Emergency department pressures rise despite stable numbers, new study reveals

Research highlights critical shift in patient complexity that could challenge NHS reforms

A new study from Imperial College London has revealed that while emergency department attendance numbers appear stable following the COVID-19 pandemic, hospitals are facing increasing pressure from fundamental shifts in the types of patients seeking care.

The research, published in Emergency Medicine Journal, analysed over 3.3 million emergency department visits across Northwest London between 2017 and 2023, providing crucial insights that could reshape how the NHS approaches urgent and emergency care reform.

Rising complexity behind stable numbers 

Despite emergency department attendance stabilising after the COVID-19 pandemic, this apparent plateau masks important changes in who is attending. Attendance among older adults, particularly those aged 61 years and over, has continued to rise, alongside sustained increases in attendances by patients with multimorbidity and complex multimorbidity. The proportion of patients with multimorbidity rose from 24% in early 2017 to 38% by late 2023, an increase that represents a sustained shift rather than a temporary post-pandemic effect.

Lead author Dr Ahmad Alkhatib from Imperial College London's Department of Primary Care and Public Health explained: "Stable headline attendance figures can be misleading. They obscure the growing intensity and complexity of demand faced by emergency care services. Case-mix complexity is a critical but often overlooked driver of emergency department pressure."

Implications for NHS policy

The timing of this research is particularly significant, as it directly relates to the new NHS Urgent and Emergency Care Plan for 2025/26, which focuses primarily on improving patient flow and reducing waiting times.

The study suggests that while the NHS plan acknowledges factors such as frailty, it does not systematically address rising patient complexity as a driver of emergency department strain. The research provides population-level evidence showing why flow-focused reforms alone may not effectively resolve system pressures.

Dr Alkhatib noted: "Truly effective solutions will require a better understanding of these case mix changes and targeted holistic strategies to address them. Our findings indicate that strategies specifically targeting older, multimorbid, and high-complexity patients are essential."

The study used comprehensive data from the Whole Systems Integrated Care database, covering the entire Northwest London population of approximately 2.3 million people.
Researchers analysed trends across three distinct periods: before the pandemic, during lockdown measures, and in the post-pandemic recovery phase.

Multimorbidity on the rise 

The analysis revealed that patients with multiple long-term conditions now represent a much larger proportion of emergency department users. Among those aged 76 and older, the proportion with complex multimorbidity nearly doubled from around 30% to almost 60% between the first and last quarters of the study period.

The authors highlight the need for healthcare planners to look beyond simple attendance figures when designing interventions. As emergency departments continue to face unprecedented pressures, understanding the changing nature of demand, not just its volume, becomes crucial for developing effective solutions.

This research provides essential evidence for policymakers as they work to implement the NHS Urgent and Emergency Care Plan, suggesting that sustainable improvements will require strategies that specifically address the needs of an ageing population with increasingly complex health conditions.

The full study "Shifting patterns in emergency department attendance: a time series analysis" is published in Emergency Medicine Journal.