022-23. Where they overlap the figures are close, meaning the data can be regarded as broadly comparable. From 1959 to 1983 the data were collected by calendar year, and from 1983-84 they were on the basis of financial years.
In 2022-23 there were over one million attendances at emergency departments across Wales. This was up 3% on the previous year and five times higher than the level seen in 1959. However, attendances in 2022-23 were 1% lower than the high point in 2018-19.
Figure 9: Emergency department attendances per 10,000 population by health board and month, 2012-1 to 2021-22
Description of Figure 9: line charts showing annual attendances at emergency departments have been relatively stable over the last decade in most Welsh health boards.
Source: Emergency Department Data Set (EDDS), DHCW
Attendances in NHS Wales emergency departments, on StatsWales
In 2022-23 the highest level of attendances was set with 3,353 attendances per 10,000 population for Wales as a whole. Most health boards in Wales saw their highest or close to their highest level of attendances in 2022-23. The highest attendance per 10,000 population was seen in Hywel Dda (4,301) in 2022-23 and the lowest was in Powys (1,047).
Figure 10: Attendances at emergency departments by type of department, 2006 onwards [Note 1]
Description of Figure 10: A line chart showing attendances at major and other / minor emergency departments from June 2006. The data show strong seasonality, with more attendances in the summer months and fewer in the winter months, though with no discernible long term trend.
Source: Situational reports (SITREPS), Emergency Department Data Set (EDDS), DHCW
Attendances in NHS Wales emergency departments, on StatsWales
[Note 1] From June 2006 to March 2010 emergency department data was collected via weekly SITREPS submissions. Between April 2010 and March 2012, major emergency departments submitted monthly data to the EDDS whilst minor emergency department data continued to be sourced from SITREPS. From April 2012, all data is sourced from the EDDS.
The majority of attendances are at major emergency departments. Over the long term there has been relatively little change in the number of attendances at major emergency departments or other and minor emergency departments. The higher number of attendances in summer compared with winter reflects the fact that people are generally more active in the lighter, warmer months of the year, and particularly during school holidays.
Figure 11: Monthly emergency department attendances and median waiting time to be admitted, transferred or discharged, April 2012 onwards
Description of Figure 11: a line chart showing emergency department attendances have been relatively stable over the long term, though with strong seasonality, with more in the summer months and fewer in the winter. Median waiting times have generally increased.
Source: Emergency Department Data Set (EDDS), DHCW
Attendances in NHS Wales emergency departments, on StatsWales
Prior to the COVID-19 pandemic, the median waiting time for patients to be admitted, transferred or discharged was on a slight upward trend. The relationship between the volume of attendances and waiting times has become less stable since 2020-21, with median waiting times increasing to the longest recorded despite attendances not yet reaching pre-pandemic levels.. In March 2022, a record longest median wait was set at 3 hours and 8 minutes.
Figure 12: Attendance rates at emergency departments by age, 2022-23
Description of Figure 12: a bar chart showing attendance rates at emergency departments were highest for the 85+ age group, at over 6,400 per 10,000 population in 2022-23.
Source: Emergency Department Data Set (EDDS), DHCW
Attendances in NHS Wales emergency departments, on StatsWales
The lowest rate of attendances per 10,000 population was for the 25-74 group (2,844). There is little difference when looking at gender for rates of attendance (Number of attendances in NHS Wales emergency departments by age band, sex and site on StatsWales).
Figure 13: Median waiting time to be admitted, transferred or discharged by age group 85+ and all ages, April 2012 to March 2023
Description of Figure 13: a line chart showing attendances and median waiting times to be admitted, transferred or discharged by the age group 85+ and all ages. Waits are longer than the overall Wales average in the 85+ age group.
Source: Emergency Department Data Set (EDDS), DHCW
Attendances in NHS Wales emergency departments, on StatsWales
Note: Invalid ages excluded
The longest median waiting times to admission, transfer or discharge following arrival at emergency departments are seen in the 85+ age group. This has consistently been the case over the last decade but has become more pronounced in the last few years. This reached a record high in February 2022 of 8 hours and 21 minutes. Long term trends have been similar across most age groups with a gradual increase in median waiting times, though the waiting times in the 5-17 age group were relatively stable.
Figure 14: Emergency department attendances per 10,000 population by time of day and age band, 2022-23
Description of Figure 14: a line chart showing attendance rates peak around midday for those aged over 18, and between midday and 10pm for the 0 to 17 age group. Attendances are higher on weekdays than weekends for all age groups. Monday sees the most attendances attendances falling gradually during the week.
Source: Emergency Department Data Set (EDDS), DHCW
Attendances in NHS Wales emergency departments, on StatsWales
Higher attendances on Mondays reflects patients needing care for issues that occurred or worsened over the weekend. In the younger age group (under 18), attendances have a less pronounced peak in day time but peak in the evening hours during the week.
Figure 15: Heat map of attendances at emergency departments by day and time of arrival, 2022-23
Description of Figure 15: a heat map showing most attendances at emergency departments are during daylight hours, with much less activity night. The most common time for arrival at is Monday morning between 9am to 12 noon. The higher attendances during daylight hours reflects the fact that people are generally more active and at risk of injury while awake and going about their day to day activities.
Source: Emergency Department Data Set (EDDS), DHCW
Figure 16: Heat map of median waits at emergency departments by day and time of arrival, 2022-23
Description of Figure 16: a heat map showing median times spent in emergency departments are shortest during daylight hours, despite the higher number of attendances, and longest during the early hours of the morning.
Source: Emergency Department Data Set (EDDS), DHCW
The fact that daytime waits are shorter than at night likely reflects staffing levels throughout the course of the day. The shortest waits of all were seen on weekdays between 8am and 10am, where median waits were less than 1 hour and 55 minutes. Waiting times for patients arriving between 3am and 4am on some days were over 5 hours and 59 minutes.
Calls to the NHS 111 Wales service
Prior to the COVID-19 pandemic Welsh Government published data on calls to NHS Direct Wales (StatsWales). Over a period of years NHS Direct has been phased out across health boards and replaced by the NHS 111 Wales service.
As of mid-March 2022, all health boards had implemented the 111 system and data was first published from April 2022.
Figure 17: Calls made to the NHS 111 Wales service, April 2022 to March 2023
Description of Figure 17: A line chart showing the number of calls made to the NHS 111 Wales service between April 2022 and March 2023. The trend has been relatively stable, with the exception of December 22 where there was a significant peak.
Source: Welsh Ambulance Services NHS Trust (WAST)
Calls offered, answered and abandoned for the NHS 111 service in Wales on StatsWales
Calls made to the NHS 111 Wales service were fairly stable over the 2022-23 financial year, with the exception of December 2022 when 138,000 calls were made. This high level of demand contributed to the Welsh Ambulance Service declaring a ‘business continuity incident’ across the 999 and 111 services. The fewest calls were made in February 2023 (68,000 calls).
Quality and methodology information
Further quality and methodology information relevant to this statistical release can be found in the NHS activity and performance summary quality report.
Well-being of Future Generations Act (WFG)
The Well-being of Future Generations Act 2015 is about improving the social, economic, environmental and cultural wellbeing of Wales. The Act puts in place seven wellbeing goals for Wales. These are for a more equal, prosperous, resilient, healthier and globally responsible Wales, with cohesive communities and a vibrant culture and thriving Welsh language. Under section (10)(1) of the Act, the Welsh Ministers must (a) publish indicators (“national indicators”) that must be applied for the purpose of measuring progress towards the achievement of the wellbeing goals, and (b) lay a copy of the national indicators before Senedd Cymru. Under section 10(8) of the Well-being of Future Generations Act, where the Welsh Ministers revise the national indicators, they must as soon as reasonably practicable (a) publish the indicators as revised and (b) lay a copy of them before the Senedd. These national indicators were laid before the Senedd in 2021. The indicators laid on 14 December 2021 replace the set laid on 16 March 2016.
Information on the indicators, along with narratives for each of the well-being goals and associated technical information is available in the Well-being of Wales report.
Further information on the Well-being of Future Generations (Wales) Act 2015.
The statistics included in this release could also provide supporting narrative to the national indicators and be used by public services boards in relation to their local well-being assessments and local well-being plans.
We want your feedback
We welcome any feedback on any aspect of these statistics which can be provided by email to stats.healthinfo@gov.wales.
