Half of A&Es and urgent care services ‘require improvement or are inadequate’ – CQC

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.

These services have got slightly worse than the previous year’s report, the data suggests, when 44% required improvement, 7% were inadequate, 44% were good and 4% 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: “The number of people having long waits in ambulances at hospital emergency departments, due to pressures within the hospital, has been exceptionally high.

“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.

It said that when GP practices rapidly moved to a more remote model of care during the pandemic, “this was welcomed by many people needing GP care, but it did not benefit everyone and some struggled to get the appointments they wanted”.

It added: “Findings from our inspections have noted issues with telephone systems, resulting in long hold times, people being cut off while waiting, and repeated engaged tones causing frustration for people trying to get through.”

The CQC said there are “some areas of concern” regarding GP staffing numbers, adding that the number of qualified permanent GPs, which excludes GPs in training grade and locums, has been falling, with figures in June 2021 nearly 3% lower than they were in June 2017.

“Over the pandemic, the number of qualified permanent FTE GPs per 100,000 patients has been at its lowest level in recent years,” it added.

The report also found:

• Access to NHS dental care was an issue since before Covid-19, “and there are clear signs that this has been compounded by the pandemic”.
• Improvements in maternity care “are far too slow, with continuing issues around staff not having the right skills or knowledge, poor working relationships, and not learning from when things go wrong”.
• As winter approaches, the NHS and social care workforce who face the challenges ahead “are exhausted and depleted, which has implications for the quality of care. They cannot work any harder – they need support to work differently.”
• The impact of the pandemic on many who use health and social care services “has been intensely damaging”.
• During the pandemic, there has been a “significant increase” in concerns around children and young people’s mental health, with demand for services rising.
• As of July, there were a total of 5.6 million people waiting for NHS treatment.

The Institute for Fiscal Studies, in its most optimistic scenario, has projected this will jump to nine million in 2022, returning to pre-pandemic levels by 2025.

In its worst case scenario, it would jump to 14 million in 2022.

Dr Jennifer Dixon, chief executive of the Health Foundation, said: “Today’s CQC report is further proof of the urgent need to invest in the NHS and social care workforce – or see many more people go without the care and treatment they need as services struggle to meet demand and address the backlogs created by the pandemic.”

An NHS spokesperson said: “NHS staff have gone above and beyond over the last year contending with record levels of A&E attendances and ambulance call outs, all while treating more than 470,000 seriously ill Covid patients.

“The NHS has set out a 10-point action plan to support hospitals with the significant demand ahead of winter, so anyone who needs the NHS should come forward through the appropriate route so staff can help you with the best option for your care, and it remains as important as ever to get your lifesaving Covid jab and flu jab, if you are eligible.”

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