Accident and Emergency Reports

Earlier this year, Healthwatch visited the A&E department of the Royal Sussex County Hospital (A&E) and the Children’s Emergency department of the Royal Alexandra Hospital (CED). The objective for both reviews, was:

• to find out the patient experience (or parent experience in the case of CED).
• to understand if patients (or parents) tried to seek alternative services to help with their condition (or that of their child’s) before approaching A&E or CED.
• Healthwatch was also interested in the patient’s (or parent’s) experience of using alternative services and whether this experience would encourage them to seek alternatives in the future.

Specifically in A&E, Healthwatch included in their review, questions around the newly introduced GP streaming. This system locates a GP in the A&E department. Patients on arrival can be referred to see this GP (rather than the A&E hospital doctor) if the condition is considered to be minor. This system has not yet been introduced to CED.

We present a summary of the findings from the two reports here.
Links to the full reports at the end of this article.

Patients and parents who were interviewed at A&E/CED respectively, gave very positive feedback about the staff and would recommend the service. Parents however, had some concerns about the service provided, namely that patients/parents:

• were not provided with enough information in person, about how long they might wait to be seen.
  Healthwatch recommended this information is provided in person on arrival and while in the waiting room.
• felt access to both emergency departments was difficult.
  Healthwatch noted a need for better signage and better access by car.
• felt that comfort in the waiting areas of both emergency departments could be improved.

Some patients/parents had sought help from alternative services before attending A&E/CED, though they raised some concerns with these services:

• In some cases, patients/parents felt they had not been provided with a good service in the past. This was particularly the case with the NHS 111 service and the drop-in service near Brighton station. This influenced their decision this time, to attend A&E/CED directly.  Healthwatch recommended better quality alternative services, would help take the pressure of the emergency departments.
• Where parents had sought help through an alternative (for example NHS 111 service) in many cases, the alternative had referred their child to CED and parents felt the diversion had been a waste of time. This finding was reflected in our conversations with patients in the A&E. Healthwatch recommended that more clinical support should be provided to these services, to ensure they are able to help some patients avoid the use of the emergency departments.

Most of the patients/parents we spoke with were unaware of some of the alternative services available.

• The were unaware of the ‘Help my A&E’ booklet which was produced to encourage patients (and parents of) to seek alternative services to CED and A&E.
• Most were either unaware of, or had chosen not to use, pharmacies or the NHS choices website as an alternative.

Healthwatch recommended that better publicity is required to ensure patients are receiving information on alternatives to CED and A&E.

In addition, Healthwatch recommended that better support is given to GPs to ensure they treat patients with minor conditions rather than refer to the emergency departments. This is particularly relevant when considering the following findings from our reviews:

• Almost a third of (child) patients in CED had conditions that could have been dealt with by their GP.
• One third of (adult) patients in A&E had already visited their GP who referred them to the A&E. The majority of these patients were then re-referred via the GP streaming.  This implies that they could have been treated by their own GP in the first place.

Specifically, regarding the Majors area of the A&E, Healthwatch also found:

• The average waiting time was over four hours, with 30% of patients in Majors, having waited over 10 hours.
• In the Majors section of A&E, patients were found waiting in the corridor and at close proximity to one another, compromising dignity and privacy.

Overall, Healthwatch concluded that both emergency services are run well with caring and professional staff.  With some improvements, they would offer an excellent service. However, pressure on these busy services could be eased by two key improvements elsewhere. Alternative services need to be more widely promoted to increase public awareness of them. In addition, until alternatives provide a quality service that can be relied on, patients (and parents of) will be more inclined to visit A&E and CED direct.

Since the reports were published in May and June 2018 respectively, they have already had significant impact.  They were shared with the A&E Delivery Board and used as part of the A&E patient audit, both of which have involved our Healthwatch Chair, Fran McCabe. In addition, the reports were shared with Brighton and Sussex University Hospitals NHS Trust’s Chief Executive Officer and Chief Nurse – both have promised to follow-up on recommendations. The Care Quality Commission will be using these reports to support further inspections at the Royal Sussex County Hospital and other hospitals in Sussex, due to take place after the summer. The reports were also of interest to our partner Healthwatch’s in East and West Sussex who have since agreed to carry out similar service reviews in other hospitals across Sussex.