A&E attendances in England at record low in face of Covid-19

Coronavirus | Published:

Figures show attendances were down 57% in April compared with the same month a year ago.

A&E attendances in England have fallen to their lowest figure on record

A&E attendances and emergency admissions to hospitals in England have fallen to their lowest figure on record in the face of coronavirus.

Data published by NHS England shows 0.9 million A&E attendances were recorded in April 2020, down 57% from 2.1 million in April 2019.

The number is the lowest for any calendar month since current records began in August 2010.

HEALTH Coronavirus Hospitals
(PA Graphics)

NHS England, which published the figures, said the fall was “likely to be a result of the Covid-19 response” – an indication that people have been staying away from A&E departments because of the coronavirus outbreak.

Emergency admissions to A&E departments at hospitals in England also showed a sharp fall last month, down 39% from 535,226 in April 2019 to 326,581 in April 2020.

This is the lowest number reported for any calendar month since current records began.

NHS England again said this was likely to be a consequence of the coronavirus outbreak.


Data on all cancer referrals also showed a drop of 8%.

Some 181,873 urgent cancer referrals were made by GPs in England in March 2020, down from 198,418 in March 2019.

Urgent breast cancer referrals showed a bigger drop – down from 17,137 in March 2019 to 12,411 in March 2020, a fall of 28%.


Admissions for all routine surgery in hospitals in England in March 2020 totalled 207,754, compared with 305,356 in March 2019 – a drop of 32%.

Lynda Thomas, chief executive of Macmillan Cancer Support, said: “Cancer must not become the forgotten ‘C’ in this pandemic.

“Government guidance for urgent cancer services to continue during the virus did not happen uniformly and now it is vital that we see comprehensive plans for how the NHS will catch up.”

HEALTH Coronavirus Hospitals
(PA Graphics)

Dr Nick Scriven, immediate past president of the Society for Acute Medicine, said the drop in A&E attendances was “a significant concern” and people’s conditions may have worsened as a result.

“This is a ticking timebomb in itself and it will be exacerbated by a myriad of other pressures in the coming weeks,” he said.

“There will be an ongoing need to keep people with coronavirus separate from others to prevent transmission, with segregated wards effectively reducing immediately available beds, so attempting to manage increased demand will be very challenging.”

Separate figures from NHS England show the volume of calls to the NHS 111 service in April were up slightly on the same month in 2019, following a big spike in March.

An average of 55,200 calls a day were made in April 2020, 14% higher than the average of 48,400 a day in April 2019.

This compares with an average of 95,600 calls a day in March 2020 – more than double the average for March 2019.

NHS England said NHS 111 service levels had been heavily affected by increased demand caused by coronavirus, but that figures so far for May showed a return to call volumes only slightly higher than the demand expected at this time of year.

(PA Graphics)
(PA Graphics)

Data also shows that the number of patients waiting to start treatment at the end of March was 4.2 million, down on the 4.4 million in the previous month.

The UK lockdown was announced on March 23.

John Appleby, director of research and chief economist at the Nuffield Trust, said: “People are likely putting off seeking care because of Covid-19 infection fears and worries of burdening overstretched NHS staff; this is despite some reassurance from both government and the NHS that these services are open.

“We do not yet know what impact this is having on people’s health – some people will have self-treated or sought other sources of care.”

He said the pause in routine treatments in mid-March had led to “unprecedented falls in hospital activity” as the NHS created capacity to deal with Covid-19, while GP referrals also fell.

“The NHS will find it very difficult to catch up,” he added.

“It will take many months and increased use of the independent sector to meet this unmet need and bring services back to the level we were seeing pre-Covid-19.

(PA Graphics)
(PA Graphics)

“The health service is going to have to adjust, and this will take time. That means more people waiting and some services on hold.”

Professor Stephen Powis, NHS medical director, said: “NHS hospitals went from looking after just several hundred confirmed coronavirus positive inpatients at the beginning of March to nearly 19,000 inpatients by mid-April.

“It is an amazing achievement that every Covid-19 patient who needed hospital inpatient care or critical care was able to receive it.

“A&E attendances were sharply down, but the majority of these reductions were for lower-risk conditions.

“Urgent cancer referrals are now picking back up – having doubled over the past three weeks – and the NHS has launched a public information campaign reminding the people of the importance of seeking care for urgent and emergency conditions.”

Downing Street said the “full impact” of the pandemic – including the indirect fatalities due to scaled-back NHS services – would only be revealed in excess death figures.

The Prime Minister’s official spokesman said: “It’s important to stress that the NHS has always been running services for those who needed urgent care and has shifted a lot of outpatient services to video and telephone calls.

“Trusts have been asked to start planning to bring back face-to-face, non-urgent services in a safe manner.”

Shadow health secretary Jonathan Ashworth said: “We support the lockdown to suppress this horrific virus but the far-reaching consequences for wider health outcomes must not be ignored.

“Resetting the NHS to continue treating Covid and non-Covid patients is a huge priority.”

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