A&E activityAn Official Statistics publication for Scotland
- Hospital care
We report statistics on Accident and Emergency (A&E) departments across Scotland.
When we refer to A&E departments, this includes around:
- 30 large consultant-led emergency departments (EDs) in Scotland
- 60 minor injuries units (MIUs) and community units
- Monthly statistics
Overall A&E statistics are released once a month (on the first Tuesday).
This is because data for some smaller sites is currently only available monthly.
- Weekly statistics
Statistics for EDs are released every Tuesday.
This is because all NHS boards are able to provide data for this type of site weekly.
The type of services provided by A&E departments can vary, depending on current demand and what other urgent and emergency care services are available nearby.
Sites in Scotland are categorised as either emergency departments, minor injuries units or other smaller community casualty departments, but within these categories there can be variation in service delivery which can impact comparability.
A&E data submitted to PHS should include activity in trolleyed areas of assessment units, but it is not possible to separately identify this in the data.
This means that A&E statistics reported for an Emergency Department or Minor Injuries Unit (MIU) at a hospital can also include activity from trolleyed areas of assessment units at the same hospital.
You can view further information about the sites and the data we cover in the metadata section and further information section.
There are also variations in how activity is recorded in the four home nations across the United Kingdom. Further details can be found in the data quality section of the metadata.
Since 2007, A&E performance has been monitored against the Scottish Government’s 4-hour access standard.
- What is the 4-hour access standard?
95% of A&E patients should wait no longer than 4 hours from arrival to:
Formal performance monitoring against this standard is based on unplanned attendances at all types of A&E department. This is published monthly.
Weekly updates only cover larger emergency departments and do not reflect the full range of A&E activity – they should not be used for formal monitoring of the standard.
View the Scottish Government's 4-hour access standard for A&E.
Redesign of urgent care
The National Redesign of Urgent Care was implemented in December 2020.
It changed the way people access A&E.
The advice now is that people with non-urgent conditions first phone NHS 24. Then, if appropriate, they will be advised to attend A&E at a scheduled time.
This introduces a new 'planned' type of A&E attendance.
The statistics reported here cover only 'unplanned' attendances, but we hope to be able to report 'planned' attendances when recording is improved.
Further information on current issues around unplanned/planned recording can be found in the metadata section.
All A&E sites: March 2023
This section gives you a summary of the latest available information on the number of people attending A&E services, how long they are waiting and performance against the 4-hour access standard, at Scotland level.
This summary is updated monthly on the first Tuesday of the month, with around a 5-week lag.
Full trends and further information such as demographic breakdowns are available in our interactive charts.
During March 2023
There were 128,482 unplanned attendances at A&E.
- Compliance with the 4-hour A&E access standard
87,358 (68.0%) of A&E attendances were seen and resulted in a subsequent admission, transfer or discharge within 4 hours.
Compliance has been below 80% since summer 2021.
- Attendances of over 8 hours
14,419 (11.6%) patients spent more than 8 hours in A&E.
- Attendances of over 12 hours
6,094 (4.9%) patients spent more than 12 hours in A&E.
Emergency departments: week ending 14 May 2023
This section gives you a summary of the latest available information on the number of people attending emergency departments (EDs) and how long they are waiting, at Scotland level.
These statistics do not reflect all types of A&E activity and they should not be used to monitor against the 4-hour A&E access standard.
This summary is updated weekly (on a Tuesday, with a 9 day lag).
Full trends are available in our interactive charts.
NHS Shetland were unable to submit the data for the week ending 14 May 2023. As a result, NHS Shetland and NHS Scotland totals for this week will be an undercount. Public Health Scotland are working closely with colleagues in NHS Shetland to rectify this and we will include amendments in our next weekly update.
During week ending 14 May 2023
There were 26,597 unplanned attendances at EDs in NHSScotland.
- Attendances of under 4 hours
17,059 (64.1%) of ED attendances were seen and resulted in a subsequent admission, transfer or discharge within 4 hours.
- Attendances of over 8 hours
3,143 (11.8%) patients spent more than 8 hours in an Emergency Department.
- Attendances of over 12 hours
1,161 (4.4%) patients spent more than 12 hours in an Emergency Department.
We present a series of interactive charts showing trend data by week and month for:
In addition, interactive charts show trend data by month for:
Weekly updates are made every Tuesday and monthly updates are made on the first Tuesday of the month.
Our charts have the option to select a view of the data at national, NHS board or individual hospital or site level.
You can also select to view data according to the type of A&E site (all A&E, ED only, MIU/other).
We are working to improve the way these charts work. In the meantime, you may need to refresh your browser as you move between sections to ensure that the charts are displaying correctly.
Number of attendances
This section shows the number of unplanned A&E attendances over time.
Large decreases in A&E attendances were observed during the COVID-19 pandemic, but levels have since increased and are now close to pre-pandemic levels.
Further information about attendances can be found in the metadata section.
All A&E site attendances over time
How long people spend in A&E
This section gives information about how long people have been spending in A&E departments over time.
Since 2007 the standard is that 95% of patients are seen and subsequently admitted, discharged or transferred within four hours. Formal monitoring of this is based on monthly data for all A&E sites.
Over the past two years the proportion of unplanned attendances spending under four hours in A&E has been decreasing and has remained below 80% since late summer 2021.
The length of time spent in emergency departments is generally higher than for all types of A&E sites combined – this reflects that EDs usually see patients with more serious or complex conditions.
Further information can be found in our overview and in the metadata section.
Percentage within 4 hours
Number of attendances over 4, 8 and 12 hours
This section gives information about the demographics of people with unplanned attendances at A&E departments over time.
The information is presented as population rates to help compare between groups.
Individuals living in the most deprived areas account for more than twice as many attendances as those from the least deprived areas.
Attendance rates are consistently slightly higher for males than females.
The elderly (over 75 years old) and very young (under 5 years old) have the highest attendance rates at A&E.
Monthly attendances at A&E
When people attend
This section gives information about the time of day and day of the week when people attend A&E departments.
The number of people arriving at A&E department can vary considerably throughout the day and is affected by the day of the week and season.
In general, the highest numbers of unplanned attendances occur during the afternoon and early evening, and more attendances happen on a Monday than on other days of the week.
Monthly attendance at A&E by day of week
Mondays tend to be the busiest day in terms of average monthly attendances.
Monthly attendances at A&E by arrival hour bands
Monthly attendance at A&E by in and out of hours
Routes into A&E departments
This section provides information on who refers people to A&E services.
People may be referred:
- by a healthcare professional such as a GP
- through a call to NHS 24
- via a 999 emergency call
A patient may also self-refer by making a personal decision to attend the A&E Department. Self-referral includes patients brought in by a family member or bystander.
Around half of attendances at A&E are self-referrals.
Interpretation of data
In December 2020 the Redesign of Urgent Care programme was implemented.
This introduced Flow Navigation Centres (FNC) to ensure that patients received the fastest care possible and to help avoid unnecessary attendances at A&E.
Due to coding issues, trends on those referred to A&E from FNC and NHS 24 should be interpreted with caution from December 2020 onwards.
Find our more information about data continuity in the metadata section.
Monthly referral to A&E
Monthly referral by proportion
What happens following attendance at A&E
This section provides information on where people end up after attending A&E.
Following attendance at A&E, patients may be:
- admitted to the same hospital
- transferred to a different hospital or health and social care service
- discharged home or to their usual place of residence, for example, a care home
Around 70% of people – or 7 out of 10 – attending A&E will end up discharged home or to their usual place of residence.
Looking at trend data, the proportion admitted to hospital rose during the national lockdowns of the COVID pandemic.
At these times, there were big drops in the overall numbers attending A&E, and it is likely that those attending had a more serious injury or illness.
Monthly route from A&E
Monthly route from A&E by proportion
Downloads and open data
These downloadable publication files provide the data used to produce the interactive charts on our various A&E metrics.
Weekly updates are made every Tuesday and monthly updates are made on the first Tuesday of the month.
The files include data on:
- the overall number of attendances
- how long people spend in A&E
- the demographics of those who attend
- when patients attend
- routes into A&E departments
- what happens following attendance at A&E
Overall number of attendances and waiting times
When people attend
Routes into A&E departments
What happens following attendance at A&E
Our open data
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Planned development of A&E Statistics
This section provides high-level information about planned developments for our A&E statistics. This includes continuing to expand the range of statistics we publish, work to improve data quality, and development of our user engagement.
- Multiple attendances
PHS will publish data on how often individuals attend A&E departments in the most recent year, with breakdowns by age group and deprivation, in June 2023.
- Attendance rates
Rates of A&E attendance vary across Scotland, reflecting differences in services available and accessibility. Attendance rates, including breakdowns by age group, sex and deprivation, will be published in July/August 2023.
- Admissions following A&E attendance
Currently around a quarter of A&E attendances result in admissions to hospital. PHS plans to publish more detailed information on these admissions, including breakdowns by age group, day of the week and time of attendance, in August/September 2023.
Improving data and interpretation
- Improving interpretation in main points summaries
Currently the main points in both the weekly and monthly releases are simply a snapshot of the latest week or month. PHS will explore how to include comparisons over time in this section, to improve interpretation of the data. We plan to add these updates in August/September (2023).
- Review of unscheduled care patient pathways
Various urgent and emergency care services run alongside A&E departments across Scotland, including assessment units. PHS is working with boards to undertake a review of patient flows through A&E departments. A short life working group will be established to oversee this work and PHS will aim to share the findings in autumn 2023.
- Planned A&E attendances
Currently PHS only publish data on unplanned attendances at A&E. PHS is working with boards to improve the consistency and quality of recording of planned attendances and enable accurate reporting. PHS will add updated information about planned attendances by autumn 2023.
- Patient Flow Group
Patient Flow Groups is a derived item in the A&E dataset. Those attending A&E are assigned to one of five groups.
There is currently some variation by NHS Board in how Patient Flow groups are derived. PHS have consulted NHS Boards to explore these variations and plan to release recommendations for standardisation in autumn 2023.
Regular User Engagement
PHS is considering how to incorporate broader user engagement into the regular cycle of producing A&E statistics. We are currently agreeing what types of users and organisations we need to engage with and how. We plan to add information about this engagement and how we have used feedback from users as this work progresses.
List of NHSScotland A&E sites
This is a list of all the A&E sites in Scotland.
The sites are one of two types – emergency departments or MIU/other. Files are submitted as either episode or aggregate files.
You can see the definitions for these in the glossary.
All sites have been open from before the A&E data mart started collecting data in June 2007 unless otherwise stated.
|Health board||Site type||Name of hospital||File type||Dates opened or closed|
|Ayrshire & Arran||ED||University Hospital Ayr||E|
|Ayrshire & Arran||ED||University Hospital Crosshouse||E|
|Ayrshire & Arran||MIU/other||Arran War Memorial Hospital||A|
|Ayrshire & Arran||MIU/other||Davidson Cottage Hospital||A||Closed from May 2010.|
|Ayrshire & Arran||MIU/other||Girvan Community Hospital||A||Opened from May 2010.|
|Ayrshire & Arran||MIU/other||Lady Margaret Hospital||A||Opened from October 2007.|
|Borders||ED||Borders General Hospital||E|
|Borders||MIU/other||Hawick Cottage Hospital||A||Closed from April 2020.|
|Borders||MIU/other||Hay Lodge Hospital||A|
|Borders||MIU/other||Kelso Hospital||A||Closed from April 2020.|
|Borders||MIU/other||Knoll Hospital||A||Closed from April 2020.|
|Dumfries & Galloway||ED||Dumfries & Galloway Royal Infirmary||E|
|Dumfries & Galloway||ED||Galloway Community Hospital||E||Episode file from December 2007.|
|Dumfries & Galloway||MIU/other||Castle Douglas Hospital||A||Closed from April 2020.|
|Dumfries & Galloway||MIU/other||Kirkcudbright Hospital||A||Closed from April 2020.|
|Dumfries & Galloway||MIU/other||Moffat Hospital||A||Closed from April 2020.|
|Dumfries & Galloway||MIU/other||Newton Stewart Hospital||E||Episode file from March 2012. Closed from April 2020.|
|Fife||MIU/other||Adamson Hospital||E||Episode file from October 2016.|
|Fife||MIU/other||Queen Margaret Hospital||E||Changed from ED to MIU 19 January 2012. Started Submitting E data in July 2007.|
|Fife||MIU/other||St Andrews Community Hospital||E||Episode file from July 2017.|
|Forth Valley||ED||Forth Valley Royal Hospital||E||ED opened 12 July 2011.|
|Forth Valley||ED||Stirling Royal Infirmary||E||Closed 12 July 2011.|
|Forth Valley||MIU/other||Stirling Health and Care Village||E||Opened as MIU 12 July 2011.|
|Forth Valley||MIU/other||Falkirk Community Hospital||E||MIU closed 12 July 2011.|
|Grampian||ED||Aberdeen Royal Infirmary||E|
|Grampian||ED||Dr Gray's Hospital||E|
|Grampian||ED||Royal Aberdeen Children's Hospital||E|
|Grampian||MIU/other||Aboyne Hospital||A||Closed from April 2020.|
|Grampian||MIU/other||Fleming Cottage Hospital||A||Closed from April 2020.|
|Grampian||MIU/other||Forres Health & Care Centre||A||MIU opened 8 September 2014. Closed from April 2020.|
|Grampian||MIU/other||Insch War Memorial Hospital||A||Closed from April 2020.|
|Grampian||MIU/other||Inverurie Hospital||A||No data since February 2019.|
|Grampian||MIU/other||Kincardine Community Hospital||A||Aggregate file from June 2012. Closed since April 2020.|
|Grampian||MIU/other||Leanchoil Hospital||A||MIU closed 7 September 2014.|
|Grampian||MIU/other||Peterhead Community Hospital||A|
|Grampian||MIU/other||Seafield Hospital||A||Closed from April 2020.|
|Grampian||MIU/other||Stephen Hospital||A||Closed from April 2020.|
|Grampian||MIU/other||Turner Memorial Hospital||A||Closed from April 2020.|
|Grampian||MIU/other||Turriff Hospital||A||Closed from April 2020.|
|Greater Glasgow & Clyde||ED||Glasgow Royal Infirmary||E|
|Greater Glasgow & Clyde||ED||Inverclyde Royal Hospital||E|
|Greater Glasgow & Clyde||ED||Royal Alexandra Hospital||E|
|Greater Glasgow & Clyde||ED||Royal Hospital for Children Glasgow||E||Moved from Yorkhill to SGUH 10 June 2015 (8am).|
|Greater Glasgow & Clyde||ED||Queen Elizabeth University Hospital||E||Opened 2 May 2015 (8am). Re-named from SGUH 3 July 2015.|
|Greater Glasgow & Clyde||ED||Southern General Hospital||E||Closed 2 May 2015 (8am).|
|Greater Glasgow & Clyde||ED||Western Infirmary / Gartnavel General||E||ED closed 30 May 2015 (8am).|
|Greater Glasgow & Clyde||MIU/other||New Stobhill Hospital||E||New Stobhill Hospital (formerly Stobhill Hospital) until 18 March 2011 this site had both an ED and MIU. From 18 March 2011 there was no ED on site.|
|Greater Glasgow & Clyde||MIU/other||Vale of Leven District General Hospital||E|
|Greater Glasgow & Clyde||MIU/other||New Victoria Hospital||E||New Victoria Hospital (formerly Victoria Infirmary) this site had an ED and an MIU up until 16 May 2015 (8am) when the ED closed and the site became an MIU only.|
|Greater Glasgow & Clyde||MIU/other||West Glasgow Ambulatory Care Hospital||E||MIU opened 30 May 2015 (8am). Closed 23 December 2016 (9pm). Re-Opened 3 January 2018 and closed 20 April 2018.|
|Highland||ED||Belford Hospital||E||Episode file from March 2011.|
|Highland||ED||Caithness General Hospital||E||Episode file from March 2011.|
|Highland||ED||Lorn & Islands Hospital||E||Episode file from April 2012.|
|Highland||MIU/other||Aviemore Health Centre||A|
|Highland||MIU/other||Campbeltown Health Centre||A||Data label error - this should be Campbeltown Hospital.|
|Highland||MIU/other||County Community Hospital - Invergordon||A|
|Highland||MIU/other||Cowal Community Hospital||A|
|Highland||MIU/other||Dunaros Hospital||A||Closed in November 2012. Transfer of service to Mull and Iona Hospital.|
|Highland||MIU/other||Ian Charles Community Hospital||A||Closed from April 2020.|
|Highland||MIU/other||Lawson Memorial Hospital||A|
|Highland||MIU/other||Dr Mackinnon Memorial Hospital||A|
|Highland||MIU/other||Mid Argyll Community Hospital And Integrated Care Centre||A|
|Highland||MIU/other||Mid Argyll Hospital||A||Closed in 2006. Should be Mid Argyll Community Hospital And Integrated Care Centre.|
|Highland||MIU/other||Mull and Iona Community Hospital||A||Opened from November 2012.|
|Highland||MIU/other||Nairn Town and County Hospital||A|
|Highland||MIU/other||Portree Community Hospital||A|
|Highland||MIU/other||Ross Memorial Hospital||A||Closed 2 November 2018.|
|Lanarkshire||ED||University Hospital Hairmyres||E|
|Lanarkshire||ED||University Hospital Monklands||E|
|Lanarkshire||ED||University Hospital Wishaw||E|
|Lanarkshire||MIU/other||Kello Hospital||E||Episode file from March 2019. Closed from April 2020.|
|Lanarkshire||MIU/other||Lady Home Hospital||E||Episode file from March 2019. Closed from April 2020.|
|Lothian||ED||Royal Hospital for Children and Young People (Edinburgh)||E|
|Lothian||ED||Royal Infirmary of Edinburgh||E|
|Lothian||ED||St John's Hospital||E|
|Lothian||MIU/other||Belhaven Hospital||A||Opened from December 2007. Closed October 2012.|
|Lothian||MIU/other||Edington Cottage Hospital||A||Opened from December 2007.|
|Lothian||MIU/other||Western General Hospital||E||MIU & Acute Receiving Unit (ARU) on site.|
|Orkney||ED||Balfour Hospital||E||Episode file from June 2011. Changed to ED 1 January 2014.|
|Shetland||ED||Gilbert Bain Hospital||E|
|Tayside||ED||Perth Royal Infirmary||E|
|Tayside||MIU/other||Aberfeldy Community Hospital||E||Opened from September 2008. Closed November 2015.|
|Tayside||MIU/other||Blairgowrie Community Hospital||E||Closed from April 2020.|
|Tayside||MIU/other||Brechin Infirmary||E||Closed from April 2020.|
|Tayside||MIU/other||Crieff Community Hospital||E||Opened from September 2008. Episode file from November 2008. Closed since April 2020.|
|Tayside||MIU/other||Irvine Memorial Hospital||E||Closed from July 2008.|
|Tayside||MIU/other||Links Health Centre - Montrose||E||Closed from April 2020.|
|Tayside||MIU/other||Pitlochry Community Hospital||E||Closed from April 2020.|
|Tayside||MIU/other||St Margaret's Hospital||E||Opened from September 2008. Closed since April 2020.|
|Tayside||MIU/other||Whitehills Health and Community Care Centre||E|
|Western Isles||ED||Western Isles Hospital||E|
|Western Isles||MIU/other||St Brendan's Hospital||A|
|Western Isles||MIU/other||Uist & Barra Hospital||E|
You can also download a more detailed list of hospital sites.
Data source: the A&E datamart.
Last updated: November 2022.
Public Health Scotland
We provide a number of statistical releases that may also be of interest:
- statistics on out of hours primary care services in Scotland
- COVID-19 wider impacts to the health care system dashboard
- statistics on emergency admissions to hospital
Scottish Ambulance Service (SAS)
PHS management information tools
Professional users working in the health and social care system can access a number of online management information tools.
System Watch is an online tool that monitors and predicts urgent care and emergency service pressures.
Find out more about System Watch.
Discovery is an online information system that provides comparative information to support performance and quality improvement work.
View the Scottish Government’s:
This section provides more detailed information about the A&E data and the statistics we are reporting, to help with accurate interpretation. It also confirms how we handle and report these statistics to comply with the UK Statistics Authority Code of Practice.
Official statistics release
- Publication title
Monthly Accident and Emergency (A&E) Activity and Waiting Times Statistics
Weekly Emergency Department Statistics
These pages report key statistics on unplanned attendances at A&E services across Scotland.
This includes information on:
- emergency departments
- minor injury units
- smaller community casualty and A&E departments
- patients in trolleyed areas of acute assessment units
- virtual contacts
Health and social care
Webpage with embedded RShiny dashboard content, CSV files and Excel Tables, machine readable open data.
Weekly and monthly, reflecting the timeliness of data available.
- Timeframe of data and timeliness
New data for Emergency Departments only released each Tuesday covering the week ending on the Sunday 9 days before publication.
New data for all types of A&E site released on the first Tuesday of the month, covering the month two months prior to publication (e.g. March publication contains the data for January).
- Official Statistics designation
Previously, monthly and weekly figures were released as separate publications.
The monthly data release was designated as National Statistics in 2013 based on assessment by the UK Statistics Authority.
The weekly release was originally based on aggregate data returns and was designated as Official Statistics.
Weekly submissions have improved over time and PHS now receive episode level data for all emergency departments, but this has not yet been assessed by the UK Statistics Authority.
Since these pages present both weekly and monthly figures, the suite is labelled Official Statistics.
This does not signify an updated designation or reduction in the quality of monthly figures reported.
- Relevance and key uses of the statistics
Statistics on A&E activity are important to patients and are a measure of how the NHS is responding to demand for urgent and emergency care services.
Measuring and regular reporting of waiting times and attendances highlight where there are delays in the system and enable monitoring of the effectiveness of NHS performance throughout the country.
- Coherence and clarity
Statistics are presented in summaries that highlight the main headline points from the latest releases, in interactive charts where users can select data of interest using drop down menus, and as downloadable tables or machine readable open data files.
In order to help users understand and interpret our statistics, further information is contained within this metadata section.
We have also provided a glossary and tried to minimise use of abbreviations and acronyms.
- Date of first publication
Trend data available from 3 March 2015 for weekly data (emergency department only) and from 1 July 2007 for monthly data (all types of A&E site).
- Pre-release access
Under terms of the “Pre-Release Access to Official Statistics (Scotland) Order 2008”, PHS is obliged to publish information on those receiving pre-release access ('pre-release access' refers to statistics in their final form prior to publication).
The standard maximum pre-release access is five working days. Shown below are details of those receiving standard pre-release access.
Standard pre-release access
- Scottish Government Health and Social Care Directorate
- Territorial NHS Board Chief Executives
- Territorial NHS Board Communication leads
Early access for quality assurance
The monthly statistics are made available, around two weeks prior to publication, to key individuals within the Scottish Government and NHS boards to help quality assure the publication. The contacts within NHS Boards are a mixture of information staff (data suppliers), operational staff (general managers) and clinicians. This varies by NHS Board. The contacts at the Scottish Government are analysts and policy leads for Unscheduled Care.
It is the policy of PHS to make its websites and products accessible according to our accessibility statement. Graphs and tables have been assessed against PHS accessibility standards.
- Data source(s)
NHS boards use a variety of local IT systems to collect A&E data.
NHS boards provide weekly episode-level submissions to PHS. For a small number of sites, weekly data is submitted as an aggregate return.
NHS boards provide the majority of the monthly data (covering all types of A&E site) at episode level. Monthly aggregate returns for some sites are provided by NHS Grampian and NHS Highland. These monthly aggregate returns account for around 3% of overall activity in Scotland.
Episode level data provides details about each individual attendance, enabling further analysis including breakdowns by patient characteristics (such as age or sex).
The statistics presented in the following sections exclude the small proportion of attendances for which episode-level data is not available. These are for the sections:
- who attends
- when do people attend
- routes into A&E departments
- what happens following A&E attendance
A list of the A&E sites with information about their location, the type of site and whether PHS receives aggregate or episode-level data for that site can be found in our list of all hospital sites.
All of the data submitted weekly and monthly are collated centrally in the national A&E datamart.
- Date that data are acquired
NHS board submissions completed and processed by Thursday each week for weekly data and by around 10th of each month for monthly data.
Please note that from 2 May 2023 the data included in the weekly ED publication is based on date/time of arrival instead of date/time of discharge, admission or transfer. This brings the weekly publication in line with the monthly publication. This change caused some very small changes in attendance and performance in the historical data. A note of revisions can be in the revisions section of the metadata.
- Concepts and definitions
View details of data items collected and validation process in our A&E User Guide.
View data item codes, descriptions and definitions in our A&E: Data Recording Manual
In addition to any local data quality checks, the data submitted to PHS is subject to automated validation procedures. Anomalies identified by PHS as part of these validation procedures are raised with NHS Boards, who are then required to provide more information and, if necessary, resubmit data. Revisions to previously published figures are noted as per the revisions section. For more information about this, see Appendix A of the A&E user guide and the A&E data recording manual.
The data quality and completeness is variable. Information on the date and time of arrival and discharge is of consistently high quality. Information on reasons why people attend and clinical diagnosis is less complete and less robust in terms of nationally consistent data quality.
PHS works closely with colleagues in the NHS boards to improve the validation and accuracy of the data and to ensure that the appropriate data standards are understood and applied by all sites. This takes place on a continuous basis, as queries or potential issues arise.
Annual review meetings are held between PHS and each NHS Board to take stock and discuss any outstanding or emerging issues. The meetings focus on data quality issues identified for that particular NHS Board. PHS are currently reviewing the frequency of these meetings.
In addition to these formal annual meetings, data quality is monitored and issues or queries flagged with suppliers on an ongoing basis, through the range of regular monitoring and analysis that PHS produces for NHS Boards and the Scottish Government.
The small number of aggregate returns included in the monthly report are subject to only basic quality assurance checks by PHS. NHS Boards are required to confirm to PHS that the statistics are accurate.
The statistics in the monthly release cover all A&E sites.
The weekly release covers a subset, only emergency departments (EDs, larger A&E services that typically provide a 24-hour consultant led service).
The weekly statistics for EDs cover the majority (over 80%) of total A&E activity, but they do not reflect the full range of A&E services and activity.
Data completeness varies by data item and further information can be found in the completeness tables.
The type of services provided by A&E departments can vary, depending on current demand and what other urgent and emergency care services are available nearby. Sites are categorised as either emergency departments, minor injuries units or other smaller community casualty departments, but within these categories there can be variation in service delivery which can impact comparability.
Various urgent and emergency care services run alongside A&E departments across Scotland, including assessment units. A&E data submitted to PHS should include activity in trolleyed areas of assessment units, but it is not possible to separately identify this in the data. This means that A&E statistics reported for an Emergency Department or Minor Injuries Unit (MIU) at a hospital can also include activity from trolleyed areas of assessment units at the same hospital.
How different urgent and emergency care services operate and the way space such as trolleyed areas are used can vary both by hospital (depending on the facilities available and how services have been set up to meet local demand) and also over time (depending on how many people need urgent or emergency care at different times). These differences could impact on the consistency and comparability of A&E statistics and it is important to bear this in mind when comparing statistics for different areas or hospitals, or looking at trend data over time.
Direct comparison of A&E statistics across the United Kingdom is limited by differences in service delivery and definitions in the four nations. Due to these differences and the risk that incorrect comparisons are made, PHS recommends a combined report by NHS Digital, which includes an annual comparison, with notes about the differences between statistics for each nation. The UK Government Statistical Service also maintains information about the comparability of health care waiting times statistics, including A&E.
- Continuity of data
Trend data showing number of attendances and length of time people spend in A&E departments is robust at a national level.
At site level, some hospitals which previously submitted aggregate data have moved to submitting episode level data. Those affected are flagged in the list of sites. Please bear this in mind when looking at trends in tables that are based on episode level data only (for example, the breakdowns by age, sex and deprivation); an increase in the number of attendances or population rate may be the result of additional sites submitting episode level information rather than a true increase.
The Redesign of Urgent Care (RUC) programme was implemented in December 2020. One of the main aims of the programme was to change the way people access A&E and convert some unscheduled activity into planned activity to help people get the right care in the right place. This planned activity primarily follows contacts with Flow Navigation Centres that were set up as part of the RUC programme. In order to help measure the impact of the RUC programme PHS introduced a new planned code for attendances at A&E scheduled following contact with Flow Navigation Centres.
PHS also introduced a new referral source code for Flow Navigation Centres and Virtual clinics. PHS is aware that currently not all areas are using this new code and some are recording NHS 24 as source of referral rather than Flow Navigation Centre. This may be due to how patients report this on arrival at reception.
PHS is aware that some NHS Boards are not recording planned A&E activity as expected. The planned attendances are currently excluded from both the weekly and monthly publication, and they are excluded from the 4 hour standard. PHS intend to publish information on planned attendances when the completeness and data quality have been improved.
- Revisions Statement
Due to the timeliness of submissions and reporting and the dynamic nature of the A&E dataset, figures contained within each update may be subject to change in future releases.
If NHS boards discover that data submitted to PHS is incorrect, or that data are missing, further re-submissions can be made.
Any revised figures will then be reflected within the latest update.
Figures contained within each update may also be subject to change in future releases as historic data may be re-submitted.
These amendments are usually minor, affecting a small number of records for individual sites or areas. Any major or significant changes are handled as formal revisions as outlined in PHS Statistical Revisions Policy.
- Revisions relevant to this publication
Minor amendments to historic data in the latest weekly and monthly release are noted in a monthly revisions log and weekly revisions log.
- Value type and unit of measurement
Count of total attendances. Number and proportion of attendances in department for 4, 8 and 12 hours. Guidance on when the clock should start and stop at in relation to the four hour A&E access standard can be found in the A&E data recording manual. Currently, the date and time of arrival is used for calculations published in the monthly release, and date and time of discharge in the weekly publication. The difference in approaches was retained to be consistent with legacy weekly publications. The impact on the statistics of using the different date and time values for those waiting over 4, 8 and 12 hours is very minimal. PHS is planning to align both publications to use date and time of arrival as soon as possible.
Average counts for day of the week. Count of attendances by time of day. Time of day and day of week are based on date/time of arrival at A&E.
Population rates for age groups, sex and SIMD categories. The population rates are based on the number of attendances attributed to a group or region divided by the number of residents in that group (the population). This can potentially inflate the rates for those population groups with higher repeat attenders- (that is, individuals with multiple attendances), for example those living in more deprived areas.
The PHS Statistical Disclosure Protocol is followed for both the weekly and monthly publication to protect patient confidentiality.
- 4-hour A&E access standard
Since 2007, the national standard for A&E waiting times is that new and unplanned return attendances at an A&E service should be seen and then admitted, transferred or discharged within four hours.
Formal monitoring of performance against the 4-hour standard is based on attendances at all A&E sites and compliance is reported in the monthly release. The weekly release includes ED attendances only and should not be used for formal compliance against the four hour standard.
- A&E admission
Admission to a hospital bed in the same NHS hospital following an attendance at an A&E service.
- A&E datamart
Secure medium for storing data and analysing patient-level/aggregate attendances from July 2007 for all accident and emergency services across Scotland.
Preferred tool for analysing A&E services data from this date.
- Accident & Emergency (A&E) services
Collectively the term Accident and Emergency (A&E) services includes the following site types:
- emergency departments
- minor injury units (MIUs)
- community A&Es or community casualty departments that are GP or nurse-led
At some sites, A&E activity can also take place in trolleyed areas of assessment units and this should be included in the A&E statistics we report.
- Aggregate file (A)
Monthly summary attendance figures only
The presence of a patient in an A&E service seeking medical attention.
- Attendance category
A record of whether a patient is making a planned, unplanned, first or follow up attendance at a particular A&E service.
- Discharge destination
The immediate destination of the patient on discharge from the A&E department.
Patients may be:
- admitted to the same hospital
- transferred to a different hospital or health and social care service
- discharged home or their usual place of residence, for example, a care home
- Emergency department
Includes larger A&E services that typically provide a 24-hour emergency medicine service.
They are consultant-led services.
- Episode file (E)
A detailed record for each attendance.
Includes minor injuries units (MIU), small hospitals and health centres in rural areas that carry out emergency department related activity.
Are GP or nurse-led services.
- Out of hours period
The Out of Hours time period is defined as:
- evenings – Monday to Friday, 6pm to 8am
- weekends – 6pm on Friday to 8am on Monday
- Easter, Christmas and New Year
- Referral source
A&E referral source is who makes the decision for the person to attend A&E.
This could be the:
- healthcare professional
- service – for example, the police
The referral source is recorded at reception.
Information may be taken from the GP letter of referral, as part of the handover of a patient’s care by Scottish Ambulance Service crew or as indicated by the patient or person accompanying them.
- Scottish Index of Multiple Deprivation
The Scottish Index of Multiple Deprivation is an area-based measurement of multiple deprivation ranking areas based on 38 indicators spanning seven dimensions of deprivation:
- geographic access to services
- Waiting time
The time spent in A&E, which is calculated from the date and time of arrival until the date and time of admission, transfer or discharge.