Most patients treated in NHS emergency and urgent care departments report good experiences, but problems experienced by a sizable minority show that there remains considerable scope for improvement.
The findings are included in the results of a survey published today by the Care Quality Commission and Picker. More than 50,000 people treated in September 2018 responded to the survey: 85% of these patients had attended a ‘type 1’ major accident and emergency department, with the remaining 15% attending ‘type 3’ urgent care centres and minor injuries units. The survey asked people about all aspects of their experience from attending to discharge, and focussed on issues identified as being important to people who use services.
Effective communication with trusted professionals is very important to patients, particularly in an emergency. There were small improvements in the proportion of ‘type 1’ attendees who said that they ‘definitely’ had confidence and trust in (76% in 2018 vs 75% in 2016) and time to discuss their condition with doctors and nurses (75% in 2018 vs 73% in 2016) – but one in four patients reported room for improvement in these key questions. This is a concern because evidence shows that effective communication is positively associated with better patient outcomes, as well as providing important reassurance to people at a stressful time.
Similarly, the survey identified a need for improvement around the information given to people on discharge. Half of all attendees at major A&E departments (49%) said that they were not ‘completely’ told what symptoms to watch for regarding their condition after they went home; one in four (25%) were given no information about this. Less than three fifths (59%) were “definitely” given enough information to help care for themselves at home. Addressing these issues is important not just for patients and their families but also for the NHS: one in eight (13%) of all respondents who attended a major A&E reported that they had previously attended the same department about the same condition within the last month. Avoiding repeat attendances helps to take the pressure of busy departments.
Waiting times in major A&Es continue to be a challenge. As in 2016, one third (33%) of respondents said that they waited more than one hour to be examined or treated. Longer waits were less common in ‘type 3’ departments, where less than a quarter (23%) of patients waited more than an hour to be examined or treated.
Responding to the results, Chris Graham, Picker’s CEO said:
Today’s findings show only marginal improvements in people’s experiences of emergency and urgent care in the NHS between 2016 and 2018. The lack of progress is disappointing given the system’s policy focus on person centred care – but it is also reassuring, given the widely reported pressures on emergency departments, that standards have at least been maintained from the patient perspective.
It is important to note that the survey covers people treated in September. Official statistics have shown that demand on emergency and urgent care system increased sharply over winter 2018/19 and has remained at an elevated level. For 2019, the total number of A&E attendances for the month of September was 7% higher than last year: this has led to a 30% increase in the proportion of patients spending more than 4 hours in A&E[i]. Ensuring that patient’s experiences of care are maintained in the face of this rising demand is undoubtedly a challenge and it is important that professionals are supported to deliver the standard of care that they aspire to.
Results from the survey are available now, and further details about the survey can be found here. Detailed results are available for all NHS trusts – we encourage providers to review these to identify areas for improvement and to celebrate successes.