A&E nurses under ‘unsustainable’ pressure, warns CQC

The experiences patients are having in accident and emergency (A&E) and urgent care units in England are getting worse, according to a new survey, as nursing and medical staff are stretched to their limits.

The Care Quality Commission (CQC) Urgent and Emergency Care Survey 2022, published this week, showed a deterioration in every area, including waiting times, the ability to get help when needed, and confidence in nursing and medical staff.

The survey results involved patients at 122 NHS trusts across England and were split between Type 1 centres (major, consultant-led A&E departments open 24/7) and Type 3 centres (other A&E/minor injuries/urgent care units).

Almost a third (32%) of Type 1 patients had to wait more than an hour to speak to a doctor or nurse, compared to 15% in 2020, and 19% in 2018.

As well as this, 76% of respondents at Type 1 centres and 66% of Type 3 patients said they were not told how long their wait would be.

Meanwhile, the number of Type 1 A&E patients not able to get help when they needed it because they could not find a member of staff increased to 16% in 2022 compared to 9% in 2020.

The issue of patients waiting for an extremely long period of time at A&E was raised recently by the Royal College of Nursing (RCN).

The RCN took a survey of A&E nurses, many of whom said they were concerned about ‘corridor care’, where patients are treated on trolleys outside of a ward out of necessity.

Pat Cullen, RCN general secretary and chief executive, said at the time that her union’s members were very concerned about corridor care, waiting times and A&E understaffing.

The CQC also mentioned, it in its full report released with the survey, the NHS 2022 staff survey in which only 21% of nurses felt they had enough staff to do their jobs properly.

Understaffing, under-resourcing, and patients feeling like they did not get enough contact with medics and nurses was apparent throughout the CQC survey.

It found two-thirds of patients (66%) at Type 1 units felt they had enough time to discuss their condition with a doctor or nurse, down from 74% in 2020 and 75% in 2018.

Fewer people than in previous years felt they received emotional support at Type 1 A&E units. Less than half (48%) of respondents who had anxieties or fears said staff fully discussed these with them, down from 51% in 2020, and 57% in 2018.

A similar decline was seen in Type 3 units, with 59% of patients feeling like staff “completely” discussed their anxieties of fears with them, compared with 65% in 2020.

Dr Adrian Boyle, president of the Royal College of Emergency Medicine, said the results of the survey “reflect the challenges medical professionals working in urgent and emergency care experience every day”.

“Every clinician wants to provide the best care possible. No-one wants patients to have to wait excessive amounts of time to be treated, or for that treatment to be administered in an environment – such as a corridor – which lacks privacy,” he added.

“This data reinforces that, despite experiencing the most challenge year on record for the NHS, urgent and emergency care staff are still managing to provide high standards of care and treatment to their patients. But this is despite of, not because of the wider system.”

He warned that staff and patients “deserve better” and said the college was continuing to push its #ResuscitateEmergencyCare campaign.

Among the five priorities of the campaign is a call to “eradicate overcrowding and corridor care for patients”.

Also responding to the CQC’s findings, Saffron Cordery, deputy chief executive at NHS Providers, said demand continues to “outstrip” the capacity of A&E departments.

Ms Cordery said trusts were implementing the national urgent and emergency care recovery plan, published in January, and that early improvements were being seen the number of patients being seen within four hours in A&E.

“However, performance across [urgent and emergency care] is symptomatic of pressure on the whole system including in mental health and community services," she added.

She called for “proper investment” in both capital – buildings and equipment – and workforce for the NHS and social care, explaining that this would all help to clear the overall chain reaction of delays for patients.

“This could lead to fewer ambulance handover delays and ensure patients who are medically fit to leave hospital can do so in a safe and timely manner,” added Ms Cordery.

“The CQC’s findings echo the recent British Attitude Survey’s, which found a decline in patient experience. Despite this, public commitment to the NHS model remains strong.

“It’s vital the government deliver the national support needed to put the NHS and social care on a sustainable footing.”

The survey also covered the experiences of patients once they managed to see a doctor or nurse.

For example, the survey found confidence in doctors and nurses at Type 1 centres had dropped by 6% since 2020, from 77% to 71%, as had the percentage of patients who felt they were “definitely” involved in decisions about their care.

The CQC further said that A&E departments still had room for improvement on information given to patients leaving A&E and urgent care centres.

Dr Sean O’Kelly, CQC chief inspector of healthcare, said the survey showed how “escalating demand” for A&E and urgent care was putting an “unsustainable” level of pressure on staff.

“Staff are working extremely hard amidst challenging circumstances,” said Dr O’Kelly.

“We see that reflected in these results, but also during our inspections and monitoring of services and in the discussions with clinicians in CQC’s emergency medicine specialist advisor forum.

“The last urgent and emergency survey was carried out shortly before the second peak of the pandemic when A&E and Type 3 attendances were significantly lower than pre-Covid levels – so the decline in positive feedback compared to then must be seen in that context.

“But it remains extremely concerning that for some people care is falling short, and we cannot afford to ignore the long-term decline shown in relation to issues like waiting times, information provided when people leave to go home, access to pain relief and emotional support.”

Dr O’Kelly continued that the rise in demand for emergency and urgent care units was a “symptom” of a wider problem in capacity and access to health and social care, adding: “Urgent and emergency care requires the support of the whole hospital and the surrounding local health and social care system.

“Without that support and without a more co-ordinated approach, more and more people whose needs can be better met by other services will continue to seek help at emergency departments and urgent care centres."