An independent study into patients’ attendance at North Middlesex University Hospital’s emergency department (ED) has examined 37,000 pieces of data and undertaken more than 600 individual interviews to determine what brings patients to the ED rather than use another NHS service, even for conditions that are not life-threatening like coughs, colds and sore throats.
More than a third of respondents reported being aware of options for accessing urgent medical support, such as pharmacists, the NHS111 service, GP extended access hubs and urgent care centres.
But only four per cent of patients who spoke with researchers reported using the alternatives before coming to North Mid’s emergency department.
In interviews with 630 individuals, researchers explored the reasons for this, and found that for a significant majority, the emergency department at North Mid is the only existing model of service delivery that offers ‘instant access’ to healthcare.
Almost three-quarters of individuals (74.9%) attended ED without trying to arrange a GP appointment instead.
More than half of respondents – rising to more than three-quarters at weekends – reported that the main reason they had come to the emergency department was because it offered “a convenient way to see a healthcare professional, even if it meant waiting”. Additional factors included 24/7 availability of the service, and access to a full-range of diagnostic support services.
The availability of diagnostics was a key factor in many patients’ choice to come to the ED, with many telling researchers that if GPs could offer X-rays, scans or on-site blood tests, they would have chosen it as an alternative.
The research study was carried out by Healthwatch Enfield, on behalf of North Middlesex University Hospital NHS Trust, NHS Haringey Clinical Commissioning Group and NHS Enfield Clinical Commissioning Group. Professional researchers and volunteers spent a total of 55 hours in North Mid’s ED during one calendar week in January 2018. They interviewed a total of 630 individuals who attended the department, nearly one quarter of all patients attending the ED during those hours.
The in-depth interviews found that one in three patients said they would be happy to use their mobile or tablet to seek urgent medical help, with individuals aged 25-54 more likely to prefer this option than people of other ages.
A third of patients also called for more information to help them use alternative health services, such as urgent care centres and GP extended access services, including information in alternative formats and languages which helps them understand what can be treated by the different NHS services.
And more than half said that a facility within 2-3 miles of their home, which offered ‘walk-in’ access and offered a wide range of first-line and specialist medical input, plus tests like X-rays, scans and blood tests, would stop them coming to the emergency department unless they had a life-threatening condition.
The NHS organisations, which commissioned the research, plan to use the findings to work with patients, community groups and representatives to help shape hospital, community and primary care health services for their local communities for the future.
Chief executive of North Middlesex University Hospital NHS Trust Maria Kane said:
“We saw 14,000 patients who came through the front door of our emergency department last month. Not all needed the 24/7 life-saving care which only an ED can provide, but it’s clear that as a local health system we are not communicating well enough the range of alternatives and how to use them, or how these other options can provide faster treatment and better care for our local communities overall.
“This is something we are committed to improving, and ensuring we communicate in ways that are meaningful for our local communities, which means making sure we are using the right formats, languages and information which resonates with people at the right time.
“It’s vital that patients get the most appropriate care for their needs, and across Enfield and Haringey, we will be working with all the partners we need to, so that we can properly address the issues raised in this report.
Chief executive of Healthwatch Enfield, Patricia Mecinska, said: “Given the high level of demand faced by our local hospital, we were pleased to be able to listen to individuals’ decision-making processes and amplify the voice of patients. Our research clearly demonstrates that there is a mismatch between the current NHS offer and 24/7 demand of local communities. From what residents of Enfield and Haringey told us, doing more of the same to address pressures facing A&E at North Mid will not work; people will simply keep coming.
“Through the engagement activity, Healthwatch Enfield worked alongside patients to identify potential ways of addressing the demand for instant access however further engagement with the wider communities is required. The amount of funding available to deliver NHS services of the future is limited so we need to involve patients in designing and commissioning services to ensure that we, as a health and care system, get it right the first time.”
A spokesperson for NHS Haringey and Enfield Clinical Commissioning Groups (CCGs) said:
“We welcome the findings of the Enfield Healthwatch report on emergency department services at North Middlesex University Hospital. We jointly commissioned this piece of work with North Mid in January 2018 as part of a wider strategy to further understand the use of emergency department care and importantly what needs to be done to ensure local people are accessing services suitable for their health needs. The report presents an opportunity now to take a system wide approach to how we address this working with a wide range of NHS, voluntary and council partners across both boroughs.”
You can download the full report here.