Wider health service 'must take ownership' of emergency department problems

Access to GP services and social care is worsening, CQC report finds 

Access to GP services and social care is worsening, CQC report finds 

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The Care Quality Commission’s (CQC) annual State of Care report is the most authoritative stock-take of services across the health and care sectors in England.

It draws on inspections of nearly 30,000 individual services, covering acute trusts, mental health services, GPs and the entire social care sector – domiciliary care, residential care and nursing homes.

Services at hospital trusts are broken down into core services, including maternity, medical care and end of life care. The weakest service of all in the 2017-18 version was urgent and emergency care, where almost half of services were rated as inadequate or requires improvement. The CQC found safety was of ‘particular concern’, with the four-hour target being routinely missed.


of urgent and emergency services rated as inadequate or requiring improvement

Royal College of Nursing Emergency Care Association chair Janet Youd says this is not surprising given the challenges of rising demand and complexity.

‘The key to safety is timely and accurate initial assessment, followed by appropriate reassessment,' she says. ‘Experienced emergency nurses are needed to do that, to identify those patients who do not show the obvious or classic signs of severe illness, or are at risk of deterioration.’

Symptom of the wider pressures

Janet Youd

But she adds this remains the ‘biggest challenge’ as emergency departments (EDs) are struggling to recruit sufficient staff with the ‘right skills and knowledge’ needed to cope. She says some hospitals have responded by creating frailty units to ensure vulnerable patients get the care they need that busy EDs are struggling to provide.

‘There are different models out there – some are co-located with EDs, some do in-reach and some are stand-alone. They’re making a difference,’ Ms Youd says.

But the bottom line, she adds, is that the problems with EDs are really just a symptom of the wider pressures in the system – they are effectively the safety net as they cannot ‘control demand’ like other parts of the system.

Royal College of Emergency Medicine vice president Chris Moulton agrees. ‘It is seen as an ED problem, when all parts of the system need to, and must, take ownership of it. Access to care is variable across the service, which in part is driving demand.’

The integrated care hub

An integrated care hub has been set up by the council and local NHS in Wakefield. GPs can ring just one number or complete one e-referral form for a person with multiple needs. They are then sent to the hub, which includes nurses, occupational therapists, physios, social care staff and a mental health worker.

A mixed team of health and social care coordinators sit together in one office and triage referrals.

In the past six months, the hub has seen nearly 2,000 people. Community matrons carry out immediate home visits where cases are flagged as urgent. It is estimated this has saved at least 400 emergency admissions.


The findings of the CQC report support this. It stated that while the quality of care was holding up overall, access to services was worsening across the board. The CQC pointed to Age UK figures showing 1.4 million older people do not have access to the support and social care they need. In the past two years, the numbers have risen by almost 20% with nearly one in seven older people now struggling.

Meanwhile, satisfaction with GP services – normally the first point of call for many – has slumped to its lowest level in 35 years, while community services have been hit by huge reductions in nursing staff. The result has been rising numbers of people ending up in hospital. Data on preventable admissions, such as urinary tract infections, flu and angina, show the rate per 100,000 has been rising for all age groups above 65.

Integration lottery

1.4 million 

older people not getting the support and social care they need

The CQC report said greater integration was the key, highlighting schemes such as integrated care hubs and acute response teams that were drawing NHS and council staff together into joint teams to keep people out of hospital. But it said such initiatives were not available in all parts of the country, calling it an ‘integration lottery’.

NHS Confederation deputy chief executive Danny Mortimer says the CQC is right to highlight the issue, saying ‘it is time to get serious about transformation’, adding that the delivery of integrated care must be central to the forthcoming long-term NHS plan and that funding for social care needed addressing in the green paper, which is due to be published before the end of the year.

‘Without a properly funded, well organised and integrated system we will continue staggering from one crisis to the next,’ he adds.

Further information

State of Care report 2017-18

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