Why the NHS should listen and care more: Professor Rosalynd Jowett’s talk from RCEM15

Author: Linda Dykes / Codes: CC15, CC16, CC25, CC6, CC9 / Published: 02/11/2015

From a personal viewpoint, I wasnt really sure what to expect as I took my seat for this talk. I am uncomfortably aware that we often reduce the input of our service users to a token representative on project boards, and may only get to see what patients really think of our services when the Community Health Council periodically appear in the ED armed with clip-boards (or, increasingly, from comments on social media).

I was completely unaware of the size, scale & influence of the Patients Association whose President is Robert Francis QC (as in the Francis Report about Mid Staffs). The Patients Association aims to represent the voice of patients, carers and their relatives at a senior level, and to influence key health & social care policy, as well as managing a helpline and casework service, plus campaigning on health/social care issues that arise via the Helpline.

They lobby at governmental level, and comment upon reports of interest to patients which means, of course, just about anything to do with the NHS. The bulk of Professor Jowetts talk concerned the findings of the joint RCEM/Patients Association report Time to Act Urgent Care and A&E: the Patient Perspective which was published in early June this year. Based upon a large patient survey undertaken between September 2014 & February 2015, the survey asked patients who had used EDs and arrived under their own steam (ambulance patients were excluded) how they had come to be there.

The findings make sobering reading for anyone who persists in thinking that campaigns like Choose Well do anything to reduce the British populations love affair with Emergency Departments. Firstly, 39.2% had attended on the advice of another part of the healthcare system (including those who, it is suggested, could act to reduce ED attendances), whilst 7.2% attended on advice of friends, relatives or colleagues and 51.8% decided themselves to attend (interestingly, 1.8% said they did not remember one hopes they paid more attention to the rest of the questions!) A&E departments (the terminology used by the survey) were the first choice for almost half of the respondents (47%) with GP surgeries being second (33%). And it was clear that patients opted not to wait very long before heading to the ED most attended within a few hours of symptom onset and many chose to attend A&E despite being offered a prompt same-day appointment with their own GP.

Nevertheless a substantial proportion of patients had symptoms for several days even weeks and yet still elected to attend the ED.

We know from the RCEM Sentinel Site Survey that 15% of patients presenting to ED can be seen safely in the community (if appointments are available within 24 hours), and patients do regularly access GP and community services for urgent care but many patients are reluctant to accept a wait of as little as three hours to see their GP when they perceive their care needs as urgent.

The bottom line? Patients have confidence in UK Emergency Departments, and they value the convenience of the service. The pull of the A&E superbrand is so strong that redirection has repeatedly been shown to be ineffective. Patients are perfectly well aware of community alternatives to ED. They just dont want to use them. From this report came the first calls for urgent care services to be co-located with Emergency Departments, a call that has now reached the stop of the current RCEM STEP campaign.

And as for Choose Well? Based on what I took away from Professor Jowetts talk, its clear that we just need to forget it. The patients arent for turning!

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