The must-read stories and debate in health policy and leadership.

Cornwall’s problems with long waiting times for patients requiring emergency care have become increasingly stark throughout 2022.

By spring the Royal Cornwall Hospitals Trust was reporting two-day waits for patients in its emergency department before admission, and by summer ambulance response times to people suffering suspected heart attacks and strokes had grown to more than three hours.

Now, external consultants from Prism have confirmed what local leaders already knew: The integrated care system is under “unprecedented and unsustainable pressure”.

Worryingly, Prism reported that although teams in Cornwall can articulate the problems, it seems no one can come up with any meaningful solutions.

“Little progress is being made, despite considerable effort”, its review said.

But the review suggests there is still plenty that can be done in a bid to improve patient flow throughout the ICS. It highlighted “multiple disconnected structures in place to manage tactical and strategic recovery of performance”, and flagged a “low appetite for risk” and over-reliance on bedded care.

It is not clear from the summary of the review (the full version has not been published) exactly how the ICS should address these failings, but it is clear that change is urgently needed.

Another new normal

Bold and “radical” solutions are required to address the “enormous gap in resources and capacity” in urgent and emergency care, a regulator and senior clinicians have said.

A Care Quality Commission report released on Wednesday urged system leaders to move away from “quick fixes” to the emergency care crisis, such as tents in A&E car parks or corridor care.

Instead, ICSs should adopt “proactive long-term solutions,” such as expanding the use of urgent community response teams, giving acute service access to GP booking systems and providing “rapid access” to social care support packages.

Other suggestions in the CQC’s People First guidance, which was based on discussions with senior emergency clinicians and CQC staff, include upskilling community and acute teams, providing greater clinical validation for 111 and 999 services and increasing the role of voluntary organisations to support vulnerable people in the community.

Sir Robert Francis, chair of Healthwatch England, who contributed to the guidance, said emergency services are in a “critical state” and “gross delays” are “becoming the new normal”.  

Also on hsj.co.uk today

In The Integrator, Dave West is sceptical of the health secretary’s “new plan for patients”, and in our comment section, Natasha Owusu and Rachel Newton say that addressing inadequate rehabilitation services and disparities in healthy life expectancy is long overdue.