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An NHS Watchdog has warned that more than half of A&E departments need improvement and are providing substandard care because they are understaffed and cannot cope with an ongoing surge in patients.

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.

The CQC also expressed strong concerns about the state of services for people with learning disabilities and mental health issues.

It also warned spending cuts in provisions for dementia and mental health patients have contributed to the deterioration, as well as difficulty securing GP appointments. The CQC found that people were turning to A&E in a crisis because of a lack of support in the community and has warned that services would remain under pressure until a funding solution was found for social care.

The CQC also said it still has “serious concerns” about patient safety in the health service. Some 36 per cent of NHS hospitals are currently ranked as requiring improvement on safety, while three per cent are inadequate.

The report also revealed that over the last five years, the 18-week waiting list for planned hospital treatment has gone up from around three million people to 4.4 million people.

The shortcomings are adding pressure to already-struggling emergency department staff, the watchdog said, and inspectors noted 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.

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.”

Kate Terroni, the CQC’s Chief Inspector of Adult Social Care, said: “This year’s State of Care report shows that people are struggling to get the right care at the right time in the right place.”

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.”

Figures show that in major A&E departments only 32% of patients were seen for an initial assessment within 15 minutes, as rules state they should and a further 33% patients reported waiting more than an hour, including 5% who said they waited more than four hours.

Despite finding that A&E departments need improvement, the same report also also found that 45% of those surveyed were satisfied the staff had done all they could.

A Department of Health and Social Care spokeswoman said: “We are supporting our most vulnerable by transforming mental health services with a record spend of £12.1 billion 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.

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