“Sharp declines in many areas of people’s experiences of urgent and emergency care” are reported following a survey of 36,000 people in 2022

More people are facing long waits and reporting poor experiences in NHS urgent and emergency care departments, according to results from a new survey published today. The proportion of people waiting more than one hour in major A&E departments before first speaking to a nurse or doctor has more than doubled since 2020, from 15% to 32% – and almost two thirds (64%) report that their A&E visits lasted more than 4 hours.

The results, from a survey of more than 36,000 people coordinated by Picker for the Care Quality Commission (CQC), show sharp declines in many areas of people’s experiences of urgent and emergency care since the pandemic.
Whilst some of the largest declines are around waiting times, these generally mirror trends shown in other datasets – albeit that data from the patient survey suggests that longer waits may be more common compared to what is recorded in hospital activity data. This is discussed further below.

What is unique to the survey, however, is the detailed insight it provides about people’s experiences of care whilst in urgent and emergency care settings.

Again, there were a number of worrying declines. In ‘type 1’ accident and emergency departments: Only two thirds of patients (66%) said that they “definitely” had enough time to discuss their condition with a doctor or nurse – down from 74% in 2020. More than half of patients (56%) who reported that they needed help with their condition or symptoms whilst they were waiting in A&E said that they were unable to get this from a member of staff – an increase of 11% points from 45% in 2020. Similarly, one in six patients (16%) who needed attention could not find a member of staff to help them – a substantial increase from 9% in 2020. More than a quarter of patients (28%) said that they were not or only “some of the time” treated with respect and dignity: an increase from 19% in 2020.

There were similar declines in people’s experiences of ‘type 3’ departments, which include minor injuries units and urgent treatment centres. In these: The proportion who said that a member of staff “completely” explained why they needed any tests fell from 87% in 2020 in 79% in 2022. Less than half (49%) said that they “definitely” had enough privacy when discussing their condition with receptionist, compared to 59% in 2020.

But type 3 departments, which represent a growing share of urgent and emergency care (increasing from 29% in September 2020 to 33% in September 2022) also provided some more positive results. For example, 84% of people attending type 3 departments said that health professionals “definitely” listened to what they had to say: a figure unchanged since 2020.

Commenting on the results, Chris Graham, CEO of Picker, said:

Today’s survey results confirm what we already knew – that waiting times in A&E and other urgent care departments have risen precipitously since the pandemic. Whilst waiting times can be a crude measure of quality, it is particularly alarming to note that the proportion of people waiting more than an hour in A&E before speaking to a doctor or nurse has doubled to almost one in three. Early clinical assessment is important both for people’s experiences of care and for effective triage.

Whilst an increase in waiting times is not surprising, the survey shows the impact that this is having on people’s experiences of care. People who reported waits of longer than four hours reported significantly worse experiences on average of almost all other areas of care and treatment, and there were declines in the quality of communication, involvement, and care coordination experienced by patients. Many of these changes were substantial, mirroring large declines in satisfaction and experience reported in other recent surveys. Urgent and emergency care services are now themselves in need of urgent attention to arrest and reverse these declines

Differences in waiting times reported by patients and NHS providers

The waiting times reported by patients are worse than those reported in hospital activity monitoring data for the month of September 2022, when patients in the survey were treated. For example, 64% of respondents say that their A&E visits lasted more than four hours, whilst hospital activity data records that 43% of people treated at type 1 departments were not admitted, discharged, or transferred within four hours. Similarly, the proportion of people spending more than four hours in a type 3 department was much higher in the survey (17%; up from 8% in 2020) was much higher than the 4% in NHS activity data.

There may be a number of reasons for this difference. Patients’ perceptions of waiting may be different to official data because they may not recognise a transfer or admission as representing the ‘end’ of an A&E episode, particularly if they are admitted for continued assessment. Alternatively, it may be that people who had longer waits are more likely to respond to the survey – either due to some common cause related to their health and care (such as less serious underlying conditions) or because they want to share a poor experience.

Whilst there are differences in the overall rate of long episodes recorded in the different datasets, they show similar trends. For September 2020, the survey reported that 39% of patients waited for more than four hours in type 1 departments, compared to a figure of 18% from hospital activity data.

Ends

Notes to editors

• The 2022 Urgent and Emergency Care Survey was coordinated by Picker on behalf of the Care Quality Commission (CQC). Picker (www.picker.org) is a health and care research charity with a vision of the highest quality person centred care for all, always. The Care Quality Commission (www.cqc.org.uk) are the independent regulator of health and adult social care in England.
• 122 NHS trusts providing urgent and emergency care services in England took part in the survey. Of these, 59 trusts had at least one type 3 department.
• In total, 134,783 people were invited to participate in the type 1 survey, and 29,357 responded: this represents a response rate of 22.6% once undelivered surveys and ineligible recipients are accounted for.
• In total, 34,220 people were invited to participate in the type 3 survey, and 7,418 responded: this represents a response rate of 22.1% once undelivered surveys and ineligible recipients are accounted for.
• The survey included people who attended a type 1 or type 3 urgent or emergency care centre in September 2022. For some trusts with smaller type 3 departments, people who attended in August 2022 were also included. Trusts with only a type 1 department selected a sample of 1250 patients. Trusts with both type 1 and type 3 departments selected a sample of 950 type 1 and 580 type 3 attendances (a total of 1,530 patients per trust).
• Type 1 and type 3 departments are defined below. Further details of the sampling methodology are available from https://nhssurveys.org/surveys/survey/03-urgent-emergency-care/year/2022/.
• Type 1 department: a major, consultant led A&E Department with full resuscitation facilities and designated accommodation for the reception of A&E patients which operates 24 hours a day, 7 days a week.
• Type 3 department: another type of A&E/minor injury activity with designated accommodation for the reception of A&E patients. The department may be doctor-led or nurse-led and treats at least minor injuries and illnesses and can be routinely accessed without appointment. Type 3 departments are often called Urgent Treatment Centres (UTC), Urgent Care Centres (UCC) or Minor Injury Units (MIU). A service that is mainly or entirely appointment-based (for example a GP practice or out-patient clinic) is excluded even though it may treat a number of patients with minor illness or injury. Walk-in centres are not classed as Type 3 departments.
• For all media enquiries please contact Greig Box Turnbull at Fortitude Communications – gbt@fortitudecommunications.com or the Marketing & Communications Manager at Picker, Lorraine Pullen – pressoffice@pickereurope.ac.uk Mobile: 07825 952160