Calderdale and Huddersfield NHS Foundation Trust, NHS Calderdale Clinical Commissioning Group and NHS Greater Huddersfield Clinical Commissioning Group are working together on a new engagement that focuses on Calderdale and Huddersfield NHS Foundation Trust A&E departments, interviewing patients anonymously about their experiences of using the two departments.

Community Voices and Engagement Champions have attended the A&E departments in Calderdale and Huddersfield to have face to face conversations with a diverse range of people that represent those who are using the department. Alongside this, we are reviewing existing data from our previous engagements, as well as:

• Patient Advice and Liaison Service (PALS) and complaints data.
• Care Opinion and NHS Choices postings.
• Friends and Family Test.

By using existing data held by our organisations, we are able to listen to and consider the views of a wider range of the local population without the need for a large-scale public consultation.

The purpose of the interviews is to build a ‘snapshot’ of one week in A&E and allows us to understand what we need to do to ensure that we can support people in the local community to seek alternative help, rather than having them travel to hospital. The hope is that this engagement will suggest improvements to how the departments can work to better serve patient needs.

We have been using a survey to help structure the interview. As part of this we are piloting a revised equality monitoring section that includes a question asking if people are in receipt of any benefits. We are asking this question to help us understand if being on a lower income affects experiences of services or health. With permission, a short follow up survey will be conducted by doctors a week after Community Voices and Engagement Champions have visited the department to gain a full view of the patient experience, which will contribute to the next steps.

The data collected from the interviews, alongside the review of existing information, will be used to create a report of findings. No confidential information will be shared, but the report will be made publically available with feedback provided to those who request it.

What we are doing

A follow up survey conducted by community volunteers recruited through ‘Engagement Champions’ will now take place with patients who attended A&E.  Once this survey is complete, the findings will be published and the hospital (CHFT) and CCG will work together to identify improvements to services.

Update on the project

Community Assets (Community Voices and Engagement Champions) attended the A&E departments over a one week period. Community Assets who attended the sessions were supported in this role by hospital staff whilst they interviewed patients and carers. A coding system for the survey was used to maintain anonymity for patients.Respondents to the survey were also be given the opportunity to take part in a follow-up survey.

The key themes from existing data and the engagement were as follows

Reasons for attending A&E

• People often report that they have sought advice from a health professional prior to attending A&E, and that they have been advised to attend A&E. Either because they have a health condition that needs to be dealt with urgently; that A&E is the best place to receive the care that they require; or they have been advised to attend if their condition doesn’t improve.
• Many people attend as they have been unable to get an appointment with their GP, or if they have been offered an appointment they don’t want to wait as they are concerned about their condition and want to be seen quickly; or the appointment is at a time that isn’t convenient for them. And for some people their health condition has occurred in the evening or at the weekend and as such they have been unable to access their GP practice.
• A few people attend A&E as they are not happy with the advice and or treatment they have received and want a second opinion.
• Some people don’t seek advice as they feel that A&E is the right place for their condition.
• Those people that attend A&E at the evening and weekends often aren’t aware of where else they could seek medical advice and support.

Quality of service in A&ampE

• People report high levels of satisfaction with the service they receive in A&E and praise staff for their quality of care. Although some felt that staff seemed rushed which impacted on the waiting times and the quality of the care provided, and felt more staff would improve this.
• Many described long waits to be seen; to receive their test results; and to be discharged. If the waiting times for each of these had been shortened this would have improved their experience. They also wanted staff to keep them informed of expected waiting times.
• When asked what they expect out of their visit to A&E, people report that they want to be able to access the appropriate diagnostic tests to support them in being provided with a diagnosis of their condition so they can be provided with the appropriate advice and treatment / medication.
• Seating provided in waiting areas was described by some as being uncomfortable.

Alternatives to A&E

• Many people report that if they had been able to access a GP appointment at a time that was convenient to them they may have not attended A&E. Suggestions were made to be able to access GP appointments early morning, evenings and weekends but they want to be able to access these appointments the same day.
• People have also suggested if GP practices were able to undertake diagnostic testing such as blood tests, x-rays, scans and treat minor injuries this would reduce the need for people to attend A&E. Some suggested having a minor injuries unit or a 24 hour walk-in centre.

Next steps

The engagement process has provided NHS Calderdale CCG, NHS Greater Huddersfield CCG and Calderdale and Huddersfield NHS Foundation Trust with the views and suggestions of the public, to help understand why people attend A&E and what support people could or should receive in the local community to support a reduction in visits to A&E.

The findings can be read in the report: A Week in A&E engagement report.

This report will also go to the A&E delivery board who will use the findings of the report in the future planning of A&E services.

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