Supporting the delivery of safe urgent and emergency care services

Published: 29 October 2021 Page last updated: 12 May 2022
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In last week’s State of Care report CQC highlighted that intense pressures on urgent and emergency services were leading to unacceptable waiting times for ambulances and in emergency departments. We called for close working between providers, commissioners and all other parts of the health and care system to safely manage the risk to patients.

As part of our work to provide ongoing support for these services we have been working with frontline urgent and emergency care staff from NHS trusts across England. Last year with their input we developed Patient FIRST.

Patient FIRST is an online resource designed to support those working in urgent and emergency services to ensure safe, effective care.

In June 2021, those frontline staff helped us to host a clinically led workshop. The event was attended by 122 urgent and emergency care leads from 81 NHS acute and ambulance trusts. It provided an opportunity for attendees to share learning from their experience of using the Patient FIRST tool. They also discussed the current pressures and what further action might help to maximise capacity and maintain effective patient flow.

The views shared at the event were then considered at a second workshop in September involving 125 executive leads from 63 NHS acute and ambulance trusts across the country. Discussions focused on effective trust and system wide responses to the current challenges.

We have updated our Patient FIRST resource to reflect insight gathered from both these workshops.

This includes extra examples of good practice and data sets that services can use to help identify risk and areas for improvement.

Patient FIRST is not mandatory guidance. It provides suggested actions that can be taken at a departmental, trust and wider system level to help maximise resources, build capacity where possible and ensure safety remains a priority.

Ted Baker, CQC’s Chief Inspector of Hospitals, said: “We head into winter with an increasing number of people seeking emergency care. As we highlighted in this year’s State of Care report, the impact of escalating pressure on the NHS is intense – with lengthy delays for patients waiting for ambulances and for treatment in hospital emergency departments. There are very real concerns about the risk to patients and the impact of these mounting pressures on staff as they do all they can to deliver safe care under the most demanding circumstances.

“Our Patient FIRST tool has been developed by clinicians for clinicians and has been well received by frontline staff since its publication last year. We want to ensure it remains relevant in the current climate and as helpful as possible in supporting the close working between providers, commissioners and all other parts of the health and care system that will be essential to safely manage risk through winter and beyond.”

Anthony Marsh, National Strategic Adviser of Ambulance Services at NHS England, said: “I really welcome the updates CQC has made to its Patient FIRST resource, and specifically, the additional information aimed at helping colleagues manage the increasing impact that heightened demand is having on ambulance handover waits.

“The pressures currently being felt across the health and social care system demonstrate the need for a coordinated response and highlight the importance of services working together to keep patients safe, to get patients out of ambulances and into emergency departments as quickly as possible and enable ambulances to get back on the road to respond to emergency calls in the community.

“I am enormously proud of all our ambulance staff across the country, on the frontline and in our control rooms, please keep doing an amazing job and please be assured of my continued full support.”

Over winter CQC will support the system as much as possible and remain sensitive to the context in which services are operating, balancing this supportive approach with the need to ensure that people are receiving safe care. We will maintain a risk based and proportionate approach, using data and intelligence to identify where we may need to follow up or carry out an on-site inspection. Our teams will focus on urgent and emergency care services provided within a local area.

We will continue to inspect at an individual provider level using our existing methodologies but may inspect more than one provider or location within a system to understand how services are working together to deliver safe, effective and high-quality care.

Alongside this, we will continue our close working with frontline emergency department care staff to share what is working well and explore how system wide collaboration can help respond to the challenges urgent and emergency care services face.

We want to encourage providers and system leaders in their efforts to collaborate locally and help them identify where further integration and cross system working may drive improvement for patients and staff.

See the updated Patient FIRST framework

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