CQC finds further system work is needed to reduce pressure on urgent and emergency care in Kent and Medway

Published: 27 June 2022 Page last updated: 27 June 2022

The Care Quality Commission (CQC) has found further work is needed to ease extreme pressure on urgent and emergency care services across Kent and Medway. This follows a series of coordinated inspections which took place throughout February, across the Kent and Medway integrated care system.

Integrated care systems (ICSs) are new partnerships between organisations involved in health and care across an area. Integrated Care Boards are being formed across the country to coordinate these services to improve people’s health and will replace clinical commissioning groups (CCGs).

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.

CQC found that many of the services inspected are individually well-run and providing safe care and effective treatment to people, and in some areas, there was effective collaborative working.  However, further work was needed across the system to ensure people were not facing lengthy delays as they wait for assessment and treatment.

As part of its review of the Kent and Medway Integrated Care System, CQC inspected over 40 individual services across the system. These included urgent and emergency care and medical services run by Medway NHS Foundation Trust, Dartford and Gravesham NHS Trust, Medway Community Healthcare C.I.C and South East Coast Ambulance NHS Foundation Trust. CQC also inspected 14 local GP surgeries, urgent care services, adult social care services and the NHS 111 service.

A full list of the services inspected and links to their reports can be found at the end of this press release.

Deanna Westwood, CQC’s director of operations - south network, said:

“During the inspections of the Kent and Medway urgent care pathway we found that a shortage of staff, due to an inability to recruit, or high levels of absence due to COVID-19, had impacted on services throughout the area.

“A number of GP practices in the area have a sizeable number of patients and demand for appointments is increasing. We saw that in the majority of cases this demand was well managed. 

“However, we did find some access issues in primary care, as some GP practices weren’t allowing patients to enter the building without permission from staff. Since our inspections, we have taken action to ensure patients can access their GP freely.

“The NHS111 service had also experienced staffing issues as well as increased demand; this had resulted in significant delays in call answering times for people trying to seek advice.

“However, we also saw some examples of innovative practice, such as employing a variety of healthcare professionals in GP practices to help meet the needs of patients more effectively making sure people receive the right care at the right time. There was also funding available to provide interpreting and translation services to support people from diverse communities and people arriving in the UK from Ukraine.

“However, staff working across Kent and Medway do require additional support to manage the continued pressure on services. Organisations could help themselves by upskilling their staff for example, training additional social care staff so they are able to detect early signs of deterioration in health.

“Further collaboration between health and social care services and stakeholders is needed to address the issue of patient flow across urgent and emergency care pathways. These pathways also require evaluation to ensure they are as efficient and effective as possible to meet people’s needs. To help facilitate this, we are in regular contact with the local services involved, and we look forward to seeing the resulting improvements.”

Across the system, inspectors found:

  • Emergency departments in Kent and Medway continue to be under significant pressure. However, improvements had been found since previous inspections, including changes in leadership and the culture within the departments. Staff had worked hard to meet current demands and felt positive about the improvements they had seen. Due to the improvements inspectors found in the emergency department at Medway NHS Foundation Trust, the rating has moved from inadequate to good.  The rating for the emergency department at Dartford and Gravesham NHS Trust has also moved from requires improvement to good. 
  • Some social care services had raised concerns in relation to the care provided to autistic people or people with dementia in emergency departments. Where specific concerns were raised, these were being investigated.
  • Primary care networks were working well with community services to help remove some of the pressure on ambulance and acute services where possible, particularly in out of hours services. In addition, technology was being used to improve services and provide timely access to patient information, especially for staff providing out of hours care.
  • Ambulance response times were poor across Kent and Medway. Whilst operational staff had done all they could to prioritise response times to serious and life-threatening calls, response times to less serious calls were unacceptable. This had an impact on people in Kent and Medway, especially those people living in care homes. Social care staff found themselves having to provide long periods of enhanced care to people waiting for an ambulance response whilst also caring for other residents.
  • There were delays in patients receiving care and treatment caused by poor patient flow across urgent and emergency care pathways. There were many urgent and emergency care pathways available within hospitals in Kent and Medway, however staff acknowledged these were not all working well or being fully utilised.
  • Referral pathways between emergency department and urgent treatment centres aimed to meet people's needs and reduce pressure on acute services. However, there were issues with inappropriate referrals, long waiting times and inconsistent risk assessments putting people at risk of harm. Patients also reported delays in their treatment due to inappropriate referrals. The system partners were aware of issues with care pathways and had an action plan in place to address them.
  • Delays in patient discharge from hospitals and a shortage of social care capacity to enable people to leave hospital in a safe and timely way was also an issue. In addition, social care services reported concerns about poor discharge processes. Examples included insufficient information about changes to medicines, or people discharged into care homes who required a level of care for which staff were not trained to provide.

Reports for the following services will be published on Friday 24 June.

GP surgeries

Care Services

Embargoed versions of these reports can be found at the end of this press release.


Contact information

For enquiries about this press release, email regional.engagement@cqc.org.uk.

Urgent and emergency care (UEC) system wide inspections

See more information about UEC system wide inspections.

About the Care Quality Commission

The Care Quality Commission (CQC) is the independent regulator of health and social care in England.

We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve.

We monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety and we publish what we find to help people choose care.