The NHS must improve emergency healthcare for vulnerable groups, including disabled people, the Healthcare Commission said today.
In a review of all urgent and emergency care services in England, it called for much greater integration in emergency and urgent care, saying current service fragmentation hit vulnerable groups hardest, and revealed service gaps for disabled people and others with long-term conditions.
The regulator found that provision for disabled people in A&E departments and urgent care centres – which deal with minor injuries and illnesses – was “variable”.
Only 54% had a hearing loop in place – and of these, one-third did not test the system regularly – while 41% produced information in easy read formats suitable for people with learning disabilities. In 49% of units less than half of staff had received disability awareness training.
Over 30% of out-of-hours GP services and almost 15% of A&E departments and urgent care centres lacked procedures to protect vulnerable adults, while 54% of out-of-hours GP services had not trained all their staff in child protection procedures.
The Healthcare Commission said services had “a long way to go before they are working in an integrated way to meet the needs of patients”, adding that this was particularly problematic for older and disabled people.
The commission added: “Negative experiences of care for these patients can not only lead to frustration and anxiety, but can leave them upset and anxious about using services in the future.”
It found patient pathways to ensure people received continuity of care were in place for people with mental health disorders in only 63% of areas, compared to 79% for people with chest pain.
It also found there were problems in emergency services accessing care plans for people with long-term conditions, despite these often setting out relevant information for providing urgent care. The commission found systems to share care plans with A&E departments and ambulance services were in place in only 12% of areas.
Overall performance and recommendations
The commission found that 60% of primary care trust areas were performing well on emergency care, 22% were fair and 18% were rated as “least well performing”, adding that those in the bottom category were less likely to meet disabled people’s needs.
The commission said PCTs needed to have a clear plan for the delivery of integrated urgent and emergency care across their areas, including urgent social care services.
It also urged the government to support integration by reviewing current targets for emergency and urgent care services, which currently only measured individual parts of the system, to ensure they covered the whole of patients’ experience of care.
The regulator welcomed proposals from strategic health authorities to introduce a single telephone number to access urgent care for non-999 cases, which were issued this year to inform health minister Lord Darzi’s review on the future of the NHS.
It said this could “fundamentally change how services are delivered” and would need to be developed with the full engagement of service users, particularly those with complex needs.
Charlotte Potter, senior health policy officer at Help the Aged, said the report showed “welcome improvements”, but added: “When older people are poorly in the middle of the night they want the reassurance of knowing who to call and getting the help they need – all too often the NHS isn’t providing this service.”
The DH welcomed the report and promised to work with PCTs and the commission to improve performance. It said it would issue further information on proposals to develop a single urgent care phone number later this year.