A&Es may struggle to cope this winter as most are ‘inadequate’ or ‘require improvement’, inspectors say

‘There needs to be a system-wide change’ to avoid perfect storm of problems, says CQC

CQC inspectors fear A&Es will be hit particularly hard (Getty iStock)

More than half of accident and emergency (A&E) departments are rated inadequate or require improvement, according to figures from the Care Quality Commission (CQC), as the NHS struggles with soaring demand and a lack of staff.

A total of 44 per cent of urgent and emergency services were told they had to improve from 2018 to 2019, while a further 8 per cent were simply inadequate, according to the regulator’s annual state of care report.

The figures represented a serious deterioration in the quality of emergency facilities, the report said. Forty-one per cent of urgent care services required improvement the year before, while 7 per cent were designated inadequate.

“We know that it’s a combination of increased demand and challenges around workforce are creating something of a perfect storm, and if that perfect storm is allowed to continue we will have a number of problems,” said Ian Tremholm, the CQC’s chief executive.

He added that people were also having to wait longer to be treated in emergency departments.

”Winter is always busy but the NHS can pause for breath – catch its breath – throughout the summer. But this year it hasn’t been able to do that," he said.

The winter months usually see high numbers of patients suffering from flu being admitted to hospitals, and the annual bug can exacerbate chronic health conditions.

Mr Trenholm said A&E “is the department in a hospital that we are most concerned about”, adding there was a “rising demand and people struggling to provide high quality care” throughout emergency departments.​

Ted Baker, the CQC’s chief inspector of hospitals, added: “There needs to be a system-wide change, people need to get the care they need in the community ... so they do not need to attend A&E unnecessarily.

"For many of those patients, going to A&E is not the best place for them to go, but it is the only part of the system that has ever-open doors and it is the part of the system they can access most easily.”

The CQC also warned of a “serious deterioration” in the quality of inpatient services for people with mental health problems, learning disabilities and autism.

Inspectors rated some 10 per cent of inpatient services for people who had learning disabilities inadequate, compared to just 1 per cent the year before.

Seven per cent of child and adolescent mental health inpatient facilities were also rated inadequate, up from 3 per cent the year before.

“We also know that adult social care remains fragile,” Mr Trenholm said. “We know that the failure to agree a long-term funding solution is driving instability in the sector.”

Last year, former prime minister Theresa May pledged an extra £20bn a year by 2023 for the NHS.

But Mr Trenholm said he could not say “one way or the other” whether the extra funding would lead to an improvement in NHS care.

“We are calling for a long-term, sustainable funding solution for social care,” he said. “The NHS cannot operate on its own. It needs that funding for social care.

In response to the report, a Department of Health and Social Care spokesperson said: “Everyone should have access to the best quality, compassionate care, whether that’s in hospital or in the community. We have underlined this commitment through our long term plan, which is backed by the largest and longest cash settlement in the history of the NHS, and extensive planning for the winter months is already underway.

“We are supporting our most vulnerable by transforming mental health services with a record spend of £12.1bn this year and are working to reduce the number of people with learning disabilities and autism in mental health hospitals by improving specialist services and community crisis care, reducing avoidable admissions and enabling shorter lengths of stay.

“We will set out our plans to reform social care in due course.”

Additional reporting by agencies