Warning over ‘long term decline’ in A&E as patients’ experience getting far worse

The CQC warned of long waits for emergency care as patients reported not always getting help

The NHS’ safety watchdog has issued a warning over the “long term decline” in emergency care as the number of patients in A&E for more than 12 hours more than doubled in three years.

Health and care regulator the Care Quality Commission found the number had risen from six per cent in 2020 to 15 per cent in 2022, as waiting times increased significantly for both A&E and urgent care centres across the country.

Thirty-two per cent of patients in A&E waited more than an hour to speak to a doctor or nurse - up from 15 per cent in 2020, 19 per cent in 2018 and 18 per cent in 2016.

Meanwhile, the proportion who said they waited longer than four hours to be examined in A&E in 2022 more than trebled to 17 per cent– up from four per cent in 2020 and five per cent in 2018.

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The CQC’s findings came after it surveyed more than 36,000 people who used NHS urgent and emergency care services in England in September 2022.

The survey found that people who said they could “always” get help from medical staff in A&E dropped from 58 per cent in 2020 to 45 per cent in 2022. The figure was 57 per cent in both 2018 and 2016.

It comes after The Independent repeatedly revealed the true scale of patients forced to wait for more than 12 hours in A&E with 50,000 patients a week recorded during the winter “crisis” in December. This was up from 10,000 a week at the onset of the Covid pandemic.

Dr Sean O’Kelly, CQC’s chief inspector of healthcare, said: “These latest survey responses demonstrate how escalating demand for urgent and emergency care is both impacting on patients’ experience and increasing staff pressures to unsustainable levels.

“Staff are working extremely hard amidst challenging circumstances. We see that reflected in these results.

Dr O’Kelly added: “We cannot afford to ignore the long-term decline shown in relation to issues like waiting times, the information provided when people leave to go home, access to pain relief and emotional support.”

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 per cent, 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 with 40 per cent reporting this, followed by being unsure their GP would be able to help with their condition at 24 per cent.

However, just four per cent of patients said their main reason for going to A&E was because they could not find a GP appointment quickly enough.

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

More than one in 10 of those who used an urgent treatment centre said they could not get a GP appointment quickly enough at 17per cent – an increase on the 12 per cent 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

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 per cent, compared with 81 per cent in 2020, 79 per cent in 2018 and 78 per cent in 2016.

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

The CQC said people in A&E were more likely to report a negative experience if they were frail, or 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.