Action must be taken now if the NHS is to avoid an even worse winter crisis next year, the chief inspector of hospitals has warned.
The Care Quality Commission (CQC) said the use of corridors to treat sick patients in A&E was “becoming normalised”, with departments struggling with a lack of staff, poor leadership and long delays leading to crowding and safety risks.
Professor Ted Baker said: “Our inspections are showing that this winter is proving as difficult for emergency departments as was predicted. Managing this remains a challenge but if we do not act now, we can predict that next winter will be a greater challenge still.
“We cannot continue this trajectory. A scenario where each winter is worse than the one before has real consequences for both patients and staff.”
Since December the CQC has carried out more than a dozen small one-day inspections of A&E departments where it had specific concerns about possible safety risks.
Prof Baker said the capacity issues traditionally reserved for the winter months were now year-round problems.
He said: “After a difficult summer we entered this winter with A&E performance at its worst level. July 2019 saw the highest proportion of emergency patients spending more than four hours in A&E than any previous July for at least the last five years. This was coupled with primary and community care services operating at full stretch, leaving little room for manoeuvre.
He said NHS staff were “going to extraordinary lengths” while performance data showed “significant, sustained demand across the NHS”.
Poor cooperation and coordination between hospitals, social care and other local organisations had “led to fragmented care” in some places and Prof Baker warned the problems would not be solved with a “quick fix”.
“Hospitals and emergency services cannot work alone to address the ever-increasing demand for care. We recognise that health and social care services are working more collaboratively and innovatively when it comes to planning for winter, but even greater system working and integration are needed across the health and care system.
“The necessary reform must proceed at pace if we are going to make a difference before next winter.”
So far this winter the regulator has carried out 13 inspections at nine hospital trusts and has taken enforcement action against some trusts to protect patients from harm.
Among concerns it identified during the inspections, the CQC highlighted a lack of consistent triaging of patients meaning some unwell patients could be missed or not spotted if they started to deteriorate while waiting.
It said some A&E departments did not have enough nurses with the skills and qualifications to care for children, while inspectors found long delays in ambulance staff handing over patients to the A&E team were causing crowding and patients waiting in corridors.
It said a “lack of consistently robust operational leadership” meant some A&E’s did not have the right numbers of staff and poor communication between A&Es and hospital bosses led to a “lack of situational awareness and understanding about the real issues” including patient safety.
It also warned mental health patients were not being properly assessed or cared for while some specialty teams were adding to length delays by not visiting A&E’s quickly enough to review patients.
But it also added: “We have seen that even the busiest departments (treating some 600 patients a day) can manage flow and deliver safe care. In such cases staff felt invested in, and there was clarity in relation to, clinical pathways to be followed.”
The government has said it is investing a record amount of cash amount in the NHS by 2023-24, almost £34bn, although experts from the Health Foundation said this did not take account of inflation and money already spent meaning the real figure is closer to £16bn.
The latest NHS performance data showed record numbers of patients waiting on trolleys in A&E departments, with 2019 seeing the worst cancer performance by the NHS since 2016.
An NHS spokesperson said: “Just this week we have seen that A&E performance improved in January compared to the previous month, thanks to the sustained hard work of NHS staff and the ability to open and staff more hospital beds than last year.
“But it’s also true that many of the solutions to the growing need for care lie outside the A&E, which is why the government’s commitment to increase the number of nurses by 50,000, invest in new and expanded beds and facilities, and find a long-term solution on social care will be crucial over the coming years.”