CQC finds half of A&E services sub-standard over winter

With demand on health and social care services upping the pressure on emergency departments, the watchdog applauded staff for going to "extraordinary lengths to mitigate risks to patient safety".

Its inspection also found evidence of good practice and of individual providers that have been able to make improvements.

However, there was too much variation in planning for demand surges and care, and increased pressures led to some patients receiving sub-standard care, it noted.

The quality and safety of urgent and emergency care "remains a concern" with 50 percent of urgent and emergency services rated as ‘requires improvement’ or ‘inadequate’ overall, and 8 percent deemed ‘inadequate’ for safety.

The CQC said 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 being identified in a timely way".

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

The group also highlighted that findings from its local system reviews show variation in the way that local systems have worked together to prepare for surges in demand.

Although there were some examples of good practice, 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," the CQC said.

"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," stressed Professor Ted Baker, chief inspector of Hospitals at the CQC.

"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."

Commenting on the report, Dr Taj Hassan, President of the Royal College of Emergency Medicine, said the data confirms that clinical care and safety "is increasingly being compromised," and that "too many of our emergency departments are struggling to cope, and patient care is suffering".

"Patient safety is now either inadequate or needs improvement in almost two thirds of Type I [emergency departments] in England," he noted, adding that just 1 percent of Trusts are rated as ‘Outstanding’ in regard to safety. Also, the RCEM’s own data "reflect a deterioration in overall standards affecting a range of common conditions".

"Hospitals must take collective ownership of ED performance and understand that every department has to play their part for these measures to work. However, we would encourage system leaders to concentrate on capacity and output measures rather than focus on the 15-20 percent of patients that could be better treated elsewhere," he argues.

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