Nearly one in six people left emergency departments before treatment was completed at Liverpool's main adult hospitals in the 12 months to March this year.
Patients attending the emergency departments at Royal Liverpool Hospital and Aintree Hospital were more likely to leave before completing treatment than patients at any other NHS hospital trust in the Liverpool City Region, according to the latest data from NHS Digital. Between April 1, 2021 to March 31 this year, 2,600 people left A&E at the two hospitals at some point before an initial assessment, before treatment began or before treatment was completed.
Representing 15% of emergency department attendances at the Liverpool University Hospitals, this is more than double the 6.2% rate in England as a whole. Although the NHS trust does have the highest median time - 135 minutes - from arrival in A&E to the start of treatment of any NHS trust in the Liverpool City Region, this is not a pattern seen in the same data for other trusts.
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A spokesperson for the Liverpool University Hospitals, which runs the Royal and Aintree hospitals, pointed to other reasons people may leave A&E. These include recovering from symptoms or intoxication, being advised of alternatives like walk-in centres, securing a GP appointment, or being abusive to staff but leaving before they're removed.
A spokesperson for the trust said: "Our teams are working incredibly hard to treat people as quickly as possible and these figures demonstrate the significant level of demand that our two Emergency Departments are experiencing. People with serious medical emergencies will always be prioritised for treatment and we would ask people with less urgent concerns to contact NHS 111 for advice on alternative services."
The hospital trust with the next highest share of people leaving A&E before treatment is complete is Wirral University Teaching Hospital, which has an emergency department at Arrowe Park Hospital. Here, 10% of attendances leave before treatment is complete, slightly higher than the 9% at St Helens and Knowsley Teaching Hospitals, and at Warrington and Halton Teaching Hospitals.
Like at the Liverpool University Hospitals, patients attending A&E at Arrowe Park Hospital with "minor injuries" are advised to seek help from pharmacies and other healthcare providers after being "assessed by an experienced clinician on arrival", according to a Wirral University Teaching Hospitals spokesperson.
This includes directing people with "minor injuries and illnesses" like rashes, burns and stomach ache to an urgent treatment centre, run by Wirral Community NHS Trust and located next to Arrowe Park's emergency department. Only 2% of people seeking emergency care from Wirral Community NHS Trust leave before treatment is complete.
A spokesperson for Wirral University Teaching Hospitals said: "In the last two months, [Arrowe Park Hospital] has seen increases in patients attending the emergency department (ED) from 240 a day to 290 a day, and has consistently emphasised the need to keep ED free for emergencies. The Trust is investing in other measures through its newly launched Patient Experience Strategy and its investment of £28m in a new Emergency Department entrance, combining the Urgent Treatment Centre and ED for an improved patient experience."
In the Liverpool City Region, only Bridgewater Community Healthcare has a higher rate of attendances leaving emergency departments before completing treatment than Liverpool University Hospitals. According to data from NHS Digital, 23% of people were early leavers of emergency care from this provider of community and specialist services in St Helens, Halton and Warrington. But the trust is challenging the NHS Digital data with the team responsible for it, saying the way the data is reported doesn't reflect how the trust operates.
Instead of running A&E departments like the Royal Liverpool, Aintree and Arrowe Park hospitals, Bridgewater operates an urgent treatment centre in Widnes, along with a telephone triage service, which directs patients to "the most appropriate and covid secure service". The trust said this telephone triage service skewed the figures because it can take multiple attempts to call a patient back before they answer and the triage can be completed, but each failed attempt is recorded as a 'no treatment' scenario
A Bridgewater Community Healthcare NHS Foundation Trust spokesperson said: "The actual number of patients leaving our urgent care setting for the reported period of March 2022 is 186 (4.9%). This is substantially lower than the reported figure. We are speaking to our colleagues at NHS Digital to make them aware of this reported data glitch and how such data is reported in the future."
