NHS England’s review of urgent and emergency care proposes a fundamental shift in the way urgent and emergency care services are provided, delivering more care closer to home where clinically appropriate. Implementing this vision is not a ‘quick fix’ but will instead be a transformational change that will take several years to effect.
‘Safer, faster, better’ has been developed as a practical summary of the design principles that local health and social care communities need to adopt to deliver safer, faster and better urgent and emergency care. These principles are drawn from good practice, which have been tried, tested and delivered successfully by the NHS in local areas across England.
However, the guide should not be taken as a list of instructions or new mandatory requirements. Implementation should be prioritised taking into account financial implications and local context.
NHS England intend this to set a clear direction of travel to generate a bespoke and common purpose in every local health economy. Delivering safe and effective urgent and emergency care cannot be done from within organisational or commissioning silos. It requires cooperation between and within numerous organisations and services, and collaboration between clinicians and supporting staff who place patient care at the centre of all they do. NHS England recognise that this transformation will be occurring in the face of significant demand pressure in general practice, primary care and across the wider health and social care system.
To be effective, changes will need to occur within some providers and commissioners and financial difficulties will need to be addressed. Commissioners and providers will have an expectation of how care models and service provision are planned to change over time, how activity may shift across care settings and how quickly these changes may occur. A multi-year planning horizon will be particularly helpful in implementation, and payment reform proposals recognise this.
Everything that is discussed has been turned into reality somewhere in the country. All the building blocks are available and have been tested by clinicians and managers and shown to work. However, NHS England know from experience that piecemeal implementation of great care in isolated parts of the pathway only creates disjointed ‘islands of improvement’. Critical mass is only developed when good practice is implemented systematically, without unwarranted variation, along the entire pathway.
The challenge is considerable. A social movement, committed to ensuring that urgent and emergency care in England is truly world-class, is needed. This guide is a contribution to making that happen.
