Watchdog concerns over A&E patients' pain relief and care as winter crisis looms
by Ella Pickover and Storm Newton PA · ChronicleLiveConcerns have been raised about the care and support people receive while facing long waits in A&E.
A major new survey has found that many emergency care patients felt they were not able to get help with their condition while waiting.
And more than a quarter said they were given no pain relief while in the queue to see a medic.
The survey results have prompted concerns about patient experience as the NHS heads into winter, which is traditionally a busy time for emergency and urgent care services.
The health watchdog, the Care Quality Commission (CQC), published the results of a survey of 45,500 people who used NHS urgent and emergency care services (UEC) in England this year. The CQC said that the "stream of demand" for care is driving lengthy waits for some and causing "difficultly for some patients in accessing information, emotional support and adequate pain relief".
The survey found:
- Among A&E patients, 60% said they felt that doctors or nurses "completely" explained their condition or treatment to them in a way that they could understand, more than a quarter (28%) said this only happened "to some extent" and 11% said it did not happen at all.
- Of the 27% of survey respondents who arrived at A&E by ambulance, 61% said they were handed over to A&E staff within 15 minutes, but 17% reported waiting more than an hour.
- Over a quarter (28%) of patients treated at a major A&E centre, who responded to the survey, reported waiting for more than an hour to be assessed by a nurse or doctor after arriving at A&E. Additionally, 47% stated they were unable to receive help with their condition or symptoms while waiting.
- Nearly two-thirds (64%) of patients revealed they waited more than four hours to be admitted, transferred or discharged at A&E.
- For those requiring assistance with medications for a pre-existing medical condition while in the department, over a quarter of urgent treatment centre (UTC) respondents (26%) and a similar proportion of A&E respondents (28%) claimed they did not receive that help.
- Less than half of people attending either an A&E (42%) or an urgent treatment centre (47%) who needed help with pain relief believed that staff "definitely" helped them control their pain. Moreover, over a quarter in both services said they were not given any help with pain relief – 27% in A&E and 26% in an urgent treatment centre.
The CQC indicated that the results also demonstrate "scope for improvements in discharge" after a third of patients seen in A&E reported they were not provided information on how to care for their condition at home.
One in five (21%) of people discharged from an A&E department claimed that they were not informed who to contact if they were worried about their condition or treatment after leaving A&E. .
Nearly a third of A&E patients and almost a quarter of those attending urgent treatment centres (UTCs) reported that hospital staff failed to discuss their ongoing health and social care needs before discharging them. The CQC noted that difficulty in securing a prompt GP appointment and a desire for same-day treatment were key factors driving people to seek urgent and emergency care.
Chris Dzikiti, the CQC's interim chief inspector of healthcare, commented: "Urgent and emergency care services nationally continue to be under intense pressure – something reflected in recent national performance data, something we hear first-hand from frontline clinicians and something that is further evident in today’s survey findings.
"The results demonstrate how the stream of demand is continuing to drive lengthy waits, and cause difficultly for some patients in accessing information, emotional support and adequate pain relief.
"They also show the impact for staff when the number of people seeking urgent and emergency care is so high and resources are stretched.
"With pressures on services only likely to increase as we head into winter, ensuring the best possible experience throughout the entirety of the patient journey is a task that needs input from all parts of the health and care system.
"Over a third of people surveyed went to A&E before contacting another service and of those that did seek help elsewhere first, many said they were directed to A&E. We must support services in their efforts to collaborate locally, ensure a joined-up approach and help people to access the care they need, when they need it from the service that is best able to deliver.
Dr Adrian Boyle, president of the Royal College of Emergency Medicine, commented on the report's findings, highlighting that "patients are suffering the consequences of a system that is in crisis, while staff continue to shoulder the burden of delivering effective and safe care in these conditions".
He added: "Issues within and outside the emergency department are negatively impacting patients’ experiences, as seen in this survey, with a high proportion enduring long wait times due to the lack of in-patient beds and inability to discharge people who are well enough to go home.
"No emergency department clinician wants to be treating a patient who is vulnerable and in need of care in a corridor and no patient wants to be put in this position. It’s degrading, demoralising and dangerous."
"The pressure in EDs will only continue to mount as we head into winter, when we know the inevitable spike in demand will hit."
"Those in power need to read the results of this survey, hear the voices of the patients who have expressed their experiences and concerns, and act on them now."
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