The Urgent and Emergency Care Review: What

Does it Mean for Independent Ambulance Services

Prof Jonathan BengerNCD for Urgent CareNHS England

April 2014

Where are we now...?

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18 Jan 2013 Mar-May 2013 Jun 11 2013

Phase 1 – Evidence gathering and principles development

Engagement

Phase 2 - Delivery

Engagement beginsEvidence base and emerging principles developed

Review launched

Jun – Jul 2013

2015 / 2016

Workstream design & setup

Close of Engagement (11 Aug) & Analysis.

Develop Clinical Models.

Publish Engagement Outcomes & Mobilise Delivery Group

Delivery Group outputs

Tariff Amendments & Commissioning Guidance

Implementation for Contracting Round

Aug – Oct 2013 Nov 2013

May – Nov 2014Feb – May 2014

NOW

The current system – why things really must change

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Big volumes….

Every year the NHS deals with:

• 438 million visits to a pharmacy in England for health related reasons

• 340 million GP consultations• 24 million calls to NHS urgent and emergency care

telephone services;• 7 million emergency ambulance journeys • 21.7 million attendances at A&E departments, minor injury

units and urgent care centres• 5.2 million emergency admissions to England’s hospitals

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Confusing (and piecemeal?) system

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Changing patients, changing country

• More frail, elderly with increasing complexity and multi-morbidities

• More treatable illnesses• Expectations of the service the NHS should

provide, and when it should provide it, are shifting:• 7 day society

• Information and communication

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Keeping pace with advances in care

• Timely access to specialist services, and concentration of expertise, improves outcomes

• But there are still some wide disparities in the system:• Self-care works, but awareness and support is sub-optimal• Primary care access variable across England• A&E departments: same name, very different services

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The Ambulance Evidence Base• 999 calls have increased from 4.7 million in 2001/02 to over

8 million in 2010/11• Costs are rising by 4% per annum• Only 4% of 999 calls are closed using “hear and treat”,

though variation from <1% to >7% (35% in France)• Most 999 calls don’t need an ambulance, but most are

transported• 21% of patients are managed at scene• 64% are transported to A&E (range 47% to 77%)• Workforce development safely reduces transportation rates

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Shifting care closer to home

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Building a new system

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Care at home

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Care close to home

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Care in hospital

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A Network approach

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Creating a “whole system” – more than the sum of its parts:

• Develop emergency care networks

• Support the introduction of an efficient critical care transfer and retrieval system

• Ensure that the networks extend to community services, with free flow of information and expertise between the hospital and community

How we will get there

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Delivery Group – invited members…Local

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Delivery Group

LGA

Patients

NHS IQ

HEE

PHE

NTDA

MonitorKings Fund

RCGP

CEM

AMRCs

AACE

Comm Assemb

FTNCommissioners and Providers

Professionals and Workforce

System Partners

Users

Challenge

NHS England

Tools & Levers

What we’re working on

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1. Better support for self-care

2. Right advice, right place, first time

3. Highly responsive out-of-hospital services

4. Specialist centres to maximise recovery

5. Connecting services, so the system is more than the sum of its parts

The 8 Workstreams1. Whole system2. Data, IT and care planning3. Community pharmacy4. 1115. Primary care6. Ambulance services7. ED and networks8. Workforce

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What Does This Mean For Ambulances?• Real change, right across the system• Fundamental changes to commissioning, payment and

standards• Increased “hear and treat”, and “see and treat” options• Urgent care alternatives to A&E• Reduced hospital transport and admission• Increased community provision• Free flow of information and patients• Joined up working with social care• Clinical support and workforce development19

Opportunities for Independent Services • Supporting new models of care• Urgent transport• Access to diagnostics• Workforce flexibility• Transfer and retrieval services

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Summary• The future system of urgent and emergency care requires a

radically different ambulance service• Emphasis on treatment at scene and in community settings• Ambulance services must be fully integrated within one or

more Urgent Care Networks• Closer integration with 111 and the support of an

interdisciplinary clinical hub• Development of the ambulance workforce, coupled with

changes to organisational culture, will be essential to long-term success

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Questions and Discussion

Professor Jonathan BengerNational Clinical Director for Urgent CareJBenger@nhs.net

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