Update on NHS England’s Urgent and

Emergency Care Review

Professor Keith Willett

National Director Acute Care

NHS England

Current provision of urgent and emergency care services

2

>100 million calls or visits to urgent and emergency services annually:

• 438 million health-related visits to pharmacies (2008/09) Self-care and self management

• 24 million calls to NHS

• urgent and emergency care telephone services Telephone care

• 300 million consultations in general practice (20010/11) Face to face care

• 7 million emergency ambulance journeys 999 services

• 14.9 million attendances at major / specialty A&E departments

(2012/13)

• 6.9 million attendances at Minor Injury Units, Walk in Centres etc (2013/13)

A&E departments

• 5.3 million emergency admissions to England’s hospitals (2012/13) Emergency admissions

0

1

2

3

4

5

6

Em

erg

en

cy a

dm

issio

ns (

millio

ns)

2+ day admissions 0-1 day admissions

Since 1990s, EMERGENCY ADMISSIONS have grown while

attendances at major A&Es have stayed broadly constant

Source: King’s Fund

Attendances at type 1 A&E units have remained

broadly constant

Type 1 A&Es account

for 98% of emergency

admissions from A&E

Emergency admissions trends vary significantly

over three periods in the last 15 years

7.8% annual growth

-1.2% annual

growth -0.1% annual growth 2+ day

2.2% annual

growth

2.0% annual

growth

4.0% annual

growth

1.0%

annual

growth Total

Type 1 A&E units are consultant-led 24-hour services

Type 2 A&E units are single specialty

Type 3 A&E units include minor injuries units and walk-in centres

1.4% annual

growth

0.5% annual

growth

0-1 day

Confusing (and piecemeal?) system

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BACKGROUND

• In Jan 2013 NHS England announced the Urgent and

Emergency Care Review.

• A steering group was established to develop an evidence

base and principles for a new system. An engagement

exercise took place from June to August 2013

• Using the information gained from this exercise we developed

proposals to transform the delivery of urgent and

emergency care, and published a report in November 2013.

• The Review is now moving into delivery phase

The 4 strongly supported design changes

…

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PATIENT NED

Phone First

Guaranteed Same-Day access to

my Primary Care team

7/7

My information is always

available to all those

treating me

7-Day Early

Senior Clinical Input

So we can ensure we best

match your need promptly

and conveniently

So your care is

personal and optimal

- accountable clinician

To reassure you

of holistic care,

and to improve

your experience

and outcome

Stakeholders are telling

us that 4 of the System

Design Objectives are

key…..

Solution: shift care closer to home

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THE REVIEW’S VISION …..

For those people with urgent but non-life threatening needs:

• We must provide highly responsive, effective and personalised services

outside of hospital, and

• Deliver care in or as close to people’s homes as possible, minimising

disruption and inconvenience for patients and their families

For those people with more serious or life threatening emergency

needs:

• We should ensure they are treated in centres with the very best expertise

and facilities in order to maximise their chances of survival and a good

recovery

… AND HOW WE WILL DELIVER

5 Key elements for success:

1. Providing better support for people to self-care

2. Helping people with urgent care needs to get the right advice in the

right place, first time

3. Providing highly responsive urgent care services outside of hospital

4. Ensuring that those people with serious and life threatening

emergency care needs receive treatment in centres with the right

facilities and expertise, and

5. Connecting all urgent and emergency care services together into a

cohesive network so the overall system becomes more than just the

sum of its parts

The new system

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PROGRESS WITH DELIVERY

• We have setup a Delivery Group consisting of stakeholders from

a range or organisations either responsible for change to the

urgent and emergency care system, or impacted by it:

• To lead and own the detailed design of new clinical models, and

any tools and guidance; and,

• To act as champions within their own organisations, securing

resources where necessary and engaging with wider stakeholders

to undertake the work.

• We have divided the work up into 8 work-packages and task

groups under the Delivery Group to take forward design

THE DELIVERY GROUP

Delivery Group

LGA

Patients

NHS IQ

HEE

PHE

NTDA

Monitor

Kings Fund

RCGP

CEM

AMRCs

AACE

Comm Assemb

FTN

NHS England

Tools & Levers

Professionals and

Workforce

System

Partners

Users

Commissioners and

Providers

Challenge

OUTLINE DELIVERY PLAN

Better support for self care

1. Promote effective self-care 1. Develop self-care resources 2. Guidance produced on marketing campaigns (so that messages are same across the country so far as is practicable) 3. Signposting/linkage to LTC third sector partners, etc, for advice and support

2. Introduction and roll-out of advanced care planning

1. Development of national care plan template and tools to support delivery of 15m care plans by 2015

Right advice right place first time

1. Integrate pharmacy into the UEC system 2. Changes to national pharmacy contract to introduce minor ailments service etc.

2. Improve clinical input to NHS 111 and

ambulance services - more ‘hear and treat’

1. Development of new national specification for NHS 111 to include recommended clinical input, and extended range of services for booking, including guidance on reprocurement 2. Development of guidance on ambulance models to include support required in control room

3. Integrate system by improving referral rights through UEC system NHS 111 and NHS ambulance services, pharmacy, etc

1. Ensure national 111 specification and procurement strategy enable local referral rights 2. Development of guidance on improving referral rights across UEC system

4. Enhance the DOS to be real time and accurate commissioning tool (refer correctly)

1. DOS development work: Health and Social Care content

OUTLINE DELIVERY PLAN (CONT.)

Highly responsive out of hospital services

1. Develop the ambulance service model to offer more treatment on the scene

1. Development of Guidance on models for treatment on scene by ambulance service 2. HEE work on paramedic Development and training 3. Enable GPs to offer support to ambulance and A&E (in enhanced service to go live from April 14)

2. Develop community pharmacy facilities to offer wider range of services

1. Principles for extended pharmacy offer, backed up by contractual changes

3. Successful models of care for improved primary care access - in and out of hours

1. Principles for improved primary care access 24/7, accompanied by necessary national contractual incentives 2. Headline specification for local urgent care facilities

4. Successful models of care for improved community services - in and out of hours

1. Principles for improved community services (in and out of hours) accompanied by necessary national contractual incentives 2. Headline specification for local urgent care facilities

5. 7/7 access to hospital specialist advice to PC and key OOH services

1. Hospital specialists: who should be available, appropriate response times – academy/colleges/specialist (NHSE)

Specialist centres to maximise recovery

1. Designation of major emergency centre and emergency centres

1. Develop national specifications in conjunction with clinical stakeholders 2. Determine process for accreditation and designation of facilities

2. Matching hospital resources to patient acuity and complexity

1. Develop appropriate tools and guidance on flow

OUTLINE DELIVERY PLAN (CONT.)

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

1. New improved system of commissioning, finance, and payment

1. Guidance on recommended footprint of the commissioning unit 2. Guidance on what is meant by joint (?)/ collaborative commissioning arrangements – Inc. health and Local Authorities) 3. Development of new tariff and incentives structure to drive dissolution of barriers across organisations

2. Timely access to relevant patient clinical data across the system

1. Full implementation of the SCR 2. Enhancements to improve SCR

3. Establishment of effective emergency networks (inc. network transportation system)

1. Development of guidance on constitution of emergency care network in conjunction with national clinical and operational stakeholders.

4. Unified quality measurement system 1. Development of metrics to measure whole system performance.

5. Identifying what good looks like in terms of dissolving boundary between heath and community care

1. Identify sites for exemplars and best practice

Questions

Urgent and Emergency Care Review

CASE STUDY: • A dispersed community of 90,000 over a 15-mile radius. • Two population foci one of 45,000 one of 20,000.

There is a small local hospital in the larger of the two towns • Geography: 40 miles, (60 minutes), by road to next nearest larger hospital

in community of 200,000 • Major emergency/specialist hospital 80 miles away (110 minutes) by road.

• Migrant tourist population for 3-4 summer months • Industries: farming, forestry, tourism • Climate: typically British! Plus restricting snow coverage for 20 days a year

Urgent and Emergency Care Review QUESTIONS:

1. “Providing better support for people to Self-Care”. What’s uniquely different for a self-sustaining community?

2. Out of Hospital

a. “Helping people with urgent care needs to get the right advice in the right place, first time”. What does that constitute?

b. “Providing highly responsive urgent care services outside of hospital so people no longer choose to queue in A&E”. What’s different?

Urgent and Emergency Care Review QUESTIONS (continued): 3.

a. “Ensuring that those people with more serious or life threatening emergency needs receive treatment in centres with the right facilities and expertise in order to maximise chances of survival and a good recovery”.

b. “Connecting urgent and emergency care services so the overall system becomes more than just the sum of its parts”.

So how does the network function for urgency, quality, safety and patient/family experience?

Thank you