CQC survey: ‘Very good’ overall experience of urgent and emergency care with improvements needed in other areas

Published today (Wednesday 15 September) 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 or minor injury unit (Type 3) run directly by one of 126 acute hospital trusts in England during September 2020.

The majority of those surveyed were positive about many aspects of their care and treatment:

• A third of people (33%) who had attended a Type 1 department and
• 44% of people who had visited a Type 3 department said their overall experience was ‘very good’ rating it ten out of ten – an increase from 29% of Type 1 respondents and
• 37% of Type 3 respondents who gave the top score in 2018, when the survey was last carried out. 

Over three quarters of people (77%) who were treated in a Type 1 department said they ‘definitely’ had confidence and trust in the staff examining and treating them (up from 76% in 2018), and 81% felt they were treated with respect and dignity ‘all of the time’ while in A&E (up from 79% in 2018).

People who had been treated at a Type 3 service were also positive about their interactions with staff. Eighty-six per cent felt that the staff they saw ‘definitely’ listened to what they had to say and 91% said that they were ‘definitely’ given enough privacy when being examined or treated.

Across the survey as a whole, the biggest positive change was in people’s perceptions of cleanliness. Just under seven in ten (69%) Type 1 patients said the A&E department was ‘very clean’ compared to 58% who said this in 2018. And for Type 3 services, 78% said the same about the cleanliness of the urgent treatment centre or minor injury unit where they were treated (up from 67% in 2018). For both types of department this is a significant increase and is likely to reflect the enhanced infection control and prevention measures introduced in response to the COVID-19 pandemic.

Responses to questions on waiting times show that the concerns about lengthy delays found in previous urgent and emergency care surveys were not evident to the same extent in 2020.The proportion of Type 1 patients who reported that they first spoke to a nurse or doctor within 15 minutes increased from 32% in 2018 to 36% in 2020. In addition, only 15% of people said they waited more than 60 minutes in A&E compared to 19% in 2018. 

These results should be considered in the broader context of urgent and emergency care demand during the survey sample month of September 2020. At this point attendances had begun to increase slightly following a sharp decline during the first wave of the pandemic but were not at levels seen pre Covid. Compared to previous surveys in 2018 and 2016, Type 1 attendances were down 8% and 9% respectively, whilst Type 3 attendances were down 28% and 20% respectively. 

While many responses reflect a positive experience, the 2020 survey also identified some areas where NHS trusts could improve.

Under two thirds (63%) of Type 1 patients said that they were ‘definitely’ involved as much as they wanted to be in decisions about their care and treatment - compared to 65% who said this in 2018.

Similarly there was a decline in the number of people who said if they had any anxieties or fears about their condition or treatment, a doctor or nurse in the A&E department ‘completely’ discussed this with them – falling from 57% in 2018 to 51% in 2020.

Across both service types, less than two thirds (60% of Type 1 respondents and 63% of Type 3 respondents) felt that staff ‘definitely’ did everything they could to help control their pain. And, just under half of patients (45%) who said that they needed help with their condition or symptoms while they were waiting to be treated in A&E felt they were not able to get that help from staff.

The results also showed scope for improvements at discharge from A&E. Four in 10 (40%) Type 1 patients said they were not given enough information about medication side effects, (up from 38% in 2018) and just six in ten (60%) said that staff ‘definitely’ gave them enough information to help care for their condition at home.

Ted Baker, CQC’s Chief Inspector of Hospitals, said: 

“This year’s survey shows some encouraging improvements with trust and confidence in clinicians, perceptions of cleanliness and overall experience all performing better than in previous years.

“This is a testament to the efforts of healthcare professionals working tirelessly to provide high quality urgent and emergency care in the context of increasing pressures and the added challenges brought by the Covid pandemic. However, the scope for further improvement remains. Access to emotional support, help with pain relief and information provided at discharge were all areas where some people surveyed were less positive. This is feedback that hospital trusts can use to help inform action at a local level that ensures all patients have a consistently positive experience.

“It is important to note that this survey was conducted last year, at a time when concerns about Covid saw a significant reduction in patients seeking urgent and emergency care, with Type 3 attendances – the service where people were most likely to report their experience as being ‘very good’ - down 28% from the last survey in 2018.

“The current challenges faced by NHS hospital services include a significant increase in demand impacting on both patients and staff. We are now seeing record levels of attendances at emergency departments and this is affecting patients’ experience of care and creating pressure on staff that cannot be sustained long term.

“These pressures can only be tackled by services working together in a truly integrated way. As a priority, urgent and emergency care needs the support of the whole hospital and the surrounding local health and social care system to tackle the wider capacity problem that exists. Innovative solutions must be found that prioritise patient safety at every stage of the pathway. In the longer term the whole model of how we provide urgent and emergency care needs to be revisited.

“In some areas we have seen positive steps to adopt a whole system approach during Covid and we must build on that to inform a new model of urgent and emergency care that is equipped to manage heightened demand going forward.”

In addition to a report on the findings for England, CQC has published the results for each of the 126 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.

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