1. Introduction and methodology

The NHS Patient Survey Programme is delivered by the Care Quality Commission (CQC) on behalf of NHS England and the Department of Health and Social Care. The Survey Coordination Centre at Picker, coordinates the NHS Patient Survey Programme on behalf of CQC. There are five surveys within the Programme: Adult Inpatient, Maternity, Children and Young People, Community Mental Health and Urgent and Emergency Care Surveys.

This report has been produced by Solutions Strategy Research Facilitation Ltd (Solutions Research) and NHS England to share national insights from qualitative thematic analysis of written responses provided by respondents that took part in the NHS Patient Survey Programme. The aim of this endeavour is to identify opportunities for learning and improvement through an in-depth understanding of experiences of care.

The focus of this report is on the Urgent and Emergency Care Survey 2024, which captured feedback from 35,670 patients who attended a Type 1 Accident and Emergency (A&E) service in February 2024 and 10,325 patients who attended a Type 3 Urgent Treatment Centre (UTC) service in February 2024.

Further information on the survey is available on the CQC website.

Qualitative data analysis

One open question was included in the survey which allowed respondents to use their own words to respond. This question was positioned at the end of the survey and included the instructions as follows:

• Type 1 (A&E): ‘If there is anything else you would like to tell us about your experience in the A&E department, please do so here.’
• Type 3 (UTC): ‘If there is anything else you would like to tell us about your experiences in the Urgent Treatment Centre, please do so here.’

To ensure a robust approach a purposive sampling method was used for thematic qualitative analysis:

• Type 1 (A&E): 682 comments were analysed as a sample from 15,908 viable comments.
• Type 3 (UTC): 681 comments were analysed as a sample from 3,935 viable comments.

Once the total sample of 1,363 comments had been analysed it was seen that data saturation had been reached i.e. no new themes were emerging from the data. Had this not been achieved, additional comments would have been added to the sample as necessary, in line with best practice in qualitative analysis. Further detail can be found in Appendix 5: Methodology and Appendix 6: Sampling Approach.

Use of illustrative quotes

Throughout the report, quotes are included to illustrate respondents’ experiences in their own words and substantiate the findings. Quotes indicate if the respondent was from the Type 1 sample (Type 1, A&E) or Type 3 sample (Type 3, UTC). Please note that the data is not edited in the interests of correct spelling and punctuation for example, to stay as true to the words of respondents as possible.

Certain information from the qualitative comments used in the report has been redacted to protect the identity of survey respondents and any other individuals referenced. Information that has been removed includes:

• names of patients or staff replaced with “(name)”
• names of wards, units or hospitals replaced with “(location name)”
• names of specific services replaced with “(service name)”
• specific dates replaced with “(date)”

Use of quantitative data

Where possible in the findings section, themes are presented in context of the most relevant quantitative survey data. This allows for insights to be considered more holistically and to provide a greater opportunity for reflection and learning.

Statistics from the Type 1 (A&E) sample reference the question number using ‘Q’, and statistics from the Type 3 (UTC) sample reference the question number using ‘T’. To reflect the statistical release, results for the Type 1 survey and Type 3 survey are reported separately.

Context to support interpretation

It was observed that some patients were not always able to identify which type of service they had accessed, particularly seen in the Type 3 (UTC) sample who were more likely not to differentiate between A&E and UTC. For example, in feedback they would use the terms interchangeably or reference their experience at A&E when known to have attended an UTC.

There is evidence that some respondents were not always commenting on the specific visit they were asked about in their survey. Some patients would share their full story, which could include multiple visits to urgent or emergency care and/or wider NHS access.

A small number in each sample, focussed on details of their health status as opposed to the care that they received. It is unclear from the comments why this was the case, and helpful to note that this detail was out of scope for analysis.

Comments reveal varied reasons for attending urgent and emergency care, alongside significant diversity in expectations, attitudes, prior experiences, and social contexts. These factors shaped how patients responded to their care and interactions, creating a challenging environment for delivering consistently high-quality experiences. Themes are closely interwoven and often interlink, and this report highlights these connections throughout. For instance, trust and confidence are influenced by multiple factors spanning the themes of ‘Staff,’ ‘Waiting,’ and ‘Treatment.’

Where feedback varied by setting this is highlighted in the report. If no distinction is made in the commentary, the findings are applicable to both A&E and UTC.

2. Headline findings

Key themes

Seven key themes were identified from the thematic analysis, listed below. Within each key theme are several sub-themes which support interpretation and use of the insights. There are 29 sub-themes in total.

1. Gratitude
2. Staff
3. Access routes
4. Waiting
5. Facilities and environment
6. Treatment
7. Outcomes and next steps

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This section of the report contains the detail of each theme with a range of quotations shared to substantiate and exemplify the experience of patients using their own words.

3. Thematic analysis findings

Key themes

Seven key themes were identified from the thematic analysis, listed below. Within each key theme are several sub-themes which support interpretation and use of the insights. There are 29 sub-themes in total.

• gratitude
• staff
• access routes
• waiting
• facilities and environment
• treatment
• outcomes and next steps

This section of the report contains the detail of each theme with a range of quotations shared to substantiate and exemplify the experience of patients using their own words.

Theme: gratitude

What does the quantitative data tell us?

• Type 1 (A&E): 38% rated their overall experience a 9 or 10 where a score of 0 represented a ‘very poor experience’ and a 10 a ‘very good experience’ (Q43).
• Type 1 (A&E): of respondents who left a viable comment, 37% rated their overall experience a 9 or 10 (Q43).
• Type 3 (UTC): 54% rated their overall experience a 9 or 10 (T40).
• Type 3 (UTC): of respondents who left a viable comment, 58% rated their overall experience a 9 or 10 (T40).

A strong, overarching theme noted across comments was overall gratitude for the NHS or the specific service attended. Often this was one part of an individual’s comment, with patients going on to discuss other aspects of their care both positively and/or negatively.

Comments of gratitude were directed at the NHS generally and broadly.

Often statements expressing appreciation referenced specific teams or individual members of staff, highlighting how the staff influenced their positive experience. The ‘Staff’ theme in this report provides further insight on the behaviours patients experienced as most impactful and valued.

Theme: staff

What does the quantitative data tell us?

• Type 1 (A&E): 67% reported having confidence and trust in doctors and nurses examining and treating them (Q21).
• Type 3 (UTC): 75% reported having confidence and trust in doctors and nurses examining and treating them (T18).
• Type 1 (A&E): 70% felt that they had been treated with respect and dignity ‘all of the time’ during their stay (Q42).
• Type 3 (UTC): 81% felt that they had been treated with respect and dignity ‘all of the time’ during their stay (T39).

Staff were found to play a critical role in shaping the experience of care in urgent and emergency services, showcasing how every individual within the workforce can have impact.

Personal attributes

Comments about staff referred to their personal qualities and characteristics that were seen to support delivery of high-quality care. Being compassionate, helpful and kind were personal attributes that were highly valued as these helped to provide comfort and reassurance.

Professional attributes

Professional attributes of staff were described in the context of being treated. Examples spanned efficiency, knowledge, and competency of staff with the impact often described as reassuring.

Other professional attributes highlighted positively were being listened to, and being treated with respect and as an individual. Experiencing these engendered confidence and trust.

Feedback about professional attributes sometimes included references to specific individuals or teams, with patients keen to show their appreciation. This is evident even where patients were unable to recall names but still wanted to highlight their positive experiences with staff.

Staff attitudes

In direct contrast to the positive experiences shared, those reporting negative interactions with staff highlighted how pivotal staff attitudes could be in defining the overall experience. In these comments, it was often individual staff members who were the source of the negative experience. Some comments indicate staff stating to the patient that they should not have attended the setting, linking to the ‘Avoidable access’ sub-theme explored later in this report.

Other feedback around staff interactions highlighted the negative impact of dismissive attitudes towards patients and their concerns. Patients shared experiences with staff members at reception and during assessments which left them feeling ignored or that they had not truly been heard.

Discrimination

While rare, a few patients reported discrimination relating to a protected characteristic. These examples are noteworthy exceptions against the backdrop of high praise for staff more typically shared. Patients described feeling that their treatment was incomplete because of this experience.

Capacity

Explicit mentions were made of the pressures facing staff in regards to capacity. Some comments demonstrated well how this can lead to even greater appreciation of positive experiences with staff when patients held a view or had experienced first-hand the capacity challenges the NHS workforce can face.

Feedback included mentions of the number of staff being too low and how, in their view, this could impact on experiences of care. This was more often seen in the comments from A&E patients. In these examples it was acknowledged to be a systemic problem and not a criticism of the staff as individuals.

Theme: access routes

There was a range of access routes into urgent and emergency care services evident in written feedback, with several patients sharing this information as a focus of what could be improved about their experience. This demonstrated that there were opportunities, both within and beyond the A&E or UTC setting, that could be a focus for improvement.

Avoidable access

What does the quantitative data tell us?

• Type 1 (A&E): 66% had contacted another service before attending (Q1).
• Type 3 (UTC): 50% had contacted another service before attending (T1).
• Type 1 (A&E): Among those who sought prior advice, 40% had called NHS 111 (Q3).
• Type 3 (UTC): Among those who sought prior advice, 48% had visited a GP practice (T3).
• Type 1 (A&E): 68% said their main reason for attending A&E was another service directed or advised them to do so (Q4).
• Type 3 (UTC): 56% said their main reason for attending UTC was another service directed or advised them to do so (T4).

Feedback included patients who themselves recognised that urgent and emergency care was probably avoidable for their situation. Some stated a preference to access care elsewhere but due to difficulties, both experienced and perceived in resolving their situation, had used urgent or emergency care instead.

Several patients shared examples of directly being told that they shouldn’t be using urgent and emergency care by a member of staff. This was experienced negatively in most examples, finding it rude and/or upsetting, linking this insight to the sub-theme ‘Staff attitudes’ detailed earlier in this report.

Primary care

Building on comments earlier shared about ‘Avoidable access’, feedback from Type 3 patients indicated that an UTC was sometimes used as an alternative when they were unable to secure an appointment in General Practice.

Further comments indicated patients were sometimes directed to an UTC by a healthcare practitioner in primary care. For those who experienced ‘Staff attitudes’ linked to ‘Avoidable access’ this highlighted a disconnect between primary and urgent care as to what was considered appropriate for referral and/or access to be made to an UTC.

NHS 111

Contact with NHS 111 was often mentioned, with varied experiences shared. It was common for patients to specify that they were directed to attend urgent or emergency care by NHS 111. Some comments where this was mentioned indicated that individuals were reluctant to use urgent and emergency care and had been seeking an alternative when they called NHS 111.

Frustrations were shared when patients experienced long waits when directed to urgent and emergency care services by NHS 111, especially if alternative settings were discussed retrospectively, while being treated.

Examples of misunderstanding or miscommunication were also evident, with some patients attending A&E or an UTC on the premise that they had an appointment or would be expected by the setting. This could lead to frustrations when this didn’t happen.

In contrast, other patients shared positive experiences of the co-ordinated care between NHS 111 and A&E, which they felt expediated their access to treatment.

Vulnerable patients

Feedback from individuals who shared they had specific needs or vulnerabilities often included requests for different access or separate areas to minimise the risks they felt were involved when attending urgent or emergency care settings. While there are strong links to the ‘Waiting’ theme detailed later in this report, examples from vulnerable patients indicated that their requirements were broader, including access and treatment. This included those who knew they were immunocompromised asking for an effective, dedicated and separate area at A&E to minimise the risk of infection.

There were also comments from patients with diagnosed mental health conditions who felt they should have been afforded more consideration given their condition or offered some form of different access to avoid aggravating their situation.

Similar, but more general comments relating to vulnerabilities were also made by patients who felt they were putting themselves at risk by attending A&E or an UTC, due to the potential for contact with other ill or dangerous patients, including where specific vulnerabilities were unclear.

Of note were comments from people who were pregnant seeking more consideration and understanding of the specific needs that they had, particularly those experiencing miscarriage.

Another notable theme in the comments related to the need for better communication support, such as BSL interpreters, so that patients could fully access care, feel involved and have a clear understanding of what was happening to them. This was only found in comments from Type 1 (A&E) patients.

Theme: waiting

What does the quantitative data tell us?

• Type 1 (A&E): 29% reported being seen within 15 minutes for their first assessment (Q11).
• Type 3 (UTC): Among walk-in patients, 34% were assessed within 15 minutes (T8).
• Type 3 (UTC): Of patients that had a booked appointment, 64% were assessed within 30 minutes (T8).
• Type 1 (A&E): 74% said they were not informed how long they would have to wait to be examined or treated (Q13).
• Type 3 (UTC): 61% said they were not informed how long they would have to wait to be examined or treated (T10).
• Type 1 (A&E): 64% of visits lasted more than four hours (Q16).
• Type 3 (UTC): 30% of visits lasted less than one hour; 18% lasted more than four hours (T13).

There was predominantly negative feedback shared about the experience of waiting, though some expressions of surprise were made as to the speed some patients were treated and cared for. This theme demonstrates that the experience of waiting is very diverse, individual and context specific for many patients. Please also note there is relevant insight shared within the theme ‘Facilities and environment’ as to other factors which impacted on the experience of waiting.

Acceptance of waiting times

There is evidence that patients arrive expecting to have to wait when they access urgent or emergency care. However, among those who commented on the experience of waiting times there lacked consistency as to what would be considered a reasonable timeframe. Diverse examples were shared as to when patients’ thresholds of tolerance or their acceptability levels of time waiting were surpassed.

‘Long’ wait times

As demonstrated earlier, there was variation amongst patients as to what was considered ‘long’ in terms of waiting times. Some comments explicitly referred to the wait being ‘long’ while in others it was inferred through statements that improvements in waiting time were needed.

This insight links to the ‘Trust and confidence’ sub-theme outlined earlier, when wait times did not match the patient’s sense of urgency as to how this undermined their confidence. Rarely did patients clarify which part of their experience required them to wait, though when shared, examples varied and included amongst others, waits for assessment; for triage; to be treated; and for medication.

Impact of waiting: self-discharge

Regarding the impact of waiting, it was observed in the data that several patients left the service and/or discharged themselves due to the length of time that had either passed or was anticipated to be spent waiting to receive care. It was often unclear if these patients accessed and received care elsewhere thereafter.

Pharmacy access delays

Of note, there were several patients that spoke of delays in accessing prescribed medication due to the closing times of the hospital pharmacy.

Speed and efficiency

While not typical, there were patients who were impressed with how quickly and efficiently they had been seen and treated in urgent or emergency care. This was sometimes shared in such a way that inferred there were low expectations held by patients, which had been easy therefore to exceed. As with the sub-theme ‘Acceptance of waiting times’ there was no consistency identified as to what timeframe was considered ‘quick’ or ‘efficient’ and examples varied.

Managing expectations

A lack of communication while waiting for an initial assessment was raised as an issue which created additional anxiety and stress. Examples highlighted the need to manage expectations, with patients looking for clear and up to date information on the status of their wait to help minimise their frustration.

Communication methods

Comments highlighted the difficulties attached to large, crowded waiting areas such as individuals waiting to hear their name being called, meaning they missed this even when vigilant.

Some comments highlighted that electronic boards were either unavailable when needed or not consistently updated, which contributed to the frustration of waiting. Note the link to ‘Managing expectations’ as a sub-theme shared earlier.

Theme: facilities and environment

Predominantly experience was discussed in negative terms and there were lots of suggestions to improve the facilities and environment of urgent or emergency care settings. It is noteworthy that most of the feedback within this section of the report, speaks to the experience of ‘Waiting’ and is linked to this key theme closely. There are also interconnections between the sub-themes shared within this section whereby one issue experienced is seen to impact and/or lead to another. For example, the experience of overcrowded waiting areas can contribute to feelings of being unsafe.

Food and drink

What does the quantitative data tell us?

• Type 1 (A&E): 44% who wanted something to eat or drink reported ‘always’ having access to food and drink (Q32).

• Type 3 (UTC): 47% said they were ‘always’ able to get food or drinks (T29).

Many comments regarding facilities focussed on there being a lack of access to food and drinks, including water. This was experienced both while waiting for their first assessment and after their first assessment, particularly for those who attended A&E. It appeared there was variation in the offering across settings, though notable was the pattern of feedback highlighting that there was no access to cafes; restaurants; shops; and vending machines. In terms of impact, there was mention of hunger and (de)hydration, as well as mention of risks for vulnerable patients such as those with diabetes.

Physical comfort

Another key area of focus regarding facilities was how the chairs in waiting areas were uncomfortable. A connection was made by some patients to waiting times when describing this experience, i.e. the longer they waited, the more uncomfortable they became in the chair(s) available.

In terms of impact on patients, the lack of comfort while waiting was described by some as exacerbating symptoms. This included those who could not find seating at all, with some concern noted over vulnerable patients particularly.

Cleanliness

Cleanliness was commonly mentioned as an issue in comments focussed on the environment of the setting. While some patients acknowledged that the volume of people would make cleaning difficult, unclean facilities were felt to be unacceptable and contributed to a sense that there was a lack of care. Of note is that issues of cleanliness were identified typically during the patients’ experience of waiting for care, relating primarily to toilets but also to floors and lifts.

Overcrowding

Overcrowding was experienced, particularly in A&E, with observations that waiting areas contained large volumes of people. A key cause of this were instances of patients taking (multiple) people along with them to wait for care, including children, which was not appreciated by those providing feedback. Some patients connected this to a lack of seating being available for patients, as well as a need for a calm/peaceful environment while unwell and waiting. A need to improve the management of the waiting area by staff was also highlighted.

Privacy

Feedback on the lack of privacy and how this increased feelings of vulnerability was evident. Concerns around a lack of privacy were raised predominantly by female patients. While this theme was mainly seen in A&E, with comments relating to both waiting and consultation spaces, there were also observations at the lack of privacy at reception areas in urgent care settings.

Safety

Patients described feeling unsafe while in the waiting area in A&E due to the actions of other people, particularly when they did not think there was effective management of patient behaviour by staff. This was linked by some patients to ‘Overcrowding,’ where there were concerns raised about the ability of the setting to manage large numbers. Concerns about security were also evident, which could leave patients feeling less safe.

Feedback about ‘treatment’ includes experience of investigations, tests, scans, assessments, support and medication. While experiences of treatment can be found throughout the report, a focus here highlights there was negative experience of pain management and variation in regards to mental health support particularly. The concept of trust and confidence spanned different treatment scenarios and was found to be of great importance and linked to themes shared earlier in the report of ‘Staff’ and ‘Waiting.’

Theme: treatment

Trust and confidence

What does the quantitative data tell us?

• Type 1 (A&E): 66% said that staff completely explained the reasons for any tests in a way they could understand (Q28).
• Type 3 (UTC): 76% said that staff completely explained the reasons for any tests in a way they could understand (T25).
• Type 1 (A&E): Of those that had further tests, 60% felt staff had explained the results in an understandable way (Q29).
• Type 3 (UTC): Of those that had further tests, 72% felt staff had explained the results in an understandable way (T26).
• Type 1 (A&E): 60% said their condition and treatment were explained in a way they could understand (Q18).
• Type 3 (UTC): 73% said their condition and treatment were explained in a way they could understand (T15).

Feedback demonstrated a lack of confidence some patients had in their treatment, particularly when they didn’t undergo investigations they had expected due to their symptoms. Within these comments there was an underlying sense that patients feeling ignored by staff contributed to a lack of trust, for example where their requests for specific tests were refused.

Further contributing factors linked to experience of ‘Long wait times’, particularly where these were seen to jar with the perceived seriousness of their symptoms. When patients were left for long periods, this could lead to questions over the decisions made about their treatment.

Being listened to

What does the quantitative data tell us?

Type 1 (A&E): 69% felt doctors and nurses ‘definitely’ listened to them (Q19).

Type 3 (UTC): 80% felt doctors and nurses ‘definitely’ listened to them (T16).

Type 1 (A&E): 58% reported being ‘definitely’ involved as much as they wanted in decisions about their care and treatment (Q27).

Type 3 (UTC): 71% reported being ‘definitely’ involved as much as they wanted in decisions about their care and treatment (T24). 

Some patients shared that they had not felt listened to by staff, which strongly relates to other sub-themes of ‘Trust and confidence,’ ‘Unresolved symptoms’ and ‘Staff attitudes.’ Examples shared here demonstrate that patients not being listened to can be experienced as having an impact on their treatment.

Coordination of care

Breakdowns in communication and a lack of coordination within settings as the cause of delays, was a focus for some patients. Feedback indicated that patients felt they had to take responsibility for coordinating their treatment or ensuring that information was shared between different staff/teams.

Pain management

What does the quantitative data tell us?

• Type 1 (A&E): 42% said staff ‘definitely’ helped control their pain; 27% did not receive help (Q30).
• Type 3 (UTC): 47% said staff ‘definitely’ helped control their pain; 26% did not receive help (T27).

Where comments mentioned pain management this was overwhelmingly negative, with experiences closely tied in with the experience of ‘Waiting’. While there were comments from UTC patients about pain, this sub-theme was more often seen in feedback from A&E patients. This included examples where no pain relief was given or when patients felt it had taken too long to receive pain relief, although it was not always clear whether this was before or after their first assessment.

Mental health

What does the quantitative data tell us?

• Type 1 (A&E): 11% indicated having a mental health condition (Q48).
• Type 3 (UTC): 9% indicated having a mental health condition (T45).
• Type 1 (A&E): 45% said doctors or nurses completely discussed any anxieties or fears about their condition or treatment (Q20).
• Type 3 (UTC): 57% said doctors or nurses completely discussed any anxieties or fears about their condition or treatment (T17).

Some A&E patients shared their experience of care in relation to their mental health needs, linking to the pivotal role of staff outlined earlier in the ‘Personal attributes’ and ‘Staff attitudes’ sub-themes. A common thread when mental health was explicitly mentioned being the impact of negative experiences leaving them in the same, if not a worse place than when they first attended.

Feedback also included positive examples where the support from staff was noted as being exceptional, with observations on the compassion shown when experiencing a crisis having a deep impact.

Theme: outcomes and next steps

Feedback from discharge through to aftercare demonstrated areas for improvement were needed to ensure patients were clear and understood both what had happened and would happen next. Clarity on roles and responsibilities including expectations of the patient would support this, linking this theme closely to ‘Treatment’ outlined earlier in this report. Note there were also examples of self-discharge linked to ‘Waiting’ and access of private healthcare when symptoms were left unresolved.

Unresolved symptoms

What does the quantitative data tell us?

Type 1 (A&E): 30% said they had been to the same service previously for the same condition (Q8)

Type 3 (UTC): 20% said they had been to a UTC previously for the same condition (T5)

Both A&E and UTC patients shared experiences where a lack of resolution to their initial attendance led to further interactions with NHS services. This included patients who lacked confidence in their initial diagnosis or treatment, and either contacted other NHS services or reattended urgent and emergency care settings.

Other examples given indicated that opportunities were perceived as missed either in terms of diagnosis and/or treatment, sometimes linked to feeling staff did not listen to the concerns raised by the patient. Commonly, these patients reported reattendance at urgent or emergency care settings.

Although limited in volume or detail, there were comments which indicated some patients were discharged without a clear idea of their diagnosis, which they believed had a negative impact on care and support after their visit.

Private healthcare

Comments which discussed patients’ use of private healthcare often shared a common thread that they felt driven to do so by their needs going unmet either during or after interactions in NHS urgent or emergency care settings.

NHS records

Feedback which touched on what happened after their visit included experiences where NHS records were not fully updated after attending urgent or emergency care. Some reported that this impacted on their ability to access appropriate follow up care.

Follow-up

What does the quantitative data tell us?

• Type 1 (A&E): 67% received information on how to care for their condition at home (Q36).
• Type 3 (UTC): 82% received information on how to care for their condition at home (T33).
• Type 1 (A&E): Of those given the information, 70% said that they understood the information given ‘very well’ (Q37).
• Type 3 (UTC): Of those given the information, 77% said that they understood the information given ‘very well’ (T34).
• Type 1 (A&E): 79% were told who to contact if they were worried about their condition or treatment (Q39).
• Type 3 (UTC): 82% were told who to contact if they were worried about their condition or treatment (T36).

Some patients described a lack of clarity about where test results would be sent, along with not being clear on who to contact to discuss them. The impact of these experiences was that patients were left wondering what the results could be and feeling unsure how to move forwards in terms of follow-up care.

Concerns were also raised about uncertainty over next steps following a visit to urgent or emergency care, with feedback on the need to improve clarity on what communication would be received once discharged. This included patients who were informed of a need for follow up appointments but were unclear about where responsibility lay to arrange these.

Other observations

Below is a list of other topics commented upon in the data that were noted during the analysis process. There was a lack of volume of comments or depth and detail to inform themes and sub-themes but suggestions are noteworthy:

• concerns for staff wellbeing were shared, with observations made on other patients being rude to staff
• observed discriminatory comments about staff within survey responses, relating to protected characteristics
• concern raised about aftercare following surgery being insufficient and creating a need to use emergency care
• experience of a lack of care, for example with open wounds, while waiting for first assessment

4. Conclusions

5. Appendix: methodology

Survey methodology

The survey has undergone significant changes to methodology, sampling and content in 2024 which prevents comparisons to data from prior iterations. Through extensive consultations, stakeholders prioritised understanding patients’ experience of care during winter pressures and identifying factors that may account for unnecessary attendances. To this end, patients who received care in February 2024 from A&E (Type 1) or urgent treatment centres (Type 3, UTC) were invited to participate.

The Type 1 survey received responses from 35,670 people – a response rate of 29%. The Type 3 survey received responses from 10,325 people – a response rate of 26%. A total of 120 NHS acute trusts in England with an A&E department (Type 1) took part in the survey, of which 70 trusts also had an urgent treatment centre (Type 3).

Qualitative analysis

Thematic analysis was undertaken to achieve a deep understanding of the findings from the open questions asked in the survey. This sought to facilitate reflection and learning across services delivering urgent and emergency care in England.

To analyse qualitative data, the standard six steps of thematic analysis were used to identify patterns of meaning within the data and explore commonality and contrast – see Figure 1.

Figure 1: Thematic Analysis Approach

The image shows a horizontal blue arrow pointing to the right, representing a process flow. Inside the arrow are six dark blue rounded rectangles arranged sequentially from left to right, each containing white text. The steps are:

1. Familiarisation
2. Initial coding
3. Generating themes
4. Reviewing themes*
5. Defining themes
6. Final analysis and report writing

The arrow visually indicates progression from familiarisation through to final analysis and report writing, suggesting a structured process for thematic analysis. 

The results of the thematic analysis have been reviewed and are shared in context of the relevant quantitative survey findings. This exploits the value of both the quantitative results, which tells us the proportion of respondents feeling a certain way, and the qualitative findings, which tells us why people feel that way. For example, where there is a high degree of agreement / positive experience evidenced in the survey data, the thematic findings offer an opportunity to understand why there was not 100% agreement / positive experience and therein, where the opportunities lie for reflection and learning.

Sub-group comparisons

Sub-group comparisons were not the focus of the analysis. Where variations were observed in the national sample, this has been included within commentary. It is recommended that further focused sampling would allow for in-depth exploration of how experiences of urgent and emergency care may vary for different groups. Observations included will unlikely be exhaustive due to the national sample and focus.

6. Appendix: Sampling approach

16,185 (A&E, Type 1) and 4,029 (UTC, Type 3) written responses were collected in total, meaning 45% and 39% respectively of the survey sample provided qualitative data in answering the open ended question.

Qualitative data cleaning

Before sampling, further data cleaning was carried out to identify and remove extremely short comments which were of no analytical value, for example those which simply stated ‘No’, ‘N/A’ or consisted of a single character.

For the Type 1 sample, 277 comments were removed in this way, leaving 15,908 comments for the sample to be drawn from. For the Type 3 sample, 94 comments were removed in this way, leaving 3,935 comments for the sample to be drawn from.

Sampling

It was decided to sample each of the surveys separately so that all respondents with viable response to an open question had the potential to be included in the final sample for analysis.

To ensure a robust approach to sampling, a purposive sampling approach was taken. This is an established best practice technique when analysing qualitative data, as it ensures that the data has enough diversity across the most relevant criteria to allow the impact of the criteria to be explored and compared. For example, if age is a criteria, including responses from all the different age groups in sufficient volume means that differences in experiences between age groups can be explored.

The criteria chosen to sample on were the age, ethnicity, sex, and deprivation level of respondents, as these were key demographic groups recorded in the data. A sample matrix was drawn up to establish how many comments from each of the demographic groups were to be included in the analysis to allow for sufficient coverage.

In addition to the three key demographic groups a minimum of 30 comments were included on all other characteristics including sexuality for instance. Please note that as there was a low volume of data from respondents identifying as Arab or other ethnic group, Intersex or different gender identity than sex assigned at birth, all of these cohorts were included in the sample. The breakdown of the volume of comments in the sample by these different criteria is provided below.

Once the original sample of 1,363 comments had been analysed it was seen that data saturation had been reached, i.e. no new themes were emerging from the data. Had this not been achieved, additional comments would have been added to the sample as necessary, in line with best practice in qualitative analysis.

The tables below show the number of comments in the analysed sample per characteristic for Type 1 (A&E) and Type 3 (UTC) services. The sampling approach ensured sufficient coverage across key demographic groups to allow for exploration of how experiences may vary.

Table 1: Number of comments in analysed sample per characteristic for Type 1 (A&E)

Table 2: Number of comments in analysed sample per characteristic for Type 3 (UTC)