Redesigning services around patients in the community and having staff who can make crucial clinical decisions to keep people at home should be explored as options for reducing pressures on NHS urgent and emergency care services. The suggestions are part of a package of recommendations from the NHS Confederation’s Urgent and Emergency Care Forum, which is made up of organisations that provide and commission urgent care services.
Published today Ripping off the sticking plaster is a response to Sir Bruce Keogh’s review of urgent and emergency care. The Forum’s report calls for an end to “sticking plaster solutions” and to shift focus to solutions that will last into the longer-term. It says fundamental change is needed and the problems of emergency care cannot be tackled by NHS organisations working in isolation.
The report urges joint work between primary care, acute, ambulance, mental health, social care and community services; with providers and commissioners working together.
The report welcomes Sir Bruce’s Keogh’s review and makes recommendations on its implementation that broadly fall into three areas:
Access to urgent and emergency care: The NHS should not simply label patients’ decisions about where they access services as wrong. Instead, more needs to be done across the whole NHS to enable better access to care. This means a move towards a clear single point of access for urgent and emergency care with a consistent triage to ensure people with physical and mental health needs are supported into the best part of the system to meet their needs. This may mean, for example, more widespread use of co-located urgent and emergency care services on a single site, particularly in urban areas; as well as community alternatives to A&E; and improved online access to NHS 111.
Getting the best from staff: Having staff with the right skills is crucial to providing care in the right parts of the system. Staff should be empowered to decide whether a patient should be treated in an emergency department or elsewhere. The NHS must also improve training and investment in its staff to ensure services are fit for the future. For example, the report encourages the development of more community-based ambulance services, through enhancing paramedic practitioner roles. The report also recommends greater clinical engagement and interaction with NHS 111 in the next phase of its development.
Emergency care networks: While the report welcomes Sir Bruce Keogh’s proposal’s on the development of emergency care networks, it says NHS England should avoid being prescriptive and must allow local areas the freedom to establish networks suitable for their population needs.
Commenting on the report, chief executive of the NHS Confederation, Rob Webster, said:
Staff and managers across the NHS have done a great job in ensuring patients are able to access care this winter. This will not be sustainable in the medium term with the huge pressures on the urgent and emergency care system and increasing demand means urgent action is needed.
This involves a hard look at why patients access care in the way they do. We know patients will go ‘where the lights are on” and instead of blaming patients for going to the wrong place, we need to build a system around patients and to give them the care they need, when they need it.
Looking at urgent and emergency care in isolation, or just as a hospital problem, without an appreciation or understanding of what is going on across the rest of the NHS and social care will not solve the long-term issues. This will require primary care, acute, ambulance, mental health, social care and community services to work together in networks.
We need to build on the existing good practice which is out there, but change needs to happen, and fast.”
An evidence review found that increases in demand for urgent and emergency care services are not solely the result of an ageing population. The research cites other factors that have produced increases in demand, including: changes to care provision, perceived limited access to primary care services, lack of sufficient alternatives to A&Es in the community and the public’s desire to go where they have always gone for treatment.
The report also urges NHS England and Health Education England to continue supporting the development of more community services to help prevent patients ending up in A&E or being admitted to hospitals.
Rob Webster, added: “What the NHS needs is a substantial change in approach, looking at the best place to provide care, with the right staff who are comfortable working in both an acute and community setting. Our members are leading the way in finding innovative solutions to reduce the pressure on emergency departments.
“The report complements our 2015 Challenge − which is about politicians from all parties recognising the urgent need for service change in the NHS; and for the NHS to be ready to change to better meet the future needs of patients.”
Other recommendations in the report include:
- The next phase of NHS England’s review should consider how senior clinical involvement can be further integrated within NHS 111 making sure there is parity of urgent and emergency care responses for those with mental and physical health needs.
- GPs are the gatekeepers in the local system, but more information must be available to the about other services and agencies in who are involved in self-care or prevention, across physical and mental health.
You can read how NHS Confederation members are coming up with innovative solutions to the pressures faced in urgent and emergency care on their website. They are also listed by individual organisation below:
Delivering ambulatory care at Airedale hospital
Delivering seven day care at Bassetlaw hospital
Delivering the right care in the right place at the right time in the South West
