NHS study highlights urgent need for faster pain relief in sickle cell crises

A new report from NHS England’s Behavioural Science Unit (BSU) looks at the key reasons behind delays in treating painful sickle cell crises, and outlined practical solutions to improve emergency care for thousands of patients. One of the most serious complications of sickle cell disorder, a vaso-occlusive crisis (VOC), occurs when sickled red blood cells block blood vessels. VOCs can cause excruciating pain and life-threatening complications, and national guidelines state patients should receive effective pain relief within 30 minutes of arriving in hospital.

However, BSU researchers found that many patients still face long waits for treatment. By mapping patient journeys, interviewing healthcare professionals, and analysing hospital practices using behavioural science frameworks, the study identified five main barriers to timely care.

Barriers include:

• Low priority in triage – VOCs are not always recognised as medical emergencies.​​
• Overcrowding and staff shortages in emergency departments – staff shortages and busy environments delay action.

• Limited access to care plans – personalised treatment plans are often hard to locate, especially in hospitals unfamiliar to the patient.

• Lack of training – many emergency department staff lack experience in treating a VOC due to limited training and high staff turnover, which slows down care. 

• Unconscious bias and mistrust – stigma around opioid use sometimes leads to under-treatment.

The research found several ways to improve care and address the challenges above, some of which are already in use.

Practical solutions

• Dedicated ED bypass units to allow patients to bypass emergency departments and access specialist care more quickly. Several hospitals are already trialling such pathways, with evaluations due later this year.

• Personalised care plans which follow a standardised template and are easily accessible to staff in the emergency department.

• Pre-approved prescriptions which cover pain relief and other medications, allowing staff to prescribe appropriate medications quickly to speed up treatment, reduce uncertainty and ensure consistency across NHS trusts.

The recommendations will now feed into the 2025/26 Sickle Cell and Thalassemia Quality Improvement Programme, as part of wider efforts to tackle healthcare inequalities. Adele Richmond and Dan Berry, who co-authored the study, said the findings pave the way for “real change, making emergency care more responsive, efficient and compassionate” for people living with sickle cell disorder.