Richard Armitage is a GP and Honorary Assistant Professor at the University of Nottingham’s Academic Unit of Population and Lifespan Sciences. He is on X: @drricharmitage
Accident and emergency (A&E) departments in England are under substantial and increasing pressure. The proportion of A&E attendances that exceed a period of 4 hours from arrival to admission, transfer, or discharge has increased from 3.4% in 2011–2012 to 30.2% in 2023–2024 Q3.1,2
In addition, the total number of patients who wait over 12 hours in A&E from the decision to admit to admission to a ward has increased 2400-fold from 170 in 2012–2013 to 410 092 in 2022–2023.1
Much of the media’s coverage of A&E pressure has a profoundly negative valence. Examples of recent media headlines with significant negative sentiment regarding A&E pressure include ‘Dumped in A&E and left untreated for 5 days or more: shameful plight of some of our most vulnerable patients’,3 ‘One in ten A&E patients face “dangerous” 12-hour wait’,4 and ‘Record 420,000 patients in England had “more than 12 hour wait” in A&E last year’.5 Furthermore, the BBC identifies the departments under greatest pressure,6 the current waiting times in particular A&Es,7–9 and the A&E performance targets that have never been met.10
“A substantial proportion of these patients make it clear to me in the consulting room that they will not attend A&E … “
Concurrently, I have noticed in my own clinical practice this winter that patients who I advise to attend A&E are often substantially less willing to do so than they have been in previous years, and cite media coverage of A&E pressure as the foundation of their reluctance. A substantial proportion of these patients make it clear to me in the consulting room that they will not attend A&E despite my recommendation for them to do so.
At least for myself and the colleagues I work with (who have also noticed a similar change), this is a new phenomenon. Assuming that the clinical need of these patients does in fact warrant A&E attendance, and that they do not immediately attend as advised, these patients will likely attend A&E at a later point in a deteriorated condition that is more likely to result in emergency admission (there has been no recent substantial change in the proportion of A&E attendances that result in emergency admission, however).1,2
This, in turn, will increase both the >4-hour wait and >12-hour wait statistics (since patients who are severely unwell often require both prolonged time in A&E and the attention of multiple clinicians), which drive further negative media coverage in a self-perpetuating cycle.
While a free press is vital to hold those in control of public services to account for their performance, and media coverage of A&E pressure might helpfully deter patients without a relevant clinical need from attending, media coverage — particularly that with negative sentiment — might also unintentionally deter those patients with a relevant clinical need from doing so promptly.
Admittedly, this hypothesis is born of merely anecdotal evidence, and empirical research is needed to test it. Specifically, quantitative analysis of delayed A&E attendances and qualitative exploration of the reasons for these delays are required before any recommendations regarding media coverage on this matter can be offered.
References
1. NHS Digital. Hospital accident & emergency activity, 2022–23. 2023. https://digital.nhs.uk/data-and-information/publications/statistical/hospital-accident–emergency-activity/2022-23 (accessed 12 Feb 2024).
2. NHS England. A&E attendances and emergency admissions 2023–24. 2024. https://www.england.nhs.uk/statistics/statistical-work-areas/ae-waiting-times-and-activity/ae-attendances-and-emergency-admissions-2023-24 (accessed 12 Feb 2024).
3. Thomas R. Dumped in A&E and left untreated for 5 days or more: shameful plight of some of our most vulnerable patients. Independent 2023; 18 Nov: https://www.independent.co.uk/news/health/a-e-mental-health-wait-times-b2442570.html (accessed 12 Feb 2024).
4. Hayward E. One in ten A&E patients face ‘dangerous’ 12-hour wait. The Times 2023; 13 Apr: https://www.thetimes.co.uk/article/one-in-ten-a-amp-e-patients-face-dangerous-12-hour-wait-t0z86sq3x (accessed 12 Feb 2024).
5. PA Media. Record 420,000 patients in England had ‘more than 12 hour wait’ in A&E last year. The Guardian 2024; 14 Jan: https://www.theguardian.com/society/2024/jan/14/record-420000-patients-in-england-had-more-than-12-hour-wait-in-ae-last-year (accessed 12 Feb 2024).
6. Triggle N, Rogers L, England R. The hospitals struggling the most as winter bites. BBC News 2023; 14 Dec: https://www.bbc.co.uk/news/health-67714151# (accessed 12 Feb 2024).
7. R Stead, L Hirst. Royal Bolton Hospital: A&E wait times hit 13 hours. BBC News 2024; 7 Jan: https://www.bbc.co.uk/news/uk-england-manchester-67906760 (accessed 12 Feb 2024).
8. BBC News. Royal Blackburn Teaching Hospital: A&E wait times hit 12 hours. BBC News 2024; 17 Jan: https://www.bbc.co.uk/news/uk-england-lancashire-68007245 (accessed 12 Feb 2024).
9. Sissons R, Martin D. Queen’s Medical Centre: patients line corridors as winter pressure rises. BBC News 2023; 7 Dec: https://www.bbc.co.uk/news/uk-england-nottinghamshire-67635482 (accessed 12 Feb 2024).
10. Triggle N, Pym H. The key NHS targets that have never been met. BBC News 2024; 11 Jan: https://www.bbc.co.uk/news/health-67884322 (accessed 12 Feb 2024).
Featured photo by Utsav Srestha on Unsplash.
