CQC finds work is needed to manage the impact of staffing shortages on urgent and emergency care in Cambridgeshire and Peterborough
The Care Quality Commission (CQC) has found more work is needed to manage the effect of health and social care staffing shortages in Cambridgeshire and Peterborough, which have left the area’s urgent and emergency care services struggling to meet patient need.
This is despite many services being individually well-run and providing safe care and effective treatment to people.
CQC’s findings come as part of a series of reviews into urgent and emergency care. These assessments consider how services work together in a geographic area to ensure people receive the right care in the right place at the right time.
This review involved over 20 individual inspections across a range of health and social care services in the area covered by the Cambridgeshire and Peterborough Integrated Care System.
Integrated care systems (ICSs) are new partnerships between organisations involved in health and care across an area. They coordinate services to improve people’s health and will replace clinical commissioning groups.
As part of its review in Cambridgeshire and Peterborough, CQC inspected urgent and emergency care and medical care services run by North West Anglia NHS Foundation Trust and Cambridge University Hospitals NHS Foundation Trust as well as the East of England Ambulance Service NHS Trust.
CQC also carried out inspections at Cambridgeshire and Peterborough NHS Foundation Trust, some local GP surgeries, adult social care services and the local NHS 111 service.
Mandy Williams, CQC’s director of integrated care, inequalities and improvement, said: “While health and social care staffing shortages are a national issue, system leaders in Cambridgeshire and Peterborough must find further ways to minimise the impact on people in their area through smarter ways of working, staff recruitment and retention, and collaboration.
“Although system leaders are finding new ways to tackle these issues, without further management there is a risk the quality and safety of care people receive could be undermined.
“Despite this pressure, staff went above and beyond for patients in many of the services we inspected in the Cambridgeshire and Peterborough Integrated Care System.
“However, people didn’t always receive timely care and treatment in the most appropriate service for their needs.
“This led to overcrowding in urgent and emergency care departments, which created avoidable pressure for staff who were trying to ensure patient safety, and it also delayed ambulance handovers.
“We found staff shortages in adult social care meant people remained in hospital when they should have been discharged to respite services. This reduced the number of available beds elsewhere in hospitals where patients in emergency departments could be referred.
“Some system-wide steps were being taken to reduce the pressure. We found some good collaboration between GPs and consultants to treat people in their homes or without using urgent and emergency care.
“We also found the local NHS 111 service performed generally as well as or better than those in other areas, and there was good triaging in this service to refer people appropriately.
“However, more work is needed locally to deliver system-wide solutions to ensure people consistently receive high-quality, timely care and treatment in the right service for their needs.
“If successful, this would reduce pressure on urgent and emergency care services and reduce the risk of harm to people living in Cambridgeshire and Peterborough.”
Across the system, inspectors found: Staffing shortages were an issue in many services inspectors visited including primary medical services, hospitals, adult social care and the ambulance service. The cumulative effect of this negatively impacted urgent and emergency care.
There had been a lack of action in some GP surgeries to reduce people attending hospital emergency departments unnecessarily.
A high number of 999 calls were made when people could have received more appropriate assessment elsewhere. This included instances when older people called 999 when they felt their care packages did not meet their needs.
Ambulances were not always quickly dispatched back into the community after taking people to hospital, and they faced frequent handover delays at hospitals due to pressures inside preventing people’s quick transfer.
Staff working across health and social care reported poor discharge processes. Staff working in care homes and domiciliary care services reported that patients were often discharged late at night and with insufficient information to ensure a safe transfer of care.
There was a lack of knowledge across social care services regarding managing deteriorating patients. By increasing staff awareness, services may meet people’s needs without requesting emergency services.
The mental health service inspectors visited, run by Cambridgeshire and Peterborough NHS Foundation Trust, met the needs of people presenting in emergency departments or transferred between acute and mental health services. However, emergency department staff reported not being able to make referrals at all hours.