Hospitals struggling to cope with rising numbers of patients who cannot get help elsewhere

More than half of A&E units are providing substandard care because they are understaffed and cannot cope with an ongoing surge in patients, the NHS watchdog has said.

The Care Quality Commission (CQC) said 44% of emergency departments in England required improvement and another 8% were inadequate, its lowest rating. Last year 48% of A&Es fell into the two ratings brackets combined.

Ian Trenholm, the CQC’s chief executive, said A&E was “the department in a hospital we are most concerned about”. The regulator said units were struggling because of increases of as much as 10% a year in the number of people seeking care.

Prof Ted Baker, the CQC’s chief inspector of hospitals, said A&Es were getting overloaded because too few NHS services existed outside hospitals, meaning patients’ health could worsen. He said: “There needs to be a system-wide change: people need to get the care they need in the community …so they do not need to attend 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.”

Children undergoing a mental health crisis, for example, too often ended up in A&E because there were no specialist mental health services in their area, Baker said.

Patricia Marquis, the Royal College of Nursing’s England director, said: “In A&E in particular, nursing staff have been left to pick up the pieces of a health and social care system that is failing to meet need outside emergency department doors.”

The CQC found that 40% of outpatient departments, 35% of medical care units and 27% of surgical departments provided substandard care. However, it said hospital care was getting slightly better overall.

Dr Katherine Henderson, the president of the Royal College of Emergency Medicine, said: “As well as more patients coming to emergency departments due to a lack of accessible alternatives, there are fewer and fewer staffed beds in hospitals to admit sick patients to, which results in long waits for patients and overcrowded emergency departments. It is little wonder just over half of urgent and emergency services are rated as needing to improve.”

Too many people with mental health problems, autism or learning disabilities received inadequate care, especially in inpatient units, the CQC said in its annual report. It said there had been an “increasing and accelerating deterioration” in the care they experienced.

The proportion of units for people with learning disabilities, autism or both that the CQC rated as inadequate rose from 1% last year to 10% this year. Similarly, 7% of child and adolescent mental health inpatient services were deemed inadequate this year, compared with 3% last year.

The proportion of wards looking after adults with acute psychiatric illness and psychiatric intensive care units that were rated inadequate rose from 2% to 8%.

Paul Farmer, the chief executive of the mental health charity Mind, said it was “disturbing” that the CQC kept finding poor-quality mental health care.

“The promise of more money at a national level is not enough. People are still reaching crisis point because they are aren’t getting the help they need. We know that even when people are able to get help, it is delivered in sub-standard facilities which limits the quality of their care,” he said.

Inpatient mental health units for people with autism, learning disabilities or both that are run by private firms appear to be a particular problem. Since last October the CQC has rated 14 such hospitals as inadequate and put them into special measures, including units run by the Priory and Cygnet, a major provider of NHS-funded care.

The number of nurses who specialise in caring for people with learning disabilities has fallen by 8% in the last year, NHS figures show.

Oonagh Smyth, an executive director at the learning disability charity Mencap, said: “As local authorities struggle to fund sufficient provision in local communities, vulnerable people are ending up sectioned in inpatient units, which are not only inappropriate environments for meeting their needs but also costly and ineffective.”