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National survey highlights decline in experience of emergency care
Findings from a survey of more than 36,000 people who used NHS urgent and emergency care services in September 2022 show that many people had a worse experience than in previous years – particularly those treated in an A&E type department. Published by the Care Quality Commission (CQC), the survey reveals the responses from patients who attended either a major consultant-led A&E department (Type 1) or an urgent treatment centre or minor injury unit (Type 3) run directly by one of 122 acute hospital Trusts in England during September 2022.
Although people surveyed remained broadly positive about their interactions with staff, this year’s results show a decline in positivity for every question asked where a historical comparison is available.
Most people (80%) surveyed who had visited a
Type 3 department said they ‘definitely’ had enough time to discuss their condition with the healthcare professionals treating them (down from 85% in 2020), and a large number (84%) of those who used a Type 3 service said that staff ‘definitely’ listened to what they had to say (no significant change compared to previous years). For respondents who had attended a Type 1 department in 2022, 73% felt that doctors and nurses ‘definitely’ listened to them, compared with 79% in 2020, and over two thirds (71%) said they ‘definitely’ had confidence and Trust in staff - which is still high, but a lot lower than the 77% who said this in 2020. Responses to questions about other aspects
of care including fundamental issues like waiting times, availability of staff, pain management and information provided at discharge showed an even more marked decline. The number of Type 1 patients who reported
waiting more than an hour to first speak to a doctor
or nurse increased to 32% in 2022 (compared with 15% in 2020 and 19% in 2018). In 2022, the proportion who said they waited more than 4 hours to be examined in a Type 1 service more than trebled to 17% - up from 4% in 2020 and 5% in 2018. Over half of patients (56%) who said that they needed help with their condition or symptoms, while they were waiting to be treated in A&E, said they were not able to get that help from staff (up from 45% in 2020). In Type 3 services, 10% of people with an appointment said they waited more than 2 hours to first speak with a health professional (compared with 3% in 2020 and 4% 2018), and 15% of those with an appointment said they waited more than 2 hours to be examined (up from 5% in 2020 and 3% in 2018). Only 57% of Type 1 patients said that they were ‘definitely’ involved as much as they wanted to be in decisions about their care and treatment in 2022 - compared to 63% who said this in 2020 and 65% who said this in 2018. Similarly, there was a decline in the number of people who said if they had any anxieties or fears about their condition or treatment, a doctor or nurse in the A&E department ‘completely’ discussed this with them – falling from 51% in 2020 to 48% in 2022.
Across both service types, less than half (45% of
Type 1 respondents and 49% of Type 3 respondents) felt that they ‘definitely’ had enough privacy when discussing their condition with the receptionist. This compares with 55% and 59% for Type 1 and Type 3 services in 2020. In addition, fewer Type 1 patients ‘definitely’ had enough privacy when being examined and treated - 78% in 2022, compared with 84% in 2020. Only 53% of Type 1 patients and 69% of Type 3 patients who had communication needs (language needs or communication needs related to a disability, sensory loss, or impairment) said staff ‘definitely’ helped with their needs - with 27% of Type 1 patients and 20% of Type 3 patients with those needs reporting that staff gave them no help. Pain management was another area of care
highlighted as an increased concern. Fifty-one per cent of Type 1 respondents and 58% of Type 3 respondents felt that staff ‘definitely’ did everything they could to help control their pain. This compared with 60% and 63% for Type 1 and Type 3 services in 2020. As has been the case in previous years, the 2022 results also showed scope for improvements at discharge from both A&E and Type 3 departments. Only 46% of Type 1 patients surveyed said they were ‘completely’ told what symptoms to watch for when they were at home (down from 53% in 2020) and 51% of Type 1 patients and 65% of Type 3 patients were ‘definitely’ given enough information to care for their condition after leaving the department. This is compared with 60% and 70% for Type 1 and Type 3 services in 2020. People surveyed who had attended A&E were
more likely to report a negative experience of care if they identified as frail, if they were disabled, if their visit lasted longer than 4 hours or if they had been to the same A&E for the same condition within the previous week.
Survival extended for babies with rare disease
Nearly three in four babies born with a rare muscle-wasting disease are now surviving for two years or more thanks to advances in NHS treatment, new data shows. Around 70 children are born with spinal muscular atrophy (SMA) each year in the UK, a rare genetic condition that causes muscle weakness, progressive loss of movement and paralysis. Historical studies of the disease in the US have estimated that before the availability of treatments, fewer than one in ten (8%) children born with SMA type 1 (SMA1) – the most common form of
the condition – survived to the age of 20 months without permanent ventilatory support. Thanks to advances in treatment on the NHS, now nearly three quarters (73%) of children with SMA1 in the UK are older than two years, according to new data from the national SMA Research and Clinical Hub (SMA REACH UK) database. ONS data also suggests a significant reduction in deaths from SMA1 in this country, with just 11 deaths in total recorded across the UK between March 2018-March 2023 – compared to around 25 deaths each year in England between 2008-2017.
This progress has followed the roll-out of three
new SMA medicines on the NHS, from 2019. Data demonstrates the initial impact of injectable drug nusinersen (Spinraza) – the first treatment to target the underlying cause of SMA – which was made available on the NHS from Summer 2019. With gene therapy Zolgensma and oral treatment risdiplam secured in 2021, the NHS has ensured access to treatment for patients with types 1, 2 and 3 SMA, and it is hoped all three treatments will continue to deliver improved outcomes as more data is collected.
September 2023 I
www.clinicalservicesjournal.com 9
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