Survey finds improvements in patients’ urgent and emergency care experiences in England at start of second wave of Covid

Patients attending urgent and emergency care departments in England in September 2020 had better experiences overall and found departments to be cleaner compared to in 2018, according to results from a new survey published today. The proportion of patients rating their overall experience of care at 9 or 10 on a 0-10 scale rose by 5% points (from 48% to 53%) for ‘Type 1’ accident and emergency (A&E) departments and by 5% points (from 58% to 63%) for ‘Type 3’ urgent treatment centres (UTCs).

The survey, coordinated by Picker for the Care Quality Commission, gathered responses from almost 50,000 people who attended urgent and emergency care centres in September 2020. This included 41,206 people who attended ‘Type 1’ centres (major, consultant-led accident and emergency departments) and 7,424 people who attended ‘Type 3’ centres (such as minor injuries units and urgent treatment centres). These patients were seen at the start of England’s second wave of the Covid-19 pandemic [1] but before the ‘three-tier’ system and second national lockdown were imposed on the 14th and 31st October respectively. Almost one in ten (9%) of survey respondents who attended a Type 1 department were treated in a separate area because they had Covid or Covid symptoms.

Attendances at urgent and emergency care centres during this period remained markedly lower than in the prior year. Nationally, there were 1.164m Type 1 and 497 thousand Type 3 attendances – down 13% and 32% respectively compared to September 2019 [2]. Differences in demand are likely to have affected people’s experiences of waiting in urgent care departments, and it is encouraging that survey respondents typically reported shorter waits to initial assessments. The proportion who were spoken to within 15 minutes by a doctor or nurse in Type 1 A&E departments rose from 32% in 2018 to 36% in 2020; similarly, there was a 5% point increase from 35% to 40% of patients attending type 3 UTCs speaking to a healthcare professional within 15 minutes.

One of the most striking findings from the survey was around cleanliness. Compared to 2018, there were remarkable 11% increases in the proportion of patients who said ‘Type 1’ A&E departments (from 58% to 69%) and ‘Type 3’ UTCs (from 67% to 78%) were ‘very clean’. Perceptions of cleanliness may have been influenced by very visible infection control measures taken to limit the spread of Covid: almost all respondents reported seeing hand sanitisers available (95% and 97% in Type 1 and Type 3 departments respectively), staff wearing personal protective equipment (PPE; 96% and 97%), and social distancing in effect (96% and 98%). However, there were also large drops in the proportion of patients able to access food and drinks in Type 1 A&Es (down 6% points to 52%) and in Type 3 UTCs (down 13% points to 48%). Again, this likely reflects the impact of enhanced infection control and hygiene measures, which in some cases will have included removal of shared drinks stations and vending machines.

Despite the improvements in people’s overall experiences and around cleanliness, there remain areas for concern in the survey findings. There has been little progress in the quality of communication or patient involvement. As in previous years, around 3 in 10 (31%) of Type 1 A&E and 1 in 5 (21%) of Type 3 UTC attendees said they could not or could only partly understand doctors’ or nurses’ explanations of their condition and treatment. Most concerningly, there was a sharp drop in the proportion of Type 1 A&E attendees who said that doctors or nurses ‘completely’ discussed their fears or anxieties with them – down 5% points from 57% in 2018 to 51% in 2020.

Commenting on the results, Chris Graham, Chief Executive of Picker, said:

These results provide detailed insight into people’s experiences of urgent and emergency care at the start of England’s second wave of Covid. Although patients completing the survey received their care before infection rates began to rise precipitously in October, the effect of the pandemic on how services are organised and delivered is evident in the results. Some of these impacts are positive: NHS organisations have made remarkable progress around cleanliness and infection control, waiting times for initial assessments have improved, and patients are reporting more positive overall experiences. In the context of the wider challenges facing the health and social care system in 2020, these improvements should be celebrated.

Despite these positives, the survey continues to show significant room for improvement around communication and involvement, two fundamental aspects of high quality person centred care. As the health service begins the process of recovery from the pandemic it is vital that these crucial areas of relational care are nurtured and not neglected, as they are vital to ensuring that all patients have good experiences of urgent and emergency care. We urge all NHS providers to review their results carefully and to work with staff and patients to put in place plans for improvement.

[1] Source: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/articles/coronaviruscovid19infectionsurveytechnicalarticle/wavesandlagsofcovid19inenglandjune2021
[2] Sources: https://www.england.nhs.uk/statistics/statistical-work-areas/ae-waiting-times-and-activity/ae-attendances-and-emergency-admissions-2020-21/ and https://www.england.nhs.uk/statistics/statistical-work-areas/ae-waiting-times-and-activity/ae-attendances-and-emergency-admissions-2019-20/

Notes for editors

• The 2020 Urgent and Emergency Care Survey was conducted by Picker on behalf of the Care Quality Commission, and received a total of 48,630 responses.
• Survey fieldwork took place from November 2020 to March 2021. Some smaller Type 3 departments included patients attending in August as well as September, but this represents a minority of all responses.
• Definitions of the types of A & E services can be seen here.
• Type 1 survey – A total of 126 NHS trusts took part in the survey, 59 of these trusts also submitted a Type 3 sample, as they directly run a Type 3 department.
• Type 1 survey received responses from 41,206 patients, a response rate of 30% (same as 2018).
• Type 3 survey received responses from 7,424 patients, a response rate of 31%, up from 29% in 2018.
• Please note that whilst percentages are reported without decimals, differences have been calculated with more precise data. This may mean apparent inconsistencies due to rounding: for example, where a percentage has fallen 5% points from 57% to 51%.
• Full details of the survey methodology, questions, and results are available on the dedicated survey website.
• Chris Graham is available for media interview. To arrange your interview, or if you have any other media enquiries, please contact Greig Box Turnbull at Fortitude Communications – gbt@fortitudecommunications.com or the Communications Manager at Picker, Emma Newton – emma.newton@pickereurope.ac.uk.