Understanding people's experiences of urgent and emergency care in Gloucestershire

Healthwatch Gloucestershire wanted to investigate the demands on urgent and emergency care services by supporting our local communities to speak about their experiences. They wanted to look in more depth at what services people are aware of, what services are being used and why, what barriers there are for different people when accessing these services, as well as what can be done to improve the patient experience and pathways through the various urgent and emergency services available.

They used a survey to collect feedback on people’s experiences of urgent and emergency care in Gloucestershire over a seven-week period during November and December 2023.  They also engaged with community groups, did a focus group and visited Emergency Departments and Minor Injury Units.  Their volunteers did some mystery shopping of information online about access to urgent and emergency care.  In total they spoke to 300 people.

Accessibilty

•  Transportation to and from services is not always easily accessible and can leave patients in a vulnerable position. 
• Learning disability and mental health liaison nurses improve a patients’ experience; however, they are not always available when needed. 
• Patients with disabilities can be put off seeking medical help due to the environment in urgent and emergency care settings and the lack of support or advocacy. 
• Documents in accessible formats, such as Easy Read, are not always available or easy to find. 
• Many NHS websites do not provide alternative language options.

 Communication 

• It is not easy to understand the difference between terms used to describe services, such as ‘rapid’, ‘emergency’ and ‘urgent’; in an emergency, people may try any service with these words in the title. 
• Patients are waiting a long time to be seen by a medical professional and people would like staff members to communicate more with them about waiting times. 
• When people are triaged quickly they often assume they will see a doctor quickly too, when this is not the case.
• People do not like sharing private information about their visit to a service at the reception desk, and sometimes this communication can be difficult, for example, for people with disabilities and long-term health conditions. 
• Documents that help a patient proactively communicate their medical wishes, needs and history, such as Health Passports, What Matters to Me folders and ReSPECT forms are seen as beneficial, but easily lost and people do not feel staff have the time to look at them.

Service efficiency and joined up care 

Services are not providing joined up care or communicating efficiently with each other which can lead to a waste of resources. For example, when ambulances arrive at people’s homes after they have already been taken to hospital or when GPs are unable to get through to the ED. 

Increasing pressure on GP services has led to people losing faith in their GPs, so they are resorting to emergency care instead. 

A high number of people are leaving urgent and emergency care services with no resolution to their health problems, and many are unsure about what to do next. 

 People are waiting a long time and feel they must ‘make a fuss’ to be seen which causes frustration amongst patients if they are not updated when there are expected delays. For example, when there are issues with booking systems within hospitals.

General 

There were clear benefits to having a carer or companion to support a person in need of urgent and emergency care, with advocacy, retention of information, and practical things such as car parking and getting refreshments. However, this also adds to overcrowding in waiting rooms. 

Feedback on staff attitudes was mixed, however there is a lot of empathy among patients about the conditions and pressure staff work under. 

Most people are aware of EDs/A&E, MIIUs and NHS 111. However, in an urgent or emergency situation a lot of people may struggle to think of other services that might meet their needs such as an out of hours GP or UTCs. 

A lot of people see little point in contacting NHS 111 as it is often perceived as a barrier to reaching emergency care. They are also put off by the number of questions asked by call handlers and the fact they are not medical professionals. Long wait times and a poor experience means that often people skip this step and go straight to another service. 

There were concerns around the cleanliness of EDs and MIIUs and the lack of available space for those with potentially contagious conditions. 

Refreshments are not always easily accessible, which is difficult during long waits to be seen and the lack of communication about how long a person will be waiting sometimes adds to this issue.

The report contains a large number of recommendations to improve people's experience of urgent and emergency care.