Information is collected on every patient that attends accident and emergency (A and E). However, there is currently no central collection of these data. In 1999 it was decided to collect data on all A and E attendances in the West Midlands region. All 21 hospitals with 24 h A and E departments were asked to submit data to the Surveillance Centre at the University of Birmingham. To date, 19 hospitals have submitted data but the formats vary leading to a substantial amount of data processing. There are several limitations to the data set, for example a lack of information on the reasons for attendance. Despite this, routinely collected A and E data have great potential for surveillance and the data have been used in original research and to guide local policy. The West Midlands system is the largest source of A and E data in the United Kingdom. This information is of use to a wide range of organizations.