Summary
Challenges faced by urgent and emergency care services include:
- Rising demand and an ageing population.
- Lack of comprehensive, effective alternatives to hospital admission seven-days a week.
- Complex discharge issues.
- Handover and patient flow.
- Recruitment into emergency and acute medicine.
The ten priorities agreed by the Royal College of Physicians (RCP), the NHS Confederation, the Society for Acute Medicine and the College of Emergency Medicine are:
- Providing effective and simplified alternatives to hospital admission, seven days a week.
- Adjusting financial incentives across the system to support effective management of demand for unscheduled care.
- Supporting patients to leave hospital seven days a week. Hospital teams should ensure early planning for discharge from hospital, involving a range of health care professionals. The use of “step down” care facilities should be extended for people who need supportive care but not a hospital bed.
- Organising high-quality consultant-led hospital services, seven days a week.
- Promoting collaboration within the hospital and beyond to manage emergency patients. A collaborative model of care would include multi-specialty teams, with expertise in physical and mental health, working in a network across the hospital and community, to manage patients on an emergency care pathway.
- Ensuring sufficient capacity within the hospital, and the wider system, to meet changing demand. Community health and social care capacity should be increased to absorb preventable unscheduled admissions.
- Focus on ambulatory (“day case”) emergency care where appropriate, for admissions considered to be avoidable and for cases which can be managed more appropriately in the community.
- Development and retention of a sustainable workforce, and attractive career options to ensure the long-term sustainability of consultant careers.
- Enabling leadership development and cultural change within the NHS.
- Focus on public health and preventive health strategies.
Reference
Urgent and emergency care: a prescription for the future. London: Royal College of Physicians (RCP), July 18th 2013.
The following summary analysis appeared later, from the CEM:
Reference
McMillan, P. (2014). 10 priorities for resolving the crisis in Emergency Departments (NHS England version). London: College of Emergency Medicine (CEM), January 21st 2014.
Possibly Also of Interest
The following Foundation Trust Network (FTN) report analyses the results from a survey of members on the development of local Urgent Care Board plans.
Reference
Funding and planning of urgent and emergency care over winter 2013: the NHS foundation trust and trust view on progress with the creation and funding of local Urgent Care Board plans. London: The Foundation Trust Network (FTN), July 15th 2013.
House of Commons Health Select Committee Assessment
The Health Committee has effectively nominated A&E to be Keogh’s next challenge. MPs felt unclear whether urgent care boards are voluntary or compulsory, temporary or permanent.
Reference
Triggle, N. (2013). A&E crisis plans ‘not good enough’. London: BBC Health News, July 24th 2013.
This relates to:
Reference
House of Commons (2013). Urgent and emergency services. Second Report of Session 2013–14. Volume I: Report, together with formal minutes, oral and written evidence. Additional written evidence is contained in Volume II, available on the Committee website: www.parliament.uk/healthcom. Ordered by the House of Commons. London: The Stationery Office Limited (House of Commons Health Committee), July 16th 2013. Reference No. HC 171.
£500m Government Bailout
A £500m government bailout has been made in early August 2013, to help struggling accident and emergency units in England.
The funding will help A&E departments identified as under pressure and targeted on “pinch points” in local services. Hospitals are making proposals how to improve local services, with improvements to A&E and additional services away from A&E which are designed to reduce unnecessary admissions and the length of hospital stay.
Reference
Prime Minister announces £500 million to relieve pressures on A&E. London: Department of Health, August 8th 2013.
A couple of BBC commentaries:
Reference
Bailout for A&E units only ‘papering cracks’ say doctors. London: BBC Health News, August 8th 2013.
Reference
Triggle, N. (2013). Is A&E bailout a drop in the ocean? London: BBC Health News, August 8th 2013.
[A brief reference to the above features in Dementia and Elderly Care: the Latest Evidence Newsletter (RWNHST), Volume 3 Issue 9, August 2013].
The 53 trusts most at risk this year will share £235m, but to qualify for next year’s funding trusts will have to get 75% of staff vaccinated against flu. Currently less than half of health staff have their flu jab, potentially putting themselves and their patients at avoidable risk.
Read more: BBC News. A&E cash linked to staff flu jabs.
Reference
A&E cash linked to staff flu jabs. London: BBC News, September 10th 2013.
£1bn for A&Es and NHS Staff to Access Medical Records
The government is investing £1 billion in technology to ease pressure on A&E departments and improve patient care. The idea is to reduce pressures on A&E by “freeing-up” doctors’, nurses’ and care professionals’ time to spend actively caring for patients by cutting paperwork and bureaucracy. This funding also supports the government’s commitment to allowing patients to book GP appointments and order repeat prescriptions online by March 2015. It should enable people to access their GP records online.
Reference
£1 billion to help A&Es and NHS staff access medical records in hi-tech hospital revolution. London: Department of Health and NHS England, September 4th 2013.
