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Under Pressure: CQC calls for whole system approach

A report published by the Care Quality Commission - 'Under Pressure: Safely managing increased demand in emergency departments' - sets out practical solutions for managing increased demand in NHS emergency departments and calls for a whole system approach to ensure services are resilient for next winter. 


The report is based on findings from the CQC’s inspections of emergency departments over winter 2017/18 and from engagement with clinicians.


As the population ages and more people are living for longer with one or more chronic conditions, the demand for emergency services will only continue to grow. It is already acknowledged that 2017/18 saw an unprecedented demand on services. Patient safety is under threat and many staff are working in difficult circumstances.


The CQC report states: "Looking at our local system reviews, it is evident that the problems we are seeing in urgent and emergency care are symptomatic of a much wider problem of capacity in the health and social care system. The demand for emergency care has steadily increased year-on-year and there is no reason to expect that this trend will change. The situation will only get worse unless there is a whole system approach to planning for, and managing heightened demand."


It also highlights variation in the way hospitals and health and care systems have planned for and managed the increase in demand for emergency services. The CQC has held two workshops recently to identify best practice in addressing the risks to patient safety and the operational pressures. The report publishes some good practice case studies and a list of recommendations that all emergency departments could, and should, be taking to prevent the issues experienced during winter 2017/18 from happening again. These recommendations are split into three sets: steps to address demand, steps to address capacity and capability and steps to address output. (Click here to download the report and read the full detail of these recommendations).


Responding to the report, the Deputy Chief Executive of NHS Providers, Saffron Cordery, says: “This winter saw the NHS frontline and its staff working at full stretch. One of the driving factors behind this unprecedented rise in demand is the reality of an ageing population, many attending emergency and A&E services with complex and multiple conditions. This, together with a lack of capacity across community, primary and social care, hospital and mental health services, meant that Trusts lacked the necessary resources to meet this additional demand."


Cordery refers to the findings of its recent report - 'Community Services: Taking Centre Stage' - to emphasise that more needs to be done to prioritise and invest in services in the community. This helps to keep people living well and avoid unnecessary hospital attendances and on this NHS Providers and CQC are in agreement. However, NHS Providers adds that Trusts need support. 


"The CQC rightly recognises good practice within emergency departments. Trusts need to be supported to share practice and lessons learnt from their experiences last winter to ensure services are safe and resilient next time," says Cordery.


“However demand will continue to grow, it is urgent that the much anticipated long-term and sustainable funding plan addresses the gap between what is asked of the health and care system as a whole and the resources it has to deliver those high quality and safe services for patients.”


The CQC report is described as "the beginning of the conversation," and it is a conversation that needs to begin immediately because next winter is already only a few months away. As the trend continues to improve the situation for patients and staff next year now is the time for action.