The Care Quality Commission (CQC) has released its main findings from a review looking at how healthcare providers worked together to provide urgent and emergency care (UEC) during the Covid pandemic last year.
The regulator carried out the provider collaboration reviews (PCRs) across eight areas in England between October and November 2020, and focused on issues such as access to care, the flow of people through the system and the quality of UEC services.
The CQC concluded that some UEC services ‘appear to have fared better than others, sometimes benefitting from the strength of previously established working relationships’.
Collaboration
The regulator looked at a wide range of providers, including NHS 111, GP out-of-hours services, urgent treatment centres, accident and emergency, ambulance services and pharmacies.
The CQC’s report found that the quality of relationship between the local providers ‘played a major role’ in coordinating and delivering joined-up UEC services to meet the needs of the local population.
The regulator said that some patients were ‘very positive’ about the care they received, but complained about ‘disjointed care’ where they experienced a lack of communication between services on their care pathway.
In Cornwall, community assessment and treatment units (CATUs) were created to bring multi-disciplinary teams together, closer to people’s homes, the report said. Geriatricians were moved from acute sites into the CATUs to help keep older and frail people out of hospital – a model explored by other neighbouring systems, it added.
Meanwhile, in Newham, East London, a multidisciplinary discharge hub was created early in the pandemic to make hospital discharges safer – which included hospital and social care staff, an infection and prevention control nurse, Age UK, and others, the report said.
Digital
The CQC said that the pandemic was a ‘catalyst for innovation and change’ – pushing UEC providers to work together and deliver care in new ways.
They used digital technology ‘more widely and more often’ so people could still access services, while some have also worked to address the negative impact of digital exclusion and maintain patient choice, it added.
The purchase of electronic tablets for care homes in Cornwall and the Isles of Scilly allowed for virtual ward rounds and primary care assessments, ensuring residents had continued support in their homes, the report said.
Inequality
The CQC said it found evidence of inequality in some places for patients as well as staff at different care providers.
To help address this, a system in Herefordshire & Worcestershire tried to identify patient risk by flagging patients’ vulnerabilities on the electronic patient record shared with West Midlands Ambulance Service, and making them known to emergency departments in advance.
Also, services in East London helped spread key public health messages through community leaders and influential people on TV and on Bengali radio stations.
Staffing
The regulator said providers expressed concern for the mental health and resilience of staff ahead of winter, and that there were examples of ‘good collaboration’ to ensure staffing levels. There was, however, ‘little evidence’ of widespread shared strategies across the system for managing the anticipated demand for services, it added.
Planners in Northamptonshire looked ahead to the winter months by considering national and local staffing as well as staff skills, to see where it could be beneficial to move staff around and where upskilling would be useful.
Meanwhile, Liverpool City Council commissioned a workforce capacity dashboard across health and social care in Cheshire and Merseyside, and held a workshop with providers to review winter pressures.
The CQC said the full report findings will be published this month, and expects to have looked at provider collaboration in all Integrated Care System (ICS) and Sustainability and Transformation Partnership (STP) areas in England by spring 2021.
