{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:58:45Z","timestamp":1791421125754,"version":"4.3.3"},"reference-count":23,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2024,11,1]],"date-time":"2024-11-01T00:00:00Z","timestamp":1730419200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Norfolk County Council","award":["R210935"],"award-info":[{"award-number":["R210935"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Access to and use of urgent and emergency care in the United Kingdom\u2019s National Health Service reduced during COVID-19 related lockdowns but demand reportedly increased since then. We investigated the impact of COVID-19 on urgent and emergency health care services activity in an eastern England population of 1.1 million.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We used health care activity data from a municipal health department, recorded at the level of discrete events (such as visits to hospital or ambulance calls) to compare system activity between 2018\u20132020 (pre-COVID), 2020\u20132021 (lockdown) and 2021\u20132023 (post-lockdown), carrying out interrupted time series analyses to describe changes in activity.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Daily emergency department (ED) attendances were 10% (95% confidence interval 9\u201312%) lower during the lockdown period, and 7% (6\u20138%) higher in the post-lockdown period than pre-COVID. Attendances arriving by ambulance were 13% (12\u201314%) lower post-lockdown than pre-COVID, while attendances of arrivals by other means were 17% (16\u201319%) higher. Post-lockdown, overall attendances were continually reducing. ED waiting times were 45% (44\u201347%) longer in the post-lockdown period compared to the pre-COVID period and continued to increase post-lockdown. There was a 15% (14\u201316%) reduction in daily ambulance dispatches post-lockdown versus pre-COVID. Ambulance arrivals with delayed handover to hospital care exceeding 60 minutes increased by 17% (16\u201318%) post-lockdown versus pre-COVID, and probability of delay showed a continuously upward trend post-lockdown of 20% (19\u201321%) per year.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Patients are facing long waits in EDs to be admitted to hospital, discharged or transferred. This results in delays in ambulances handing over patients and attending to other calls, which may explain decreasing rates of ambulance dispatches. Potential solutions are likely to involve enhancing the flow through and discharge of patients from hospital, and a whole systems approach which considers the capacity of the local health and care infrastructure, including intermediate care and social care.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0311901","type":"journal-article","created":{"date-parts":[[2024,11,1]],"date-time":"2024-11-01T17:30:52Z","timestamp":1730482252000},"page":"e0311901","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Changes in urgent and emergency care activity associated with COVID-19 lockdowns in a sub-region in the East of England: Interrupted times series analyses"],"prefix":"10.1371","volume":"19","author":[{"given":"Zillur Rahman","family":"Shabuz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1770-3506","authenticated-orcid":true,"given":"Max","family":"Bachmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8989-2389","authenticated-orcid":true,"given":"Rachel","family":"Cullum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7905-8947","authenticated-orcid":true,"given":"Amanda","family":"Burke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9791-0760","authenticated-orcid":true,"given":"Charlotte Emily Louise","family":"Jones","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4287-7145","authenticated-orcid":true,"given":"Oby Otu","family":"Enwo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice M.","family":"Dalton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5272-7995","authenticated-orcid":true,"given":"Julii","family":"Brainard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9109-6164","authenticated-orcid":true,"given":"Michael","family":"Saunders","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Steel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,11,1]]},"reference":[{"key":"pone.0311901.ref001","author":"Department of Health & Social Care and Public Health England","year":"2023","journal-title":"Handbook to the NHS Constitution for England"},{"key":"pone.0311901.ref002","year":"2022","journal-title":"The King\u2019s Fund. What\u2019s going on with A&E waiting times?"},{"key":"pone.0311901.ref003","author":"NHS England","journal-title":"A&E Attendances and Emergency Admissions 2011\u20132023"},{"key":"pone.0311901.ref004","author":"I Boyle AH","year":"2021","journal-title":"Crowding and its Consequences"},{"key":"pone.0311901.ref005","author":"NHS England","journal-title":"About urgent and emergency care"},{"key":"pone.0311901.ref006","author":"Ipsos Mori Social Research Institute","year":"2021","journal-title":"GP Patient Survey."},{"issue":"1","key":"pone.0311901.ref007","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1111\/bjhp.12615","article-title":"\u201cI have travelled along on my own\u201d\u2014Experiences of seeking help for serious non-COVID health problems during the COVID-19 pandemic: A qualitative study.","volume":"28","author":"HM Parretti","year":"2023","journal-title":"British Journal of Health Psychology"},{"key":"pone.0311901.ref008","article-title":"How has uptake of the NHS Health Check changed over time?:","author":"Public Health England","year":"2021","journal-title":"Nuffield Trust"},{"key":"pone.0311901.ref009","first-page":"1","article-title":"Tackling the elective case backlog generated by Covid-19: the scale of the problem and solutions","author":"N Macdonald","year":"2020","journal-title":"Health Policy Journal of Public Health"},{"issue":"1","key":"pone.0311901.ref010","first-page":"26","article-title":"Decreasing Wellbeing and Increasing Use of Negative Coping Strategies: The Effect of the COVID-19 Pandemic on the UK Health and Social Care Workforce","volume":"3","author":"P Gillen","year":"2022","journal-title":"Epidemiologia 2022, Vol 3, Pages 26\u201339."},{"issue":"11","key":"pone.0311901.ref011","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1177\/0141076820962447","article-title":"Impact of COVID-19 on accident and emergency attendances and emergency and planned hospital admissions in Scotland: an interrupted time-series analysis.","volume":"113","author":"RH Mulholland","year":"2020","journal-title":"J R Soc Med."},{"issue":"1","key":"pone.0311901.ref012","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1186\/s12913-021-07008-9","article-title":"The impact of the COVID-19 pandemic on patterns of attendance at emergency departments in two large London hospitals: an observational study.","volume":"21","author":"MAC Vollmer","year":"2021","journal-title":"BMC Health Services Research"},{"issue":"3","key":"pone.0311901.ref013","doi-asserted-by":"crossref","first-page":"603","DOI":"10.5811\/westjem.2021.2.49614","article-title":"Changes in Emergency Department Activity and the First COVID-19 Lockdown: A Cross-sectional Study.","volume":"22","author":"K Honeyford","year":"2021","journal-title":"West J Emerg Med."},{"key":"pone.0311901.ref014","year":"2023","journal-title":"Norfolk and Waveney Integrated Care System"},{"key":"pone.0311901.ref015","author":"CRAN","year":"2023","journal-title":"R statistical software. 4.2.2 ed"},{"key":"pone.0311901.ref016","author":"Nuffield Trust","year":"2023","journal-title":"Ambulance handover delays"},{"key":"pone.0311901.ref017","article-title":"Why have ambulance waiting times been getting worse?:","author":"A Alarilla","year":"2023","journal-title":"The Health Foundation"},{"key":"pone.0311901.ref018","volume-title":"Access to unplanned or urgent care","author":"Department of Health & Social Care","year":"2023"},{"key":"pone.0311901.ref019","author":"Department of Health & Social Care","year":"2023","journal-title":"Delivery plan for recovering urgent and emergency care services"},{"key":"pone.0311901.ref020","article-title":"Hospital Accident & Emergency Activity, 2018\u201319.","author":"NHS Digital","journal-title":"Tables 11a and 11c"},{"key":"pone.0311901.ref021","article-title":"Hospital Accident & Emergency Activity, 2022\u201323.","author":"NHS Digital","journal-title":"Tables 1a and 1c"},{"key":"pone.0311901.ref022","author":"Office for Health Improvement & Disparities (OHID).","journal-title":"Fingertips Public Health Profiles; Care Home Beds per 100 people 75+ 2011\u20132021"},{"issue":"5","key":"pone.0311901.ref023","doi-asserted-by":"crossref","first-page":"e0303270","DOI":"10.1371\/journal.pone.0303270","article-title":"Association between emergency department attendances, sociodemographic factors and long-term health conditions in the population of Norfolk and Waveney, England: Cross sectional study.","volume":"19","author":"C Jones","journal-title":"PLoS One."}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0311901","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,1]],"date-time":"2024-11-01T17:31:12Z","timestamp":1730482272000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0311901"}},"subtitle":[],"editor":[{"given":"Niklas","family":"Bobrovitz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,11,1]]},"references-count":23,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2024,11,1]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0311901","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,1]]}}}