05 April 2022
During an inspection looking at part of the service
We carried out an announced focused inspection of King Street Health Centre on 5 April 2022. We undertook this inspection as part of a system-wide inspection looking at a range of urgent and emergency care providers in West Yorkshire. This was an unrated inspection.
A summary of CQC findings on urgent and emergency care services in West Yorkshire.
Urgent and emergency care services across England have been and continue to be under sustained pressure. In response, CQC is undertaking a series of coordinated inspections, monitoring calls and analysis of data to identify how services in a local area work together to ensure patients receive safe, effective and timely care. We have summarised our findings for West Yorkshire below:
West Yorkshire.
Provision of urgent and emergency care in West Yorkshire was supported by multiple provider services, stakeholders, commissioners and local authorities.
We spoke with staff in services across primary care, integrated urgent care, community, acute, mental health, ambulance services and adult social care. Staff continued to work under sustained pressure across health and social care and system leaders were working together to support their workforce and to identify opportunities to improve. System partners worked together to find new ways of working, linking with community services to meet the needs of their communities; however, people continued to experience delays in accessing care and treatment.
During our inspections, some staff and patients reported difficulties with providing and accessing telephone appointments in GP practices. Some of these issues were caused by telephony systems which were being resolved locally. We found inconsistencies with triage processes in primary care which could result in people being inappropriately signposted to urgent and emergency care services. However, a number of staff working in social care services reported good engagement with local GPs.
We visited some community services in West Yorkshire and found these were generally well run. Service leaders were working collaboratively to identify opportunities to improve patient pathways across urgent and emergency care. These improvements focused on meeting the needs of local communities and alleviating pressure on other services. There were strong partnerships with social care and community teams, so patients had the right support in place on discharge.
However, we inspected one intermediate care service and found it could only take referrals from an acute trust, which meant there were no step-up facilities for patients in the community. The service struggled for ward space to deliver therapeutic activities and there were no communal spaces for patients to meet together or engage in group therapy. Plans were in place to provide additional facilities and to reconfigure the existing layout to provide communal spaces.
The NHS111 service was experiencing significant staffing challenges and were in the process of recruiting a high number of new staff. Staff working in this service had experienced an increase in demand, particularly from people trying to access dental treatment although a system was in place to manage the need for dental advice and assessment. Due to demand and capacity issues, performance was poor in some key areas, such as providing a call back to patients from a clinician.
The ambulance service had an improvement programme in place focused on performance and staffing. Whilst we saw some improvement in ambulance response times and handover delays, performance remained below target. We identified impact on other services due to the availability of 999 responses; for example, a maternity service had to close temporarily to keep women safe, due to system escalation and because ambulance responses couldn’t be guaranteed in an emergency. Staff working in social care services also experienced lengthy delays in ambulance response times which further impacted on their ability to provide care to their residents.
We inspected some mental health services in Wakefield which were delivering person-centred care and responded to urgent needs in a timely way. Staff worked in multi-disciplinary teams and collaborated with system partners.
People’s experiences of Emergency Departments were varied depending on which service they accessed. Some Emergency Departments had long delays whilst others performed relatively well. In services struggling to meet demand, patient flow was a key factor. Poor patient flow was primarily caused by delays in discharge with a high number of people fit for discharge unable to access community or social care services.
Staff working in some social care services reported significant challenges in relation to unsafe discharge processes, this included a lack of information to support their transfer of care and we were told of examples when this resulted in people having to return to hospital. Local stakeholders had a good understanding of this problem and were looking to improve pathways and discharge planning.
Staffing and capacity issues in both care homes and domiciliary social care services have at times impacted on timely and safe discharge from hospital.
We found services were under continued pressure and people experienced difficulties accessing urgent and emergency care services in West Yorkshire. System and service leaders across West Yorkshire were working together to seek opportunities for improvement by providing services and pathways to meet people’s needs in the community; however, progress was needed to demonstrate significant improvement in people’s experience of accessing urgent and emergency care.
At the inspection of King Street Health Centre we found:
- The service had systems in place to manage risk so that if safety incidents occurred, they were investigated and any learning from them was shared and used to improve the service and prevent the recurrence of similar issues.
- Safeguarding systems, processes and practices had been developed, implemented and communicated to staff to manage risk and ensure patient safety.
- Staff informed us that they had access to policies, procedures and guidance relevant to their role and responsibilities including clinical protocols and guidance.
- The provider had appropriate clinical equipment in place to enable the effective assessment of patients. The provider also had the necessary equipment and medicines available to deal with medical emergencies including emergency resuscitation equipment.
- Infection prevention and control was appropriately managed to help safeguard people from COVID-19 and healthcare associated infections.
- There were arrangements in place for planning and monitoring the number and mix of staff needed. There was also an effective system in place for dealing with surges in demand. The provider supported the training of advanced care practitioners to increase clinical capacity.
- There were processes in place to coordinate, monitor and respond to the clinical needs of presenting patients.
- Clinical records viewed showed that care and treatment was provided safely, effectively and in accordance with evidence-based guidelines. The provider had systems in place to audit consultations and prescribing practices.
- Quality and performance was routinely monitored and records indicated that the service was performing well against key performance indicators such as initial assessments, and completion of care.
- The provider had an effective governance system in place that enabled ongoing monitoring and scrutiny of the operation and performance of the services provided. We saw that meetings were regularly held at both an operational and a senior management level.
- There were effective communication systems in place to facilitate information sharing across the organisation.
- Staff had access to induction, training and development opportunities. We saw that staff had received regular supervision and support and were subject to appraisal.
- There was a focus on continuous learning, improvement and innovation. This included via a programme of clinical and non-clinical audits, and participation in several pilot initiatives to improve local access to care.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care