The Care Quality Commission (CQC) has found improvements are needed to ease extreme pressure on urgent and emergency care services across Cheshire and Merseyside, which includes Liverpool, Knowsley, South Sefton and St Helens. This follows a series of coordinated inspections which took place throughout March and April, across the Cheshire and Merseyside integrated care system.
Integrated care systems (ICSs) are new partnerships between organisations involved in health and care across an area. Integrated care boards (ICBs) are being formed across the country to coordinate services to improve people’s health and care and are replacing clinical commissioning groups (CCGs).
These inspections were conducted to understand how services respond to the challenges they face as individual providers, but may require a system wide response. They are also intended to support ICBs 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 were experiencing high levels of demand which meant there were delays in people receiving the care and treatment they need. Leaders must work together to ease the pressure across the whole system and make sure people can access the right service in a timely way without putting unnecessary pressure on emergency services.
As part of the review across the Cheshire and Merseyside integrated care system, CQC inspected over 20 individual services across the system. These included 999 and NHS 111 services run by North West Ambulance Service NHS Trust, and some aspects of medical services, as well as urgent and emergency care run by Liverpool University Hospitals NHS Foundation Trust.
CQC also inspected mental health services run by Mersey Care NHS Foundation Trust, local GP surgeries, urgent care out of hours services and adult social care providers. (Links to these services can be found at the end of this press release.)
Ann Ford, CQCs director of operations, said:
“During the urgent and emergency care inspections across Cheshire and Merseyside, we saw significant levels of demand on emergency departments which resulted in long delays for patients receiving care and treatment. This was made worse by staffing challenges across the system and difficulty with recruitment in some services such as NHS 111.
“People were experiencing difficulties when trying to make face to face GP appointments, so were using urgent care services, including walk-in centres to access care and treatment. We found there was availability in many GP services with extended hours, however these weren’t always being accessed as some patients were unaware of this availability. More work needs to be done to ensure people know about these services to help ease some of the pressure on emergency services.
“We found a significant shortage of dental provision, especially for urgent treatment, which resulted in people attending emergency departments.
“Further work is needed by GP and dental organisations to support people to stay in their own homes. This would also reduce pressure on emergency services by avoiding unnecessary trips to hospital which can be traumatic. Additionally, staff working in adult social care should be supported and trained to manage and prevent people’s deteriorating health to avoid them having to go to hospital.
“There were times when people were not discharged from hospital in a timely and supported way. This is an area that needs to be improved so that people can return home safely and quickly.
“Leaders are working with partner organisations to make improvements to ensure people are able to access the appropriate service in a timely way. They are working with mental health services to ensure people are signposted directly and quickly to the most appropriate service to receive care and support.
“Better engagement between organisations is needed to improve patient flow between hospitals and social care services to reduce the risk of harm to people.”
Across the system, inspectors found:
- Staff and patients across primary care reported a preference for face to face appointments that some people found difficult to access. As a result of this they preferred to access urgent care services or go to their nearest emergency department
- Urgent care services, including walk-in centres were very busy and struggled to assess people in a timely way
- The NHS 111 service was experiencing significant staffing challenges across the whole area
- People waiting for call backs from a clinician at the out-of-hours service could wait up to 24-48 hours during peak times
- People who called 999 for an ambulance experienced significant delays
- Ambulance crews found it challenging managing different handover arrangements at different hospitals
- There were examples of effective community nursing services, but these were not consistently embedded across social care. Staffing across social care services was a significant challenge and there was a high use of agency staff.
GP surgeries
- Bigham Road Medical Centre
- Islington House Medical Centre
- Gillmoss Medical Centre
- Dr Jude's Practice - Riverside & Picton
- Fir Tree Medical Centre
- Four Acre Health Centre
- Lance Lane Medical Centre
Urgent care out of hours service
Emergency care services (all run by Mersey Care NHS Foundation Trust)
Care services
- Comfort Call - Bailey Court
- Hawthorne Lodge Residential Care Home
- Cressington Court Care Home
- Granby Care Home
- Millvina House
Embargoed versions of these reports can be found at the end of this press release.
Hospitals (both run by Liverpool University Hospitals NHS Foundation Trust)
Mental health (psychiatric liaison teams provided by Mersey Care NHS Foundation Trust)
Ambulance service