Inspectors Raise Safety Concerns About Majority Of A&E Units In England

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The Law Of... receiving rightful emergency care

An inspection of healthcare provision in England has revealed that emergency care services are amongst the poorest performing parts of the system.

The Law Of... receiving rightful emergency care

A review from the Care Quality Commission (CQC), the independent regulator of health and social care in England, revealed that of 187 A&E units just under 10% are classed as inadequate and a further 48% require improvement; this means less than half of A&E units are classed as good or outstanding.

Responding to the review, which raised safety concerns for A&E attendees, Daxa Patel – Medical Negligence Partner – explains how reduced social care provision could explain failing A&E departments.

Inadequate & Requiring Improvement

The CQC's 'State of Care' report highlighted the worrying figures for A&E, with the number of patients waiting for more than 4 hours at A&E rising 30% from 2014/15 to 2015/16, this comes as the demand for emergency care increased pressure on the system's capacity.

CQC categorise their data for service safety as follows:

  • Inadequate A&E units: An A&E unit would be judged to be inadequate if there was serious overcrowding or delays; it can also be judged inadequate on safety measures if there is a delay in getting access to key equipment
  • A&E units requiring improvement: An A&E department would require improvement if there was evidence of poor hygiene standards, with cleaning practices and equipment not being adequately checked and maintained


It is assumed that the strain on A&E departments caused by increased attendance, which rose by 2%, could be causing the safety concerns in a number of units.

Alongside these concerns, the CQC raised questions about the state of adult social care, claiming that services are reaching tipping point and causing increased pressure on other areas, namely A&E departments.

Social Care Issues Increasing Attendance

In a statement concluding their annual State of Care report, the CQC claimed that a rationing of council-funded social care was causing pressures on other services.

It is claimed that the fragile nature of adult social care is beginning to impact both the patients that rely on care and the performance of the NHS more generally.

Figures showed that the number of older people receiving local authority-funded social care fell 26% from more than 1.1million in 2009 to around 850,000 in 2013/14; furthermore, 81% of local authorities have reduced their real-term social care spending for the elderly in the last five years.

It is thought that the reduction of provisions in social care is causing an increase in attendance to A&E units, as those who would normally be supported by a local authority are seeking alternative assistance for basic medical needs.

Explaining how these services should work in collaboration to avoid such strains on one particular service, Daxa said:

"The pressures on A&E services caused by the closure of care homes, or the lack of care home support for the elderly, is an on-going issue."

"There has always been a tug of war as to whether elderly care should be funded by the NHS or the social sector and as always it is the elderly who continue to be the victims as they see their budgets cut."

"Recent legal changes were meant to offer better integrated care but this is not happening and services are continuing to fail on simple communication processes."

"Elderly patients are the most vulnerable in the system and while they may be perceived to be blocking beds in A&E departments, it is vital that they are treated with the care and dignity they are due."

"Cases of pressure sores, broken hips and negligent care continue to increase in the elderly population, so it is high time there was better co-ordination between the health and social sector."

"Ultimately, the elderly are just as entitled to the best health care as the rest of the population."


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