An overview of work underway to improve urgent and emergency care:
- Improving patient flow in the rest of the hospital.
- Getting a better understanding of the impact of social and community care.
- Supporting the mid-long term sustainability of A&E departments.
- Supporting efforts to tackle local issues.
A&E delays: why did patients wait longer last Winter?: Next Steps. [Online]: Monitor, September 3rd 2015.
Missed A&E Waiting Times Targets: Why Patients Waited Longer Last Winter
The performance of A&E departments against the four-hour waiting-times standard was lowest in ten years last Winter. This report from Monitor, which tests ten hypotheses as to the underlying cause(s) of the problem, indicates that the main cause of longer A&E waiting times involved delays in admitting patients to other hospital departments from the emergency department. Hospitals struggled to cope with the increasing admission rates because of high occupancy rates and delayed transfers of care at the back-end.
This implies that reducing A&E waiting times can only be tackled across the wider local health and care system (not simply within emergency departments in isolation) and that solutions lie in improving the flow of patients through inpatient wards, towards patient discharge and back into the community.
The Emergency Care Improvement Programme (ECIP) has been created, based on these findings. This is a clinically led joint programme which will involve Monitor, NHS TDA, NHS England and the Department of Health working to offer practical help and support to the urgent and emergency care systems across England which are most under pressure.
A&E delays: why did patients wait longer last winter? London: Monitor, September 2nd 2015.
There is also an Executive Summary in infographic format.
More detailed analysis:
A&E delays: why did patients wait longer last winter?: Conclusions from the 10 hypotheses tested. London: Monitor, September 1st 2015.
The econometric analysis:
A&E delays: why did patients wait longer last winter?: our econometric analysis. London: Monitor, September 1st 2015.
Safer, Faster, Better: Good Practice Guide for Local Health and Social Care Communities
The coup de grâce?:
Transforming urgent and emergency care services in England. Safer, faster, better: good practice in delivering urgent and emergency care. A guide for local health and social care communities. London: NHS England / UEC Review Team / Emergency Care Intensive Support Team (ECIST), [August 2015] September 1st 2015.
January 2017 Update: Watering-Down of the Four Hour A&E Performance Target?
Almost a quarter of patients waited longer than four hours in A&E in early 2017, with 18,000 trolley-waits over four hours duration.
Kirkland, F. [and] Triggle, N. (2017). Leak shows full extent of NHS winter crisis. London: BBC Health News, January 10th 2017.
Jeremy Hunt MP suggested that patients attending A&E units with more minor problems may no longer be guaranteed to be seen within four hours:
Triggle, N. (2017). Jeremy Hunt casts doubt on NHS’s four-hour A&E target. London: BBC Health News, January 9th 2017.
Scotland Versus England: Performance Compared?
International A&E waiting times comparisons are not straight-forward:
Reality Check: Is Scottish A&E outperforming England? London: BBC Reality Check Team / BBC Health News, October 9th 2018.
Attempts to Improve Patient Access to GPs (and Relieve Pressures on A&Es)
The government would like GP surgeries to be open between 08:00 and 20:00, seven days a week. Some might lose some of their “additional” funding (unless they can prove there is genuinely no demand from patients).
GPs urged to commit to seven-day service or lose funding. London: BBC Health News, January 14th 2017.