Watchdog calls for action to improve patient safety in emergency care

Action is needed to “keep patients safe” in A&Es, the health watchdog has warned.

The Care Quality Commission (CQC) said that safety is a “key area of concern” in urgent and emergency care departments – with almost two thirds (64%) not performing well enough in terms of patient safety.

As of April this year, 8% of A&E departments were deemed to be “inadequate” in terms of safety and 56% “require improvement”, the CQC said.

In its latest report the regulator said this raises “serious concerns about the risk to patients that the pressures on the system are creating”.

The health service must address underlying issues which are leading to pressure on A&Es, it said.

The report, on how the NHS can cope with surges in demand, particularly over winter, states that the health and social care system faces a “formidable challenge” as it is faced with rising demand and caring for patients with increasingly complex needs.

The authors wrote: “The ongoing trend of increasing demand on health and social care services is not abating and it is clear that action is needed now to address the pressures on emergency departments, and in turn keep patients safe.”

The document states that inspections have shown that hospitals across England “are improving many of their services despite the operational pressures they face”. But urgent and emergency care services “are an exception to this”.

The chief inspector of hospitals in England warned that “it cannot be accepted that each winter will be worse than the one before”.

In the foreword to the report, Professor Ted Baker, chief inspector of hospitals for the health regulator, said that demand for care is “inexorably” rising.

He wrote: “The dedication of emergency staff has enabled the service to deliver safe care to many patients.

“However, we have also found exceptions to this. In some of our inspection reports we have highlighted how increasing pressure on emergency departments has led to patients receiving care that is wholly unsatisfactory and in some cases unacceptable.

“The problems in urgent and emergency care are a symptom of much wider capacity problems across health and social care. If we are to reduce the burden on emergency care we must not only learn the lessons from this winter to improve our planning for next winter, we must as a matter of urgency address the underlying system issues.”

He added: “It cannot be accepted that each winter will be worse than the one before – we are already seeing the effect of this on both patients and staff and action needs to be taken now to address these pressures.

“It is clear that what used to work doesn’t work any more – while a long-term plan is developed and implemented to make system-wide and sustainable changes, we need to immediately introduce new ways of collaborating and planning for surges in demand to make sure that next winter is different.”

The report highlights particular concerns raised by emergency care staff including: ambulances queued outside hospitals, staffing problems, the use of corridors to treat patients and ensuring patients get a clinical assessment promptly on arriving in an emergency department.

It shares practical solutions for managing demand in emergency departments.

The solutions focus 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.

A Department of Health and Social Care spokesman said: “This report rightly recognises the hard work of staff throughout a winter exacerbated by high levels of flu and extremely bad weather, and while the NHS is ranked as the safest healthcare system in the world, this report also shows what can be done to improve safety in A&E.

“The NHS is already planning for next winter, supported by the £1.6 billion allocated for 2018/19 in the most recent Budget, and the Prime Minister and Jeremy Hunt have committed to a long-term plan with a sustainable multi-year settlement for the NHS to help it manage growing patient demand.”

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