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Emergency Medicine

People living in deprived areas visit A&E twice as much as the affluent

Nearly 25 million people attended A&E in 2018-19.



Busy A&E waiting room

Over a quarter of all A&E attendances are by the 20% of the population living in the most deprived areas.

Accident & Emergency (A&E) attendances for those living in most deprived areas are around double that of those living in the least deprived, official figures have revealed.

NHS Digital’s data on Hospital Accident & Emergency Activity in 2018-19 show that the bottom 10% account for the largest number of A&E attendances of any group, with just over 3 million attendances in 2018-19. In contrast, the top 10% only accounted for around 1.5 million A&E attendances.


Expanding these figures further shows that 27% of all A&E attendances are by the 20% of the population living in the most deprived areas.

A recent study suggested that socioeconomic such as poor housing quality, unemployment, self-care difficulties, depression, and proximity increased a person’s likelihood of attending an A&E service.

The report includes data from all types of Accident and Emergency departments ranging from major A&E departments, single specialty, consultant-led emergency departments to Minor Injury Units and Walk-in Centres.

An overall increase in attendances.

Looking at all arrival times, 1.5% of all attendances in 2018-19 spent more than 12 hours in A&E, compared with 1.6% the previous year.

The data also shows a 4% increase in attendances to A&E from 23.8 million in 2017-18 to 24.8 million in 2018-19 and a 21% increase from 20.5 million in 2009-10. Since 2009-10, the average growth in A&E attendances per year is 2%.

An NHS spokesperson said; “Over a busy summer, NHS staff have continued to deliver more care than ever before for those who need it, with 37,000 more people receiving A&E treatment within four hours this August compared with last August.”

“July also saw the highest ever number of people in a month benefiting from fast NHS cancer checks, other routine tests and rapid treatment for serious mental health problems, while an extra 1,600 people started planned treatment every day compared to last year, showing that every part of the health service is playing its part in meeting the rising demand for care.”

Clinical Updates

First dementia-friendly ambulance to launch in the UK

The redesigned ambulances will start serving patients on Monday.



Dementia Friendly Ambulance

For people with dementia traveling in an ambulance can be a potentially frightening experience.

The UK’s first ‘dementia-friendly’ ambulance was launched by East Midlands Ambulance Service (EMAS) earlier this week.

EMAS work alongside UnityDEM, the University of Northampton’s Dementia Centre, to update four emergency vehicles, making people with dementia feel less frightened or confused when traveling in them.


The redesigned ambulances will start serving patients throughout Northamptonshire and Leicestershire on Monday.

Responding to around 43,000 emergency calls a year from patients living with a diagnosis of dementia, there are plans for all 104 ambulances across the two counties to be dementia-friendly by the end of October.

‘Subtle adjustments can have a big impact’.

The vehicles include several key changes.

The window nearest the ambulance stretcher – is now covered with a scene that contains key points to talk and reminisce about, including children playing to remind people of their youth and animals for patients to guess what they are.

Music provision – a USB device provided with music in specific decades to allow staff to choose tracks that patients are most likely to have positive reactions/memories to.

‘Twiddlemuffs’ – a knitted hand muff, decorated with internal and external items, such as buttons and ribbons.

This is Me documents – these include information such as what people like to be called, where they grew up, how they take their medication, things they don’t like and can be completed at home by patients and their carers for paramedic crews to refer to during future emergency call outs.

Communication guide for staff – dementia friendly training for all front-line EMAS staff was rolled out from April this year; this guide contains top tips on using the changes in the ambulance to prompt conversations, how to alter their communication style to meet the needs of the patient and things to keep in mind for any patients who may not be able to communicate verbally.

‘A sudden, strange and potentially frightening experience’.

Charlotte Walker, Ambulance Operations Manager and project lead said: “Continuously developing our service to meet the specific needs of our patients is vital and enables the response patients receive across the East Midlands to be of the highest possible standard.”

Professor Jacqui Parkes, the University’s NDRIC lead, said: “Sometimes, it’s not just the big things that make a difference in people’s lives, but more subtle adjustments and tweaks can cumulatively, make a big impact.

“For people with dementia, going into an ambulance can be a sudden, strange and potentially frightening experience, but EMAS have shown with their dementia friendly ambulance – the first of its kind in the UK – that with little adjustments, this can be reduced and lead to a much more positive experience. We look forward to seeing the full fleet in action very soon.”

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Clinical Updates

Majority of people think patients often use A&E ‘unnecessarily’

Over half of the population say they find it hard to get a GP appointment.



hospital waiting room

Patients say they prefer A&Es departments as they can get tests done quickly.

New research shows that 86% of people believe too many patients often use A&E services unnecessarily.

The most recent British Social Attitudes Survey, carried out by The National Centre for Social Research and funded by the National Institute for Health Research, is the first ever large-scale research into attitudes towards emergency care conducted.


Alicia O’Cathain, Director of the Medical Care Research Unit at the University of Sheffield, said: “Today’s findings illustrate that while the majority of the British population are satisfied with A&E services, there are marked differences in attitudes and understanding between different social groups when it comes to views on access and confidence in A&Es and GPs.”

Patients prefer ‘on-demand’ services.

With 94% for people aged 65 to 74 years old and 79% of those aged 18 to 24 years believing A&Es are overused, the research explores the possible reasons why.

It shows that over half of the population find it hard to get a GP appointment and nearly 40% said they prefered accessing ‘on demand’ health services where they are not required to make an appointment.

It also showed that 17% of all Brits prefer A&Es to GPs because they can get tests done quickly.

Confidence in primary care services could also be a contributing factory with patients living in the most deprived areas and 20% of parents with a child aged under 5 said they don’t have much faith in GPs.

Forced to go where the lights are on.

In response to the survey, Patricia Marquis, Royal College of Nursing Director for England said: “A&E departments across the country are crammed because people are forced to go where the lights are on when they can’t get the treatment they need elsewhere.”

”After the recent rhetoric around access to GPs and other services it must quickly become a reality. Staffing levels aren’t improving and yet demand is continuing to rise,” Marquis commented.

Adding; “This survey demonstrates the need for proper concerted investment across the whole of health and care services and accountability for safe staffing levels set in law.”

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