Throughout November and December the Care Quality Commission (CQC) undertook inspections of a number of urgent and emergency care services in the Barking, Havering and Redbridge area of the North East London Health & Care Partnership integrated care system (ICS). An ICS consists of all healthcare partners in a specific geographical area.
These inspections were conducted to understand how services respond to the challenges they face as individual providers, but that require a system wide response. They are also intended to support ICSs to better understand the journey people experience when seeking urgent care and identify where they can make improvements. To read more about this work visit the CQC website.
Inspectors visited the emergency department at Queen’s Hospital, part of Barking, Havering and Redbridge University Hospitals NHS Trust and London Ambulance Service NHS Trust, visiting the emergency operation centre, ambulance service and NHS111 service. Inspectors also visited the Partnership of East London Co-operatives (PELC) Limited (which provide urgent care at four treatment centres) as well as liaising with local GP surgeries and care services in the area.
A full list of the services involved and links to their reports can be found at the end of this press release.
Philippa Styles, head of inspection for emergency care, said:
“Despite exceptionally challenging circumstances, we found examples of staff working in partnership, with good engagement between service leaders to understand the impact of demand on different services. Leaders were also discussing opportunities to signpost patients to services which were under less pressure. However, our inspectors found that the whole health and social care system for the area needed to work in a more integrated way to reduce the pressure and risks to patient safety that we found in the emergency department inspected.
“Our inspection of Queens Hospital found that local services didn’t always collaborate effectively to help reduce attendances or the length of stay for people in the emergency department. The system needs to work together to ensure that, where appropriate, people can be discharged safely into adult social care services, making ward space more readily available and reducing overcrowding in the emergency department, which in turn will support quicker ambulance handover times.
"System leaders also need to consider what more they can do to maximise resources and improve access to GP and dental appointments. This would help avoid people looking to urgent and emergency care services when the right care and treatment to meet their needs is more appropriately provided by another service."
“There are areas where closer partnership working and more effective communication between the emergency department and other local urgent centre services would help improve people’s experience of accessing urgent and emergency care. We saw that leaders from a range of services were looking to further integrate services in the local area and, in direct response to our findings, were actively collaborating to implement new and innovative ways to assess and treat patients in a timelier way. We are in regular contact with local services involved in this work and look forward to seeing the resultant improvements as it progresses.”
Inspection findings included:
- CQC adult social care inspectors highlighted the importance of including local authorities in care planning. This was not happening consistently and doing so could help support more timely discharge from the hospital emergency department.
- Adult social care inspectors found inappropriate discharges had increased in care services, resulting in older people being sent back to hospitals in the area because they were either medically unfit at home, or did not have the correct equipment to keep them safe at home.
- In addition, adult social care inspectors found some discharge paperwork was of poor quality with incorrect details of next of kin, phone numbers, incorrect addresses and postcodes. Paperwork sometimes didn’t include the correct medical history or didn’t clarify the reason for a patient’s admission and treatment while in hospital. For example, there was an insulin-dependent patient who was discharged from hospital, but the discharge paperwork did not include specific detail regarding their condition and care needs.
- At Queens Hospital, inspectors found that some patients waiting to be admitted to a ward sometimes had to wait up to 24 hours in the emergency department. These delays exposed people to a risk of harm.
- Inspectors were told by people that they couldn’t get access appointments at their own GP practice or out of hours service. This led to patients queuing to access both the urgent treatment centre and emergency department which put further demand on the hospital and caused extra delays in patients accessing treatment. This reflects the findings of some additional research that CQC commissioned which was undertaken in December 2021 at King George and Queen’s Hospital run by Barking, Havering and Redbridge University Hospitals NHS Trust. This work set out to identify why people were attending the emergency department, and to understand their experiences of accessing health services prior to attending.
- Inspectors also found capacity issues in GP practices which resulted in delays for patients and meant the NHS111 service was referring patients to the emergency department at Queens Hospitals instead. There had also been an increase in the number of NHS111 calls from patients requiring dental treatment, this was as a result of patients reporting a reduction in dentists accepting new patients.
- Technical issues were affecting further integration between 999 and NHS111 services which had been identified as a problem nationally. Ambulance service leaders in London were aware of this and undertaking work to address the co-ordination issues to help improve people’s experience.
- London Ambulance Service NHS Trust had started daily calls with system partners to try and reduce ambulance handover delays and to monitor demand across North East London. Leaders from healthcare services in the area acted to support the emergency department and were working with colleagues from other healthcare services to put improvement plans in place.
The providers involved in these inspections are listed below, including a link to their individual provider report:
- Queens Hospital
- London Ambulance Service NHS Trust
- Partnership of East London Co-operatives (PELC) Limited
- Abbeys Care Support & Training Ltd
- Br3akfree Respite Care
- Chandos Road
- Precious Homes East London
- Sable Care Limited - 22 Ashbridge Road
- Willows Care Home
- Arran Manor
- Just In Time Agency JIT Ltd
- Bennetts Castle Care Centre
- Lodge Group Care UK Limited
- Emerson Court
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