Throughout November and December, the Care Quality Commission (CQC) undertook inspections at a number of urgent and emergency care services across the One Gloucestershire integrated care system (ICS). An ICS consists of all healthcare partners in a specific geographical area.
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.
Inspectors visited the emergency departments at Cheltenham General Hospital and Gloucester Royal Hospital, both part of Gloucestershire Hospitals NHS Foundation Trust as well as minor illness and injury units run by Gloucestershire Health and Care NHS Foundation Trust. They also inspected both the emergency operation centre and the emergency ambulance service at South Western Ambulance Service NHS Foundation Trust, and an independent NHS 111 service and out of hours service run by Practice Plus Group. Inspectors also visited adult social care services in the area.
A full list of the services that were inspected and links to their reports can be found at the end of this press release.
CQC deputy chief inspector for hospitals, Nigel Acheson, said:
“Following our inspection of services in the urgent and emergency care pathway in the Gloucestershire area, we saw leaders and staff across all services were working well together in challenging circumstances.
“Some health services had responded to the challenges by introducing a number of same day emergency care services to try and reduce the pressure on the emergency departments we inspected.
“We found the system to be complicated. As a result, staff and patients weren’t always able to understand which urgent and emergency care service was best suited to their needs. This meant people sometimes attended the emergency department when they could have been treated more appropriately elsewhere.
“The urgent and emergency care pathways in Gloucestershire should be streamlined to ensure that people and staff are better able to understand the services available and allow people easy access to the right care. This will help create additional capacity as well as reducing the amount of calls to the 999 and NHS111.
“Ensuring the timely transfer of patients waiting in ambulances into the urgent and emergency care department was a significant challenge. System leaders should consider how they might better maximise the local authority’s experience to help free up space on hospital wards to enable patients to be transferred out of the emergency department to create space.
“Due to staffing pressures there are empty beds in care homes across Gloucestershire which could be used to support older patients to leave hospital as soon as they are able to. In turn this would free up beds in the hospital wards easing pressure on the waiting times there. This can only be achieved if the pressures placed on the workforce right across the whole system are addressed and we recognise that co-ordinating this could be challenging”
Across the system inspectors found:
- The NHS111 service was performing well, compared to the national average. However, a higher than normal staff sickness rate combined with an increase in the volume of calls higher due to the COVID-19 pandemic caused longer delays in giving clinical advice than had been seen before. However, the provider of this service, Practice Plus Group had an action plan in place to manage the risks involved and inspectors are monitoring its progress in taking this forward
- The local directory of services used by staff in urgent and emergency care to direct patients to the right treatment and support was found to have inaccuracies and out of date information. This meant there was a delay in assessing patients and some patients were sent to the wrong services. For example, the local directory of services had not been updated to ensure children were signposted to an emergency department with a paediatric service
- The community urgent care services in Gloucestershire were generally well run, there were still opportunities to improve patient flow through services to reduce delays, and ensure people are treated in the correct environment
- During the inspection of South Western Ambulance Service NHS Foundation Trust CQC found some patients experienced a long delay in response to 999 calls. There were also delays in the handover from the ambulance crew to local hospitals due to a lack of available beds on wards meaning patients were waiting too long in emergency departments
- Patients were also remaining in hospital for longer than necessary, due to delays in their discharge home or to other services. The reasons for these delays were complex and involved many different providers of health and social care.
The providers involved in this inspection activity are listed below, including a link to their individual provider report:
- Gloucestershire Hospitals NHS Foundation Trust
- South Western Ambulance Service NHS Foundation Trust
- Practice Plus Group - Gloucestershire Out of Hours
- Gloucestershire Health and Care NHS Foundation Trust
For enquiries about this press release please email regional.engagement@cqc.org.uk.
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