Urgent and emergency care: patient safety and quality issues

The public and the media often seem to judge how well the NHS is performing by reference to urgent and emergency care provision. This is the bellwether NHS speciality by which all the others appear to be judged. Long-reported delays and missed targets in accident and emergency (A&E) lead to a public and media clamouring that the NHS is a failing public service.

Emergency and urgent care provision does suffer from the same problems faced by other clinical specialities in the NHS. Services are over-stretched because more patients are using them, which is reflective of a growing elderly population presenting with more complex and multiple conditions. There are also acute staff shortages. When accessing primary care services becomes difficult for patients, they resort to using A&E. If we can sort out better access to primary care, then we will relieve pressure on A&E. There was a 4% increase in attendances at A&E during 2018-19 (24.8 million) compared with 2017-18 (23.8 million), and a 21% increase since 2009-10 (20.5 million) (NHS Digital, 2019). Furthermore, A&E attendances were twice as high for people in the most deprived areas as in the least deprived. Let that sink in: more than twice as many attendances. This raises important issues such as equality of access to primary care services in deprived areas.