With ambulance waiting times at an all-time high, the staffing crisis in social care, and hospital bed capacities completely overwhelmed, it's clear that the urgent and emergency care system is very much in crisis. This is a crisis that sees people routinely spending over 12 hours in emergency departments, a crisis that sees ambulances regularly queuing outside hospitals and a crisis that ultimately, leaves those in the community at risk of suffering avoidable harm.

In May 2022, these extreme pressures led to the Care Quality Commission’s urgent and emergency care workshop, which was attended by more than 250 leaders across the health and social care sector. It aimed to answer three key questions:

1. How do we support people to stay well at home, and what services do we need to do this?
2. What services do we require to ensure a person with a new unmet care need is seen by the right team, in the right place, at the right time?
3. How can we safely discharge people from hospital as soon as they are able, with the right care and support in place?

From this, came PEOPLE FIRST. Developed by the National Emergency Medicine Specialist Advisor Forum, PEOPLE FIRST is a practical resource, designed to help embed the principles of person-centred, urgent and emergency care within (and between) integrated care systems. Applying to system leaders, service providers, national oversight bodies and government alike, it aims to encourage innovation and the sharing of examples of good practice, recognising that no organisation works in a silo.

Divided thematically, PEOPLE FIRST covers the following topics: Prevention; Escalation; Optimising Pathways; Leadership; Equality; Flow; Innovation, information and technology; Risk sharing; Staffing and training; and Transformation.

Each topic covers the pressures and challenges the sector faces and then gives actionable suggestions and good practice examples in order to effect positive change. The emphasis is on the wider picture, encouraging all health and social care organisations to work together towards the common goal of supporting those that need it. For example, a system-wide risk register is encouraged to track risks in real-time across sites and services to give everyone an overview of risks.

Clearly, the issues are wide-reaching and there is no quick fix or one-size fits all approach, so we will leave it to providers to work out how the relevant action points in PEOPLE FIRST might assist them.

From our review, however, what seems to be missing / overlooked is practical advice on the steps care providers should take when faced with delays in ambulance response times. For example, in homecare, how can staff cover be maintained for over 12 hours and what should care workers do to ensure the safety of someone who has fallen and cannot be moved from the floor due to injury concerns?