Understanding emergency department attendance in Herefordshire

Healthwatch Herefordshire explores how and why people access urgent and emergency care services, particularly the Emergency Department (ED). It is based on 501 patient engagements conducted within the ED, supported by follow-up interviews, and aims to inform improvements to local urgent care services.

The findings show that many patients attend the ED because they believe their condition is serious or urgent, but a significant number also report uncertainty about alternative services or difficulties accessing them. Limited availability of same-day GP appointments, lack of awareness of options such as NHS 111 or pharmacies, and a perception that ED is the safest or quickest option all contribute to this behaviour.

Awareness and understanding of urgent care services were found to be inconsistent, with some patients unclear about when and how to use services other than ED. Barriers such as long waiting times elsewhere, complicated system navigation, and low confidence in non-ED care further drive ED attendance.

Patient experience in the ED is mixed. While most patients report positive interactions with staff and feel reassured by the quality and compassion of care, long waiting times, overcrowding, and discomfort in the physical environment are common concerns. Communication is a key issue, with patients wanting clearer and more regular updates during their visit.

The report also highlights the influence of demographic and socio-economic factors on ED use. Individuals from more deprived areas and those living closer to the hospital are more likely to attend, while working-age adults often cite convenience and older patients are more likely to be referred by professionals. Language barriers and lack of GP registration also affect service choices.

Additional findings show that GP access issues, NHS 111 referrals, and system pressures contribute to ED demand. Some patients repeatedly attend ED due to unresolved long-term conditions, indicating gaps in ongoing care. Mental health presentations are also significant, with ED often acting as a safety net due to limited availability of specialist services.

Follow-up feedback indicates that around 80% of patients report positive experiences overall, largely due to the professionalism and kindness of staff. However, long waits—sometimes exceeding 5 to 14 hours—remain the main source of dissatisfaction, alongside communication gaps, limited privacy, and feelings of being overlooked.

The report concludes that while ED care quality is generally high, system pressures and access issues across the wider urgent care system are driving inappropriate or avoidable attendance. It recommends improving public awareness of urgent care options, increasing access to primary care, simplifying system navigation, building confidence in alternative services, and providing targeted support for vulnerable groups.