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Changes needed for emergency care to avoid winter crisis

Some 50% of urgent and emergency care below par

Jo Carlowe

Thursday, 24 May 2018

New ways of collaborating and planning are needed to avoid a repeat of the winter pressures experienced in emergency care.

This is the message from the Care Quality Commission (CQC) in its report published today, which notes that 50% of urgent and emergency services were rated as requiring improvement or were inadequate overall.

The report, Under pressure: safely managing increased demand in emergency departments, presents the findings from CQC’s inspections of emergency departments over winter 2017/18 alongside the findings of workshops attended by over 70 frontline clinicians aimed at understanding the issues facing staff and what needs to change.

The report reveals that some 8% of services were rated inadequate for safety.

CQC inspections found specific concerns around delayed ambulance handovers and people waiting for long periods of time before their first clinical assessment, with patients needing urgent care not always identified in a timely way. While escalation policies were generally in place, they were not consistently followed or were not effective in coping with increased demand.

A further concern was the use of inappropriate spaces - such as corridors - for patient care. CQC found that many hospitals were caring for patients in such spaces routinely, with no plans in place for alternative safer accommodation.

Included in the report, were practical solutions from frontline staff to help maintain safe services when faced with surges in demand, but also calls for wider action by the whole health and care system to ensure a joint approach to managing the capacity problem as demand continues to grow.

The solutions focused on action that can be taken to help keep people well and reduce emergency department attendances, steps that emergency departments can take to better manage the flow of patients through the hospital, and ways to help avoid unnecessary admissions and ensure early discharge.

Commenting, Professor Ted Baker, chief inspector of hospitals at the Care Quality Commission, said: “During an unprecedentedly challenging winter, we have seen staff going above and beyond to deliver safe care to patients…Our inspections of urgent and emergency services have found evidence of good practice and of individual providers that have been able to make improvements. However, we have also found too much variation and we have seen how increased pressure has led to some patients receiving care that is wholly unsatisfactory.”

He added: “Hospitals cannot work alone to address the ever increasing demand on services - there has to be a system-wide approach with all parts of the health and social care system working together to find solutions. We cannot accept that each winter will be worse than the one before – we are already seeing the impact on both patients and staff. It is clear that what used to work doesn’t work anymore - new ways of collaborating and planning for surges in demand need to happen now to ensure that next winter is different.”

Looking beyond hospital emergency departments, the findings from CQC’s local system reviews show a variation in the way local systems have worked together to prepare for surges in demand. These government-commissioned reviews of 20 local areas are exploring how well local health and social care systems work together to support and care for people aged 65 and over, including the interplay between emergency care provision and other local services.

Although in some cases CQC has seen good examples of systems working collaboratively to plan for winter pressures, the reviews have raised concerns about the timeliness of this planning and the extent to which all partners across the system are involved in the planning process, with independent social care providers and voluntary, community and social enterprise organisations often less engaged.

Commenting on the report, Dr Taj Hassan, president of the Royal College of Emergency Medicine, said: “We greatly welcome this report from the Care Quality Commission that fully bears out what our members have been telling us and experiencing directly with increasing frequency. The data confirms that clinical care and safety is increasingly being compromised. Too many of our emergency departments [EDs] are struggling to cope, and patient care is suffering.

“The report rightly commends staff for going above and beyond in increasingly difficult circumstances, and the ratings bear out the compassionate care our patients are receiving. But it is also clear from these ratings that patient safety is now either inadequate or needs improvement in almost two thirds of type I EDs in England. Just 1% of trusts rated as ‘Outstanding’ in regard to safety. Our own recent clinical audits also reflect a deterioration in overall standards affecting a range of common conditions."

Dr Hassan called for a significant "boost in resources" to enable the CQC’s recommendations to be put into effect.

“The recommendation of provision of sufficient bed numbers and improving staffing capacity are both key to unlocking the problems of crowding and patient flow that will lead to safer and better care. Both will only realistically be achieved through a significant boost to resourcing; something the College hopes will be addressed by the government in the months to come,” he said.


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