Emergency care response in Leicestershire and Rutland needs improving, report finds
A CQC inspection found staff were working hard across the board, but a change is needed
A new inspection has found that emergency and urgent care response needs improving in Leicester, Leicestershire and Rutland (LLR).
The Care Quality Commission (CQC) looked at adult social care services, GP surgeries, NHS 111, minor injury units, as well as accident and emergency departments within the area.
The report stated that "closer working between the healthcare organisations who deliver care" across Leicester, Leicestershire and Rutland was needed, "including sharing risks to ease pressure on key services".
It also found the current way of how services work together to support people moving between health and social care has increased the pressure on - and caused delays to -Leicester Royal Infirmary's emergency department.
A systemic fix
Fiona Allinson, CQC Director of Operations in the Midlands, said that staff were working to the best of their ability, but a communicatory change was needed:
'We found that staff were working incredibly hard especially under sustained pressure across health and social care services, and what we found was they'd actually made some starts into addressing the issues in timely patient care.'
'There is still delays within the system there is still waits to get into GPs, waits to get responses through ambulance services, call-backs from 111 services, and to get in and out of the hospital.'
Across the system, CQC inspectors found:
- Long delays in handover of patients from ambulance to hospital resulted in a high number of ambulances waiting outside Leicester Royal Infirmary, this caused delays in responding to 999 calls.
- People reported difficulties when trying to see or speak to their GP. Some GP practices had invested in new technology to improve telephone access. Staff working in GP practices signposted patients to extended and out of hours services to prevent people attending emergency department whenever possible.
- Staff working in urgent care services reported challenges due to the volume of pilots being carried out to reduce admissions. Many pilots ran for relatively short periods of time and were often impacted by staffing issues. This made it difficult to maintain oversight of pathways available to avoid acute services. However, some pilots had proved successful and prevented hospital admissions.
- Psychiatric liaison services at Leicester Royal Infirmary were well run and designed to meet people’s needs. Staff demonstrated effective partnership working with a person-centred approach and good use of alternative pathways to avoid admission into acute or social care services.
- There was a high number of patients in hospital who were medically fit for discharge but remained in acute services. Communication about discharge and discharge processes were impacting on the quality of transfers of care to social care services.
- Out of hours care had been challenging throughout the pandemic as staff were redeployed to other key services, this had particularly impacted on home visiting services.
Plans in place
On behalf of Leicester, Leicestershire and Rutland healthcare services, Chief Executive of the NHS Integrated Care Board Andy Williams said:
“The report acknowledges the challenges we face and recognises the hard work of health and care staff and those in care homes and other services in response to significantly increased levels of demand faced by urgent and emergency care services. Importantly it emphasises the need for a system response with all organisations involved in urgent and emergency care needing to play their part to make the necessary improvements."
“We have an action plan in place which focuses on reducing unnecessary attendances; improving patient flow across the system; and enabling patients to be seen in the right place first time, which we have further strengthened to address the recommendations in the CQC report."
“Patients rightly expect high standards and quality of care and we, as a system, are fully aware of the need to drive the necessary improvements for patients. Our priority is that local people should be confident that their journey through the services should be as smooth as possible from the moment they access them.”
Health Minister Maria Caulfield said the Government had given £150 million to the ambulance service this year, as well as investing £50m in NHS 111 to help alleviate pressure on workers.