Key points

  • Recent NHS England data show that A&E visits in April 2020 were 57% lower than in April 2019 and were the lowest monthly number since records began in 2010. This chart explores how COVID-19 is changing use of emergency care on a regional level.
  • Falls in visits to A&E in March and April 2020 were very similar across regions. There were bigger falls in April, the first full month of the lockdown, than in March. The fall was also always greater in minor units than major units. Reductions were slightly larger in London than other regions.
  • There is more variation in reductions in emergency admissions through major A&E units. In March, there were larger percentage falls in admissions in London (30%) relative to the rest of the country (18-22%). In April, London again saw the largest fall in admissions (45%). Another five regions had falls of between 34% and 40%, with the North West an outlier, seeing a reduction of just 28%.

How is the changing use of emergency care playing out at a regional level?

The changes in A&E visits during the early stages of the COVID-19 pandemic were similar across all regions, despite differences in the timing and infection rates.

The number of A&E visits fell in both March and April relative to the same month in 2019. Falls were greater in April than in March, which is to be expected as the lockdown only started midway through March. The percentage reduction in visits is always larger for minor units than major units. This is consistent with patients with less severe conditions being directed towards other services, such as NHS 111, GPs or pharmacies, or not seeking medical help at all.  

Are there any differences emerging between regions?

The percentage fall in A&E visits was slightly larger in London than in other regions, in both March and April. London was badly hit at the start of the pandemic, but the overall pattern by region is not strongly related to the spread of COVID-19. For example, there was a 26.5% reduction in major A&E visits in the Midlands during March, where early infection rates were high, but a similar 27% fall in the South West where initial infection rates were low.

In all cases, the percentage fall in emergency admissions through major A&E units was smaller than the drop in the number of visits. However, there is more regional variation in how the number of emergency admissions has changed. In March, admissions fell by 30% in London, while in all other regions the falls ranged from 18–22%. In April, emergency admission through major A&E units in London fell by 45%. Five regions had reductions of between 34–40%. The North West was an outlier, with a reduction of just 28%. This compares to a fall of 35% in the South East, which had similar percentage fall in major A&E visits.

It is important to note that the change in emergency admissions through A&E will depend on the patients that arrive in A&E, and the decisions of clinicians about whether they should be admitted. The local prevalence of COVID-19 may affect how many patients who may have COVID-19 arrive at A&E. It may also affect decisions about whether to admit patients. Clinicians must balance the need of A&E patients to receive inpatient care, with the risk that the patient could catch COVID-19 in hospital. There may also be additional concerns about the capacity of the hospital to treat both current and future COVID-19 patients.

These charts explore the regional breakdown in England of A&E visits and emergency admissions via major A&E units. In the coming weeks we will publish further analysis exploring the regional picture for ambulance incidents.

Further reading

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