An earlier BBC News description of the problem:
Cawley, L. (2017). Four-hour accident and emergency waits rise 300% at some hospitals. London: BBC Health News, March 16th 2017.
Further context and introductory analysis:
Pym, H. (2017). Can the NHS cope better next year? London: BBC Health News, March 10th 2017.
Talking the Problem Up?
The NHS has prepared for winter this year on many fronts (as discussed below), more so than ever before; yet there is little respite from the ongoing demands for more funding / bailouts. Estimates vary as to the true scale of the problem.
Triggle, N. (2017). The worst is yet to come for the NHS – hospital chiefs. London: BBC Health News, September 3rd 2017.
Exceptions to the downwards trend in performance:
Pym, H. (2017). Why is Luton & Dunstable University Hospital hitting A&E target? London: BBC Health News, December 7th 2017.
Preparations for Winter: National Priorities for Acute Hospitals
A growing collection of practical resources is available from NHS Improvement, on improving urgent and emergency care services.
Improving patient flow through urgent and emergency care. [Online]: NHS Improvement, July 2017.
This relates to:
Good practice guide: focus on improving patient flow. London: NHS Improvement, July 14th 2017.
The main contents headings – covering the main areas for improvement (regarding safety, efficiency and effectiveness) in local urgent and emergency care programmes – include:
- Why focus on patient flow?
- Making it happen – good principles of patient flow.
- The 10 areas for focus.
- Ambulance handovers.
- Primary care streaming.
- Emergency departments.
- Mental health.
- Clinical decision units.
- Ambulatory emergency care.
- Acute assessment.
- Admission, transfer, delays in discharge.
- Appendix 1: The SAFER patient flow bundle and Red2Green days.
- Appendix 2: Trusted assessment.
A collection of case studies:
Case studies: focus on improving patient flow. London: NHS Improvement, July 14th 2017.
On trusted assessment schemes, which are said to be an important aspect of best practice for reducing delays in transfers of care between hospital and home:
Developing trusted assessment schemes: essential elements. London: NHS Improvement, July 31st 2017.
Further documents in this series are expected soon…
Planning For Winter Pressures in A&E (NHS Improvement / NHS England)
The recommendations discussed above were developed in the context of growing pressures within the system. The following document examines how NHS England’s Emergency Medicine and Urgent Care system coped with Winter pressures last year in detail, and considers improvements for the coming Winter season.
A review of winter 2016/17. London: NHS Improvement and NHS England, Summer 2017.
Planning For Winter Pressures in A&E (Department of Health)
Government Response to Health Select Committee Report on Winter Pressure in Accident and Emergency Departments. Presented to Parliament by the Secretary of State for Health by Command of Her Majesty. London: Department of Health, July 2017. Cm. 9485.
More From the “Informed Pessimism” Camp
According to NHS Providers, rising patient demand for services continues to outstrip the increasing numbers of NHS staff.
Triggle, N. (2017). NHS staff ‘working on edge of safety’. London: BBC Health News, November 7th 2017.
The British Medical Association (BMA) has warned of patients waiting longer than 4-hours for treatment in A&E, and a dramatic increase in the number of patients waiting on trolleys for treatment in hospitals or at home for non-emergency elective procedures.
NHS pressures – future trends. [Online]: British Medical Association (BMA), October 30th 2017.
Full Text Link (Note: This article is available freely at present, but may soon require a suitable Athens password, a journal subscription or payment for access).
Hawkes, N. (2017). Winter crisis? What crisis? BMJ. November 13th 2017; 359: j5203.
How is the NHS performing? November 2017 Quarterly Monitoring Report (King’s Fund)
The November 2017 Quarterly Monitoring Report, similarly, indicates that NHS performance, as measured by several indicators, has worsened.
Quarterly Monitoring Report. QMR No.24. November 2017. London: King’s Fund, November 2017.
November 2018 Update
NHS performance targets still missed widely across the UK:
Triggle, N. [and] Jeavans, C. (2018). The hospitals that fail to treat patients on time. London: BBC Health News, November 20th 2018.
Possibly of background interest, on the use of tele-tracking technology in American healthcare organisations:
Castle-Clarke, S. (2017). Managing patient flow and improving efficiencies: the role of technology. [Online]: Nuffield Trust, August 18th 2017.
Integration of Primary and Secondary Care
A showcase case study on the Royal Wolverhampton NHS Trust model for integrating primary and secondary care:
The Royal Wolverhampton NHS Trust: Integrating primary and acute care. London: NHS Confederation [and] The Royal Wolverhampton NHS Trust, June 14th 2016.