Integrated Care & Social Care

Prof Ted Baker: A whole-system approach

CQC’s chief inspector of hospitals, Professor Ted Baker, discusses the importance of a whole-system approach to managing the capacity problem as demand for health and social care continues to rise.

Every year, we are seeing more and more people in need of health and care support. This rising demand is partly due to our ageing population, but also the increasing number of people living with complex, chronic or multiple conditions such as diabetes, cancer, heart disease and dementia.

Emergency departments are often the first point of contact for people in need of care, and the number of people seeking help from emergency departments is continuing to increase year on year, made worse by spikes in seasonally-related conditions. Last winter saw an unprecedented number of people requiring help from services in emergency care and follows an ongoing pattern of rising demand, with the number of emergency admissions growing by 42% over the last 12 years.

However, it is not just in winter that emergency departments experience such pressures, as has been evident during the recent period of hot weather which saw a record 2.2 million patients attending A&E departments during July 2018. This year-round pressure was something we highlighted in our recent report, ‘Under pressure: safely managing increased demand in emergency departments,’ which presents a summary of the findings from CQC’s inspections of emergency departments alongside practical solutions to help manage capacity from frontline clinicians at some of the best and most challenged emergency departments in the country.

The report shows that our inspections of urgent and emergency services have found evidence of good practice and of individual providers that have been able to make improvements. However, it also highlights a variation in quality and how, in some cases, increased pressure has impacted on staff wellbeing and patient care. Some clinicians told us that escalation has become normalised, and we found that building resilience to manage the additional demands placed on the urgent and emergency care services needs greater input and buy-in from health and social care organisations across local areas.

The practical solutions put forward by clinicians, and shared in the report, can be used by others to help maintain safe, high-quality care in the face of operational pressures – but they are only part of the answer. Hospitals cannot work alone to address the ever-increasing demand on services; there has to be a collaborative approach, with all parts of the health and social care system working together to manage the capacity problem as demand continues to grow.

The findings from CQC’s local system reviews have also shown a variation in the way that local systems have worked together to prepare for surges in demand. These government-commissioned reviews of 20 local areas explored how well local health and social care systems work together to support and care for people aged 65 and over, including the interplay between emergency care provision and other local services. 

In July, we published ‘Beyond Barriers,’ which brought together the key findings and recommendations following all 20 individual reviews. The report highlights that, where systems have established and joined up processes to support people to stay safe and well in their usual place of residence through an effective prevention approach, and implemented initiatives to avoid unnecessary hospital admissions, they are more likely to manage pressures well. Unfortunately, we found this was not happening everywhere and a number of the reviews identified ineffective coordination of health and care services, leading to fragmented care.

In these cases, the lack of a shared plan or vision resulted in people not receiving the right care in the right place at the right time, with consequences ranging from care being provided at greater expense than necessary, to increased pressure on services and staff, to people’s quality of life being significantly diminished.

Both our individual provider inspections and the local system reviews have shown that no partner can work alone to address the ever-increasing demand on services – there has to be a system-wide approach, with all parts of the health and social care system working jointly to find solutions – including the government and CQC.

The problems facing the health and social care system are not amenable to a quick fix or simple solution, but it is clear that developing new ways of system collaboration and planning for surges in demand are both urgent and need to happen now. We must continue to focus on the whole-system approach to ensure that we safeguard quality of care both now and into the future.

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