‘Gross’ care delays could become ‘new normal’, says CQC report

A report by the CQC and a large group of emergency clinicians and other health and care leaders calls for a ”move away from reactive ‘quick fixes’ such as tents in the car park or corridor care to proactive long-term solutions and to address the enormous gap in resources and capacity”.

The use of tents and treating more patients in corridors have been increasingly adopted by hospitals in recent months, sometimes encouraged by NHS England, particularly when they are under pressure to reduce handover delays from ambulances.

People First: a response from health and care leaders to the urgent and emergency care system crisis went to the CQC’s board meeting today. Its suggestions include:

• expanding use of urgent community response teams to attend minor injuries 999/111 calls,
• giving acute and social care providers direct access to GP and community service booking systems, and
• providing “rapid access” to support packages to help people avoid hospital admission.

The People First guidance and recommendations were based on a workshop of senior clinicians and CQC staff, which was “unanimous” that “radical and bold solutions must be urgently sought and sustainably delivered” to avoid the current situation in urgent care becoming “a worrying new status quo”.

Sir Robert Francis, chair of Healthwatch England, which contributed to the guidance, said the situation in urgent care represents a “system crisis”. In a foreword he says: ”No-one can deny that our emergency services are in a critical state, and with bed capacity now overwhelmed in our hospitals, they are constantly failing to meet reasonable expectations for response times, quality of care and safety.

“This [guidance] rightly describes the situation as a system crisis and alerts us to the danger of gross delays becoming the new normal, while undermining the trust and confidence the public are entitled to have in their NHS and social care services and the already stressed morale and wellbeing of our hard-working and dedicated NHS and social care staff.”

He said “change is required throughout health and social care services” because “patients cannot wait until the gaps in staffing have been addressed when there is not even a national workforce strategy in place”.

The guidance says staff need “sustainable workloads” and better pay and terms and conditions, to improve retention – as services which are “excessively supported by inexperienced or agency staff” will “compromise [patients’] safety.

Recommendations on staffing include offering flexible rostering, upskilling community and acute teams, providing frailty care for older people in emergency departments seven days a week and providing clinical validation to 111 and 999 services to safely reduce avoidable hospital admissions.

System leaders are also urged to “shift from a primarily hospital-based model of urgent and emergency care to one that provides more services in the community” and to “share risks” among services and organisations.

They are advised to run falls prevention programmes in all communities, increasing the role of voluntary organisations to support vulnerable people, and to consider the widescale use of urgent community response teams respond to category three or four 999 calls – which could raise challenges where the patient needs transport to hospital.

Systems are also encouraged to provide “consistent” same-day emergency care services with “clear routes” for referrals from GPs, community response teams, 111, ambulances and emergency departments. Virtual review systems should also be used to reduce avoidable hospital admissions and delayed discharge, the guidance says.

To tackle health inequalities, ICS leaders are encouraged to establish diversity boards within governance structures, equality and diversity champions at operational levels and support diversity in senior roles.