People’s experience of A&E getting far worse, report warns

Waiting times have increased for both A&E and urgent care centres and people feel less likely to get help, the Care Quality Commission found.

Patients are suffering longer waits in A&E and sometimes go there because they believe GPs cannot help, a new survey has found (Jeff Moore/PA) (PA Wire)

People’s experience of A&E is getting far worse, with long waits to be seen and patients not always getting help, according to a new report.

Hospital regulator the Care Quality Commission (CQC) surveyed more than 36,000 people who used NHS urgent and emergency care services in England in September 2022.

The results showed that waiting times have increased significantly for both A&E and urgent care centres, with 32% of people in A&E waiting more than an hour to speak to a doctor or nurse (compared with 15% in 2020, 19% in 2018 and 18% in 2016).

The proportion who said they waited longer than four hours to be examined in A&E in 2022 more than trebled to 17% – up from 4% in 2020 and 5% in 2018.

Furthermore, being able to get help when needed from medical or nursing staff at any point during an A&E attendance also fell compared with previous years.

People who said they could “always” get help dropped from 58% in 2020 to 45% in 2022 (the figure was 57% in both 2018 and 2016).

Three-quarters (76%) of people in A&E were also not told how long their wait would be, the survey found.

The CQC has previously said that high call volumes and staff shortages in NHS 111 are leading to delays in people receiving medical advice and more people going to A&E.

A lack of available GP and dental appointments means that NHS 111 cannot always send people to those, leading to people being asked to call 999 or go to A&E instead, it added.

In the new poll, more than a third (37%) of people who used A&E said it was the first service they went to, or contacted, for help with their condition.

Their top reasons for going straight to A&E were that they thought they might need tests (40%), followed by being unsure their GP would be able to help with their condition (24%).

People who had contacted another service first before going to A&E were most likely to say they contacted NHS 111 by phone (39%), followed by their GP practice (34%), or 999.

Meanwhile, more than half (53%) of people who used an urgent treatment centre also said it was the first service they went to, or contacted, for help.

The main reasons were the condition was urgent (51%), they were unsure their GP would be able to help (25%), and the urgent treatment centre was easy to get to.

More than one in 10 of those who used an urgent treatment centre said they could not get a GP appointment quickly enough (17%) – an increase on the 12% in 2020 during the pandemic.

The poll also looked at dignity and privacy in A&E, and found that people were less likely to feel they had enough privacy at reception and during examination and treatment.

Staff are working extremely hard amidst challenging circumstances

Dr Sean O'Kelly, Care Quality Commission

In 2022, less than half (45%) of patients felt they “definitely” had enough privacy when discussing their condition with a receptionist, compared with 55% in 2020 during the pandemic.

Similarly, fewer people felt they had enough privacy while being examined and treated (78% compared with 84% in 2020, 83% in 2018 and 82% in 2016).

Other declining standards compared with previous years included the proportion of people who said staff “definitely” did everything they could to control their pain, and levels of patient confidence and trust in doctors and nurses examining and treating them.

The proportion of people feeling they were treated with respect and dignity declined to 72%, compared with 81% in 2020, 79% in 2018 and 78% in 2016.

Less than half (46%) of A&E patients were also “completely” told about what symptoms to watch for when they went home, compared with 53% in 2020 and 51% in 2018.

The CQC said people in A&E were more likely to report a negative experience if they were frail, disabled, if their visit lasted longer than four hours or if they had been to the same A&E for the same condition within the previous week.

We cannot afford to ignore the long-term decline shown in relation to issues like waiting times, information provided when people leave to go home, access to pain relief and emotional support

Dr Sean O'Kelly, Care Quality Commission

Dr Sean O’Kelly, the CQC’s chief inspector of healthcare, said “staff are working extremely hard amidst challenging circumstances”, but added: “We cannot afford to ignore the long-term decline shown in relation to issues like waiting times, information provided when people leave to go home, access to pain relief and emotional support.”

Professor Kamila Hawthorne, chairwoman of the Royal College of GPs, said: “At present, demand for general practice services is exceeding its capacity.

“When general practice is under pressure, and through no fault of hardworking GPs and their teams, patients are finding it difficult to access our care, this does reverberate across the NHS.

“GP teams make the vast majority of NHS patient contacts and in doing so alleviate pressure across the NHS, including in A&E, but for this to work, general practice must be properly resourced and properly staffed – and currently that is not the case.

“We need to see the foundations of the recently announced long-term workforce plan laid now, alongside significant investment for hugely improved retention initiatives – curbing the rate at which GPs leave the profession and encouraging in the next roster of young GPs to bolster the workforce.”

An NHS spokeswoman said: “Since this survey was carried out, NHS staff have delivered significant improvements in performance with faster ambulance response times and a greater number of patients being seen in A&E within four hours in June – this is despite unprecedented levels of demand, pressures on patient flow and industrial action.

“These findings also demonstrate how patients value the hard work and care from staff, with the vast majority of respondents having confidence and trust in health professionals, and we will continue to work with local services to deliver measures outlined in our urgent and emergency care recovery plan to improve the experience for patients and boost capacity ahead of winter.”