By John Tingle
The Accident and Emergency (A&E), the Emergency Room, is the bellwether NHS speciality from which all the other clinical specialities appear to be judged. Long reported delays and missed targets in the A&E (Emergency Room) lead to a public, media clamoring that the NHS is a failing public service. The independent regulator of health and social care in England, the CQC (Care Quality Commission) recently published findings from a national survey of more than 50,000 people who received urgent and emergency care from 132 NHS trusts (hospitals).The survey looked at people’s experiences, from decision to attend, to leave, using Type 1 (major A&E) and Type 3 (urgent care centers, minor injury units, urgent treatment centers) urgent and emergency care services.
The survey revealed both positive and negative findings. Overall most people experience good urgent and emergency care in the NHS in England, but an acute issue that always seemed to persist is lengthy waiting times to be seen by clinical staff. This is a seemingly intractable problem for the NHS to manage. The NHS in England has an infinite demand for finite resources and will soak up all resources given to it. We have an increasingly elderly population who are presenting to hospitals and general medical practitioners with multiple, more complex, acute conditions. We also have an acute staffing crisis in the NHS.
Long Waiting Times
The report found that patients are seen quicker, and they have a shorter visit at urgent care centers. Sixty-eight percent of Type 1 respondents waited more than 15 minutes before they first spoke to a nurse or doctor. Most Type 3 respondents are also waiting longer than recommended:
The report states:
The operational standard is that 95% of people should spend four hours or less in the urgent and emergency care department. Just over two fifths of Type 1 respondents (41% in 2018, an increase from 40% in 2016) said that overall, their visit to A&E lasted for more than four hours. For Type 3 departments this is much lower at 12%, improved from 15% in 2016.
These are very long wait times in A&E and cause a great deal of controversy in the NHS and politically, especially at election time in the UK. From a patient safety perspective, delay in diagnosis and being seen by a nurse or doctor can result in malpractice claims.
There has been recent litigation on the issue of waiting times in A&E and the sufficiency of information given to a patient about how long they would have to wait.
The Darnley case maintains important practical and legal implications for all those who manage and staff A&E departments and other health care departments. The case states that a legal duty of care in the tort of negligence is owed by A&E receptionists. The court held that the scope of the legal duty of care extends to a duty to take reasonable care not to provide misleading information which may foreseeably cause physical injury. This case will also extend to other non-clinical staff in many other hospital departments who advise patients in reception areas about waiting times.The case can also be applied to primary care and general medical practice. Protocols and staff training need to be in place to deal with this issue.
The CQC report has several other important findings on matters such as patient information giving, pain control and so on.
The Report Overall
The report does have positive findings and reveals that most patients who attended a Type 1 department said they ‘definitely’ had enough time to discuss their condition with the nurse or doctor. A large proportion of patients in Type 1 departments also said they had confidence and trust in the staff examining and treating them. Patients treated at a Type 3 service were also positive about health carer patient interactions. The report is by no means a catalogue of doom and gloom findings.