Improvements needed to reduce pressure on urgent and emergency care in Leicester, Leicestershire and Rutland following CQC inspections

Published: 13 July 2022 Page last updated: 13 July 2022
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The Care Quality Commission (CQC) has found improvements are needed to ease pressure on urgent and emergency care services across Leicester, Leicestershire and Rutland. This follows a series of coordinated inspections which took place from February to June, across the Leicester, Leicestershire and Rutland 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 these partnerships 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 co-ordinated 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.

Following these inspections, CQC has called for closer working between the healthcare organisations who deliver care across the county, including sharing risks to ease pressure on key services.

The emergency department serving Leicester, Leicestershire and Rutland is at Leicester Royal Infirmary, and how services work together to support people moving between health and social care has increased pressure on this emergency department, resulting in delays in the care and treatment for patients.

As part of this programme of coordinated inspections, CQC inspected over 30 individual services across the system. These included urgent and emergency care and medical services run by University Hospitals of Leicester NHS Trust, East Midlands Ambulance Service NHS Trust, GP surgeries, urgent care services, adult social care services and the NHS 111 service. (Links to these services can be found at the end of this press release.)

Fiona Allinson, CQCs director of operations, said:

“During the inspections across Leicester, Leicestershire and Rutland, we found staff working extremely hard under sustained pressure. It was also clear from our inspections that many services had started to think about a system wide approach to reducing demand on urgent and emergency services. However, many solutions were relatively short term, small scale pilots which were impacted by staffing issues. Organisations in the system need to work together to learn from these pilots and ensure those which are successful are sustained.

“Staffing was a challenge across the NHS111 service although, it was reassuring that recruitment was on-going. It was however concerning that patients trying to contact NHS111 experienced some delays getting through to the service which could put people at risk. However, at the time of our inspection, performance was better than England averages for the percentage of calls answered within 60 seconds.

“Additionally, we found some examples of people living in social care who experienced long delays when accessing 999 services. Although advice was provided, patients were experiencing long waits and a poor outcome, especially for people who had fallen and remained on the floor. Improvements need to be made to ensure people receive a better standard of care.

“In urgent and emergency care services across the board, staff raised concerns about their skills, and some felt additional training would be beneficial to help meet the needs of patients. Senior leaders need to make sure they are supporting staff with their training needs in order to keep people safe.

“There were issues with patients receiving care and treatment in the emergency department at Leicester Royal Infirmary, particularly at night. Beds weren’t allocated to patients until they had been seen by specialist staff, this meant some patients spent more time waiting in the emergency department. Also, patient transfers to other hospitals stopped in the evening which restricted patients transferring to other services.

“Escalation processes weren’t effective. At times when Leicester Royal Infirmary and the ambulance service was under pressure, staff felt there was a lack of diverts available to other sites or services and that partner organisations were slow to respond and give support.

“We have told the health and social care organisations we inspected across Leicester, Leicestershire and Rutland, the improvements they need to make to improve people’s experiences through urgent and emergency care. We look forward to seeing what can be achieved by all partners working together.”

Across the system, inspectors found:

  • Long delays in handover of patients from ambulance to hospital resulted in a high number of ambulances waiting outside Leicester Royal Infirmary, this caused delays in responding to 999 calls
  • People reported difficulties when trying to see or speak to their GP. Some GP practices had invested in new technology to improve telephone access. Staff working in GP practices signposted patients to extended and out of hours services to prevent people attending emergency department whenever possible
  • Staff working in urgent care services reported challenges due to the volume of pilots being carried out to reduce admissions. Many pilots ran for relatively short periods of time and were often impacted by staffing issues. This made it difficult to maintain oversight of pathways available to avoid acute services. However, some pilots had proved successful and prevented hospital admissions
  • Psychiatric liaison services at Leicester Royal Infirmary were well run and designed to meet people’s needs. Staff demonstrated effective partnership working with a person-centred approach and good use of alternative pathways to avoid admission into acute or social care services
  • There was a high number of patients in hospital who were medically fit for discharge but remained in acute services. Communication about discharge and discharge processes were impacting on the quality of transfers of care to social care services
  • Out of hours care had been challenging throughout the pandemic as staff were redeployed to other key services, this had particularly impacted on home visiting services.

A full list of the services inspected and links to their reports can be found below:

GP surgeries

Urgent care services

Care services

Hospitals

Ambulance service

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.