‘Serious concerns’ over A&E services

MORE than half of A&ES and urgent care services require improvement or are inadequate, according to a report.

The Care Quality Commission’s State of Care study for 2020/2021 found inspectors had “serious concerns” about some areas of emergency care in England, including ambulance handover delays at hospitals which put “the safety of patients at risk”.

Overall, 22% of NHS acute services in the study were found to require improvement, while 2% were inadequate, 67% were good and 8% were outstanding.

Among 204 individual urgent and emergency services, 47% required improvement, 6% were inadequate, 42% were good and 5% were outstanding.

In a briefing, the CQC’S chief inspector of hospitals Ted Baker said hospitals and ambulances were seeing a “major increase in pressure”, in part due to issues in social care.

He said staff were facing a “tough winter” and needed support, and pointed to delays in people accessing emergency care and people having to wait in ambulances before they could be handed over to A&E staff.

Mr Baker also said that even when people get into A&E, there can be long delays to be seen. “Those waits we describe as unacceptable,” he said. “As the pressures on the system build, more problems like that are going to develop.”

Mr Baker said “things may well get more difficult” for the NHS and social care going into winter, though not all the pressures were about Covid.

He said problems in emergency care have been building up over the summer and the CQC had been working with organisations to focus on patient safety.

Asked about pressure through all the NHS and care system, Mr Baker said: “I think the levels of pressure at the moment are very intense and I think we are very concerned going into winter that they may get worse, which will create extra problems for the system in responding to that.”

Mr Baker said staff were exhausted, with high levels of burnout, and the CQC was worried that care for individual patients could get worse due to pressures and not enough staff.

Ian Trenholm, chief executive of the CQC, said the organisation was seeing many services “at capacity and beyond capacity and problems that could traditionally have been diverted can no longer be diverted”.

“So what we’re seeing are systems that are under enormous pressure,” he added.

In the study, experts pointed to big problems with ambulances having to queue outside hospitals to hand over patients.

In a survey of UK emergency department clinical leads, conducted in August 2021 by the Royal College of Emergency Medicine, half of respondents said their emergency department had been forced to hold patients outside in ambulances every day, up from a quarter the previous October.

The CQC report said: “Once it arrives at a hospital, an ambulance is not a suitable place for a patient to receive treatment or wait to be admitted.

“Furthermore, a parked ambulance is not available to attend other emergencies and ambulance crews are sometimes unable to end their shift because they can’t leave the patient.”

However, when it came to the performance of individual ambulance trusts, the study found 80% were good, 10% outstanding and 10% required improvement.

Elsewhere, 95% of GP practices were ranked good or outstanding, and patient satisfaction with getting through on the phone and satisfaction with making an appointment appears to have increased in patient surveys. However, the CQC did express some concerns over access to appointments.