CQC publishes system-wide report of urgent and emergency care

“We have greatly valued our involvement in the CQC urgent and emergency care system review which was about recognising what is working well in Gloucestershire, identifying how we can make improvements and providing learning for other areas.

This review which took place from late autumn 2021 was against the backdrop of considerable and on-going pressures being experienced locally and across the country, resulting from seasonal pressures, the COVID-19 pandemic and workforce challenges.

We were encouraged to see acknowledgment of the strong One Gloucestershire partnership working in evidence and our determination to provide the best possible advice, care and treatment for everyone who uses our services.

It’s this spirit of partnership working that will ensure further improvements are made, acknowledging that many of the challenges facing urgent and emergency care can only be overcome by working together and are a shared responsibility.

One Gloucestershire health and care partners are working more closely than ever before to ensure the journey in and out of hospital is as smooth as it can be.

A whole raft of measures summarised below have been put in place to improve access, help ensure people are able to leave hospital when safe to do so with ongoing care support if needed and improve ambulance handover arrangements at the hospital front door. These issues are inextricably linked.

We acknowledge the need to continue to simplify access to services, join them up further and help staff and patients better understand the services available and when to use them. This work is already well underway.

We also welcome the positive comments about how community services are run and the potential for further developments to support urgent care and reduce pressure on A&E.

Since the CQC review, we have made significant further investment in a 24/7 Clinical Assessment Service (CAS) working alongside NHS 111 and the GP Out of Hours service.

The CAS, supported by GPs, advanced nurse practitioners, therapists, pharmacists and paramedics can support people to access community services and offers increased support and advice to people remaining at home or being booked into local NHS services.

We have taken active steps to improve the local Directory of services used by staff in urgent and emergency care and we fully acknowledge the importance of maintaining accurate service profiles so that people are always signposted to the most appropriate care. A review exercise has taken place and arrangements will be further strengthened.

We have rolled out an extensive Click or Call First public campaign – print, online, social media and door to door – with simple messaging on the digital and phone services available to guide people to the right care.
Aligned to this, we also developed bite size digital and print service profiles on primary and community services. We believe this, along with other measures, has had a positive contribution with the majority of people accessing the right services and comparatively low numbers of people attending A&E with minor illness and injury.”

The CQC’s urgent and emergency care system review in Gloucestershire was part of a new national pilot approach to looking at all the key parts of the system and how they work together. It took place in November and early December 2021.

Additional Information

Measures to improve access, support people to leave hospital when safe to do so and improve ambulance handover arrangements at the hospital front door include:

• Ensuring services are in place to assess, treat and support older people and people with mental health needs to return home from hospital on the same day, with on-going support if needed
• Investing in additional NHS funded beds, in our acute hospitals, community services and in care homes
• Helping more patients to leave hospital and return home safely by increasing the staff available to support them and their families. This includes:
  o additional staff working in the hospital to home teams
  o commissioning more reablement beds in care homes
  o increasing access to reablement and domiciliary (home) care staff – providing nursing care for patients and families at home where needed
  o increasing capacity in joined up community health and care teams, including rapid response services
  o voluntary sector organisation partners providing a follow up service to ensure people are being supported to remain at home after leaving hospital

Reducing ambulance handover delays

• Introducing enhanced clinical triage (doctors, nurses and paramedics using their clinical skills to provide additional advice and assessment over the phone)
• Identifying an additional area where patients can be cared for to enable paramedic crews to be released from hospital and respond to other emergency calls
• Making arrangements to ensure patients are seen by the most appropriate specialist doctor first time, by-passing A&E if appropriate
• Introducing a Lead Paramedic Hospital Ambulance Officer who acts as a point of contact for the Ambulance Service and a conduit between the Ambulance Service and hospital teams
• Enabling the Home Assessment Team and community services to work in A&E with specialist paramedics to help avoid hospital stays where possible and reduce waiting time
• There is also now a social worker working alongside teams in the Emergency Department to provide additional support to patients, ensuring they receive the right help to return home from hospital or reducing the need for hospital stays.