How is COVID-19 changing the use of emergency care by region? COVID-19 chart series

Visits to A&E

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.

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.

Emergency admissions

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.

Ambulance incidents

While the changes in the overall number of ambulance incidents were small, there have been sizeable shifts in how ambulance crews have cared for patients. In all regions, ambulance crews have transported fewer patients to A&E and treated more people at the scene or over the phone.

In March the number of patients transported by ambulance to A&E fell by 22%, despite a 12% increase in the number of incidents overall. However, in the Midlands the fall was only 11%, even though this was also an early centre of the pandemic. In all other regions, the reduction in patients transported range from 9% in the South East to 17% in the North West. The reductions in April were even more sizeable, with the greatest reduction in London at 33% and the smallest in the South East at 24%.

There was a corresponding increase in the number of patients treated at the scene or over the phone. In March, the number of people treated by ambulances in situ increased by 89%. Patients treated in situ were again 66% higher in London in April 2020 relative to April 2019. In April, the percentage increase in the number of patients treated at the scene or on the phone in other regions ranged from just 12% in the South West to 58% in the North East and Yorkshire. In the South West, this lower increase reflects a reduction in calls in April and a higher share of pre-COVID ambulance patients treated at the scene. 

In addition to affecting volumes of A&E visits and ambulance calls, COVID-19 is also likely to have affected the composition of patients (the conditions that patients seek help for). Some of the change in ambulance treatment pattern could be explained by changes in patient conditions or severity. However, the scale of the shifts away from taking patients to A&E towards treating at the scene suggests a substantial change in how ambulance crews treat patients. Ambulance crews must trade off the benefits of each patient receiving hospital care with both the risk that non-COVID-19 patients could catch COVID-19 and the potential impact on hospital capacity.

This demonstrates how different parts to the NHS have worked together to care for patients during the pandemic.