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Professor Ted Baker's column

  • Ambulance services,
  • Community health services,
  • Diagnostic and/or screening services,
  • Hospitals,
  • Hospices,
  • Hyperbaric chamber services,
  • Urgent care

Last winter saw unprecedented demand on health and social care services, which often translated into increasing pressure on emergency departments. Although we may be heading into summer, actions are needed now across the whole health and social care system to ensure next winter is different.

Our latest report, Under pressure: safely managing increased demand in emergency departments, presents the findings from our inspections of emergency departments over winter 2017/18 alongside the findings of workshops attended by over 70 frontline clinicians aimed at understanding the issues facing staff and what needs to change.

The discussions with clinicians generated a number of practical steps to help overcome barriers and support improvements, which are outlined in the report. However, this is only part of the answer. Hospitals cannot work alone to address the ever increasing demand on services – there has to be a system-wide approach with all parts of the health and social care system working together to find solutions.

Looking beyond hospital emergency departments, the findings from our local system reviews have revealed a variation in the way that local systems have worked together to prepare for surges in demand. Although we have seen good examples of systems working collaboratively to plan for winter pressures, the reviews have raised concerns about the timeliness of this planning and the extent to which all partners across the system are involved in the planning process.

This report is likely to be of particular interest to medical directors, directors of nursing, and chief operating officers; however I would encourage anyone to read it, regardless of discipline, as there are learning opportunities for all.

A whole system view

Speaking of adopting a whole-system approach, we have recently published three further local system review reports focusing on: Birmingham, Liverpool, Cumbria, and Bradford.

CQC reviewers in Birmingham found a clear intent from the system’s new leadership to improve how people move through health and social care services, but the reality for people has been that fragmented services have led to disjointed care.

In Liverpool, we found there was a clear strategic direction for health and social care, focused on the needs of people living in the city, and described in the One Liverpool strategy, However, the experiences of people using health and social care services varied, with people not always being seen in the right place, at the right time, or by the right person.

Variation was also seen in Cumbria. While there is a health and wellbeing strategy and vision for the whole of Cumbria for the organisations involved, the review found inconsistency in how the strategy was interpreted and how services were delivered, and CQC reviewers found that older people had inconsistent experiences of health and social care.

In Bradford, meanwhile, there was a clear shared and agreed purpose, vision and strategy described in the Happy, Healthy at Home plan which was articulated throughout all levels of the system, and which most staff across all sectors were committed to. As with the other systems, however, there was some variation, with people in some areas having to rely on the emergency services because they could not get a GP or district nurse to attend in person.

New agreement to monitor quality and safety of independent healthcare services

As part of our work to improve how we monitor the quality and safety of independent healthcare services, I am pleased that we have developed new Memorandum of Understanding (MoU), agreements with four health insurers: AXA, BUPA, AVIVA and Vitality. As the main funders of care paid for privately, insurance companies hold data about the quality of care of providers they commission from, and data on experiences from claimants using those services. The information we receive will help us maintain an effective regulatory system, to ensure people are provided with safe, effective, compassionate, high-quality care.

CQC appoints new chief executive

Finally, I am sure you will have seen the news that Ian Trenholm has been appointed as CQC’s new chief executive. He will join us from NHS Blood and Transplant in July. Congratulations to Ian, and welcome to CQC!

Last updated:
31 May 2018


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