Our position on urgent and emergency care
Summary
Urgent and emergency care services are currently under intense pressure. Our latest research shows public confidence in urgent care has fallen over the course of the pandemic. People are still fairly confident they will receive high-quality care, but worry they will have to wait too long to get it.
We want to see a longer-term ambition to return to previous levels of service, as well as sharing of performance data aligned to what matters most to people.
Our evidence
Negative feedback about urgent and emergency care is rising
Over the last two years the number of people contacting us about urgent care services has significantly increased.
Feedback is largely negative, and negative sentiment is growing. 54% of feedback we received about urgent and emergency services last January was negative, compared with 42% in December 2021.
A&E targets don’t show the whole picture
Back in 2020, we fed into NHS England's Clinical Review of Standards in Urgent and Emergency Care by finding out what matters most to the public when it comes to A&E.
This work showed that a single national target does not always give people enough information about what matters most to them. Although overall waiting times are important to people, it is often more important for people to be seen quickly for an initial assessment, feel confident that they will be treated more quickly if they have a more urgent issue, and understand how long they will have to wait.
NHS 111 First has the potential to improve people’s experiences
In 2021, we commissioned national polling and gathered views from the Healthwatch network about how the new NHS 111 First service was working. This service allows NHS 111 to pre-book a time slot for people attending their local A&E.
People told us that when NHS 111 supports them and meets their needs, they are happy with the service and feel it improves their experience. But there continues to be low awareness of the service, a lack of consistency in the support people receive, and lack of confidence in call handlers.
Public confidence in urgent and emergency care has fallen
In September 2022, we published the findings of national polling assessing public confidence in urgent and emergency care services.
Key themes from this recent work include:
- People’s confidence in urgent and emergency care has fallen.
- People were significantly less confident that services would see them in a reasonable timeframe.
- Older people were particularly concerned about waiting times in A&E and for ambulances.
- However, people who received care for life threatening illness and/or injury were still confident in the quality of care they received.
- Media stories of poor performance in A&E are a key driver of people’s falling confidence, although many people also changed their views based on personal experience
What we’re calling for
In January 2023, NHS England published their urgent and emergency care recovery plan, which sets out concrete ambitions to ensure that ambulances and emergency departments see people more quickly.
Yet, at the same time, NHS England lowered the national performance target against the four-hour waiting time standard from 95% to 76%.
We want to see the following:
- A longer-term ambition to return to previous levels of service. People understand that urgent and emergency care is under pressure. The NHS hasn't met their previous performance targets, which won't change overnight. But simply reducing the performance targets is not a solution. We want to see a longer-term plan for reducing waiting times. Returning to previous performance targets will rely on answers to systemic challenges, including workforce shortages and outdated facilities.
- Sharing of additional data on what patients can expect when they go to A&E. To help rebuild public confidence while tackling systemic challenges, the NHS can share additional information with patients on the areas we know are important to patients when seeking urgent care. People have told us these include: how long they will wait to get assessed; and being prioritised if their condition is more serious. As part of the clinical standards review, some sites trialled live online updates on average waiting times at different A&E departments. This information can help set people's expectations and help them make informed choices.
- Better consistency in applying the NHS 111 First approach to pre-booked time slots in A&E. This could significantly improve people experience of navigating urgent and emergency care services and help emergency departments better manage people flow.
What action we’ve taken
NHS 111 First
Many of our suggestions for performance measures that would better align with people’s priorities were reflected in the final recommendations of the Clinical Review of Standards (2020). These included: the introduction of a new maximum time to initial assessment; a measure for extremely long waits; and splitting out measures for admitted and non-admitted patients.
This work contributed to the introduction of a “call first” model in A&E, which was later rolled out nationally as 111 First. Following the national roll-out of NHS 111 First, concerns raised by local Healthwatch led to a clarification from NHS England of how those with pre-booked time-slots should be prioritised against A&E walk-ins, and that no one without a pre-booked time slot will ever be turned away. NHS England also promised to conduct a full patient evaluation of how the NHS 111 First programme is working.
A&E waiting targets
The government has confirmed that NHS will maintain the four-hour A&E standard (i.e. patients attending A&E should be admitted, transferred or discharged within four hours). However, it has reduced the national performance target against the four-hour waiting time standard from 95% to 76%. We have called for a longer-term ambition to return to previous performance standards, as promised to patients in the NHS constitution.
In the meantime, we are working with NHS England to understand what additional data they are capturing about people's journey in A&E. For example, the time they wait for an initial assessment and how they could share this with patients in real-time.
NHS England has pledged to publish data on 12-hour waits in A&E from time of arrival starting from April 2023, accepting the principle we have long called for: that all measures of time spent at A&E should start from people arriving at A&E, not from when they are formally registered.
