The findings from a survey of more than 45,500 people who used NHS urgent and emergency care (UEC) services in 2024 show that many were broadly positive about their interactions with staff. However, a number faced lengthy waits to be assessed, and some were not given enough help to manage their pain or control their symptoms.
Published today (Thursday 21 November) by the Care Quality Commission (CQC), the survey reveals the responses from patients who attended either a major consultant-led A&E department (Type 1) or an urgent treatment centre (Type 3) run directly by one of 120 acute hospital trusts in England during February 2024.
The majority of urgent treatment centre (UTC) respondents were positive about their interactions with staff. Eighty per cent felt that the doctors and nurses they saw ‘definitely’ listened to what they had to say and most felt that they ‘definitely’ had enough time to discuss their condition and treatment (76%) with the staff treating them.
People who had been seen at an A&E service were less positive about their contact with staff. While 60% said they felt that doctors or nurses ‘completely’ explained their condition or treatment to them in a way that they could understand, over a quarter (28%) said this only happened ‘to some extent’ and 11% said it didn’t happen at all.
Reflecting on their experience as a whole, more than a third of people (38%) who had attended a Type 1 department and over half (54%) of people who had visited a Type 3 department rated their overall experience as nine or higher out of 10.
However, responses to questions about specific areas of patient experience such as ambulance handovers, waiting times and pain management were less favourable.
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 of Type 1 patients (28%) responding to the survey said they waited for more than an hour to be assessed by a nurse or doctor after arriving at A&E and 47% said they were not able to get help with their condition or symptoms while waiting.
For those waiting in A&E only 26% were informed how long they would have to wait to be examined or treated - leaving 74% who were not. Notably, 64% of patients said they waited more than four hours to be admitted, transferred or discharged at A&E, and patients whose visit lasted more than four hours reported worse than average experiences for all areas of care analysed.
Of those attending a Type 3 department who had a pre-booked appointment, 64% were assessed within the 30-minute target. However, not everyone surveyed had an arranged appointment and almost one in 5 (19%) of those without an appointment said they waited more than an hour to be seen by a healthcare professional.
For people who needed help with medications for a pre-existing medical condition while in the department, over a quarter of urgent treatment centre respondents (26%) and a similar proportion of A&E respondents (28%) said 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 thought that staff ‘definitely’ helped them control their pain. And more than a quarter in both Type 1 (27%) and Type 3 (26%) services said they were not given any help with pain relief.
The results also show scope for improvements at discharge. While two thirds of people discharged from A&E (67%) said they were given information on how to care for their condition at home, a third (33%) said they were not. One in five (21%) of people discharged from an A&E department said that they were not told who to contact if they were worried about their condition or treatment after leaving A&E. Of those respondents who felt they needed a conversation about any further health or social care after leaving A&E, 31% said staff did not discuss it with them, but they would have liked them to. And of those who tried to contact any health and social care services after leaving A&E, 28% said they were not available when needed.
Younger people aged 16-35 were more likely to report a negative experience of urgent and emergency care services as were patients with a disability, and frail patients (A&E only). Frail and disabled patients reported worse experiences with regards to being listened to and were less likely to feel they were treated with respect and dignity while in A&E.
Responses this year indicate that not being able to get a GP appointment quickly enough and wanting to be seen on the same day were both factors directly influencing people’s decisions to seek treatment at a UEC service. Of those who went directly to A&E, 20% went because they thought their GP practice would not be able to help (UTC 21%), and 26% wanted to be seen on the same day (UTC 34%). Of those who contacted another service, over a third contacted a GP (36%; UTC 48%), but 28% of those said the practice did not provide the help they needed (UTC 44%).
The survey is part of the NHS Patient Survey Programme (NPSP) and is conducted every two years. Due to the changes made to the survey methodology and sampling period this year, it is not possible to compare the 2024 urgent and emergency care survey findings with the findings from previous years.
Chris Dzikiti, CQC’s Interim Chief Inspector of Healthcare, said:
Patient feedback is incredibly important in helping shape how care is delivered. These results provide valuable insight that each participating trust can use when recognising the efforts of their staff and also to help inform work to make improvements where needed.
Urgent and emergency care services nationally continue to be under intense pressure - something reflected in recent national performance data, something we hear firsthand 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 it.
In addition to a report on the findings for England, CQC has published the results for each of the 120 individual trusts that took part so that people can see how their local services performed, and a report identifying those trusts that have performed better or worse across the survey overall.
CQC will continue to use the findings as part of its wider monitoring of the quality of hospital services and to plan and target its inspections.