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Half of NHS A&E departments ‘are inadequate or require improvement’

More than half of A&E units are failing as hospitals buckle under pressure from the broken social care system, a damning report warns today.

The Care Quality Commission (CQC) found standards of care in casualty wards has plummeted in the last year – with 52 per cent now rated as either inadequate or requiring improvement.

The watchdog’s annual report said inadequate social care is forcing patients to go to A&E because it is ‘the only part of the system where doors are always open’.

Dementia patients are among the worst affected – with charities warning they are ‘rushed to hospital with falls, dehydration, infections, and other avoidable emergencies’.

The CQC report found that in 2018/19, 44 per cent of urgent and emergency services were ranked as requires improvement while a further 8 per cent were inadequate.

The Care Quality Commission (CQC) found standards of care in casualty wards has plummeted in the last year – with 52 per cent now rated as either inadequate or requiring improvement

This is up on the 41 per cent requiring improvement and the seven per cent ranked as inadequate the year before.

The CQC also warned of a ‘serious deterioration’ in the quality of inpatient services for people with mental health problems, learning disabilities and autism.

Latest NHS figures show there were half a million more visits to A&E in the first six months of 2019 as in the same period last year. 

And this summer was the worst for A&E waiting times in England since the four-hour target was introduced in 2004.

In today’s report, inspectors warn that people with dementia, mental health problems and autism often cannot access care in their community and instead wait until ‘crisis point’ when they are rushed to A&E.

Professor Ted Baker, chief inspector of hospitals for the CQC, warned: ‘The model of care is fundamentally broken.’ 

‘A&Es are under tremendous pressure. People cannot get care in the community so they are having to access A&E unnecessarily.

‘For many of those patients, going to A&E is not the best place for them to go, but it is the only part of the system that has ever-open doors and it is the part of the system they can access most easily.’ 

Jeremy Hughes, chief executive of the Alzheimer’s Society, said: ‘Today’s report once again highlights the desperate situation people with dementia find themselves in as a result of our unjust social care system.

‘The dire state of social care is resulting in more and more people with dementia being rushed to hospital with falls, dehydration, infections, and other avoidable emergencies.’ 


The NHS is on a collision course as it heads into winter with waiting lists for routine operations at an all-time high, experts warned last week.

A damning report showed more than 4.41million patients were stuck on waiting lists in England in August – up by 250,000 from last year.  

And 662,053 people have waited more than 18 weeks for routine treatments, such as joint replacements – the highest since records began.

Health leaders have condemned the figures and said they show the NHS could face its worst winter ever with Brexit, harsh weather conditions and flu on the horizon.  

NHS bosses said trusts up and down the country are working ‘incredibly hard’ to prepare for the winter and make sure patients are kept safe. 

But the Royal College of Nursing fears more and more patients are going to be treated in corridors as pressure gets piled on the health service. 

The Daily Mail is campaigning for reform of the broken care system which neglects thousands of patients with dementia. forcing some to sell their homes.

Ian Trenholm, chief executive of the CQC, warned of a ‘perfect storm’ that is pushing people into ‘inappropriate care settings’ because they cannot get community care or GP appointments.

He said A&E departments had not had their usual ‘breathing space’ over the summer to prepare for the coming winter months, which can see high numbers of patients suffering flu and existing illnesses made worse.

Kate Terroni, the Care Quality Commission’s chief inspector of Adult Social Care, said: ‘People are struggling to get the right care at the right time in the right place.

‘For people with dementia, this can mean that they end up in emergency departments because they can’t get the help they need out of hospital.’ 

In its report, the CQC also said it had concerns regarding the safety of some NHS services, although this has improved slightly over the last year.

Some 36 per cent of NHS hospitals are currently ranked as requiring improvement on safety, while three per cent are inadequate.

The report said that 10 per cent of inpatient services for people with learning disabilities and/or autism were rated as inadequate in 2019, compared to just one per cent the year before.

And seven per cent of child and adolescent mental health inpatient services were rated inadequate, up on three per cent the year before.

Mr Trenholm said: ‘We are calling for a long-term, sustainable funding solution for social care. The NHS cannot operate on its own. It needs that funding for social care.’ 

Dr Nick Scriven, from the Society for Acute Medicine, said: ‘At some point in the near future all these sustained and repeated problems with increasing demand, inadequate workforce that is haemorrhaging senior cover, the pension tax crisis, crumbling estates, insufficient community medical care and community social care in general totally under provisioned, we will reach a vital tipping point and care will be compromised despite all the heroic efforts by the human side of this, the staff in post.’ 

A Department of Health and Social Care spokesperson said: ‘Everyone should have access to the best quality, compassionate care, whether that’s in hospital or in the community. We have underlined this commitment through our Long Term Plan, which is backed by the largest and longest cash settlement in the history of the NHS, and extensive planning for the winter months is already underway.

‘We are supporting our most vulnerable by transforming mental health services with a record spend of £12.1billion this year and are working to reduce the number of people with learning disabilities and autism in mental health hospitals by improving specialist services and community crisis care, reducing avoidable admissions and enabling shorter lengths of stay.

‘We will set out our plans to reform social care in due course.’