Plans to strengthen performance in urgent and emergency care are being put in place across the country to help hospital A&E departments meet demand and tackle waiting time pressures.

Read the A&E improvement plan and accompanying letter to staff.
(these documents are no longer available here but can be found on the National Archives website)

NHS England has joined with the NHS Trust Development Authority (NTDA) and Monitor, which are responsible for provider regulation, to ensure coordinated action to ease the immediate pressures.

At the same time, a review will take place to understand the causes of problems, which differ around the country.

A&E departments have seen a rise in the number of patients they are seeing in recent years, with an extra 4 million people a year using emergency services compared with 2004.

Although 90 per cent of A&E patients are seen within four hours – and last week the NHS met its 95 per cent standard overall – concern has been growing about the underlying trend of more patients waiting longer.

The maximum four-hour wait in A&E remains a key NHS commitment to the public, set out in the NHS Constitution.

The support plan, published today (Thursday), says: “Long waiting times in A&E – often experienced by those awaiting admission and hence ill patients – not only deliver poor quality in terms of patient experience, they also compromise patient safety and reduce clinical effectiveness”.

NHS England will therefore ensure healthcare leaders from different parts of the local NHS come together to form urgent care boards, covering all A&E departments.

These boards will, by the end of May, ensure local recovery and improvement plans are in place for each A&E on their patch. Monitor and the NTDA will expect hospitals and other providers, for example community services, to participate. This follows on from the monitoring and support programmes both regulators have been carrying out with the trusts for which they are responsible in recent weeks.

The three organisations will ensure a coordinated national approach and monitor progress. They will also ask NHS organisations to bring forward planning for next winter so hospitals are well prepared.

For the longer term, NHS England has already announced a review of the model of urgent and emergency services, led by Sir Bruce Keogh.  The review will consider and develop a new national framework for urgent and emergency care that can help the NHS deliver improvements to patient care in the future.

A&E attendances have risen steadily over the past decade, although they have been relatively flat in recent months.

To help with the immediate pressures, NHS England is ensuring that money is freed up and available to improve A&E services.

Above certain limits, hospitals are currently paid 30 per cent of the fee for emergency admissions on the nationally-set NHS tariff. The aim of this policy is to help reduce unnecessary hospital admissions and improve services in the community.

The support plan says urgent care boards should oversee use of the remaining 70 per cent of the fee.  Expenditure, which will be closely monitored, should be linked to specific improvements, including in A&E.

Professor Keith Willett, who is NHS England’s National Director for Acute Episodes of Care and a trauma surgeon, said: “When pressure builds across the health and social care system, the symptoms are usually found in the A&E Department.

“I’ve lived that environment for 30 years and I know just how tough it can be.  What we all want is great service for patients that meets and often exceeds the minimum standards.  To get there, we need the whole NHS system, in the community and hospitals, to recognise the problems and help to relieve the pressure on their colleagues in A&E.

“In the longer term we need to combine all the expertise in the NHS to determine how best to organise emergency care in future so that people get appropriate, effective and rapid care whenever and wherever it is needed.”

While the recovery plan is underway, a review will bring together data and evidence on the factors which may cause problems in A&E departments as it is clear that problems vary across the NHS.

These factors include:
• increased numbers of patients visiting A&E – although some performance problems have arisen when numbers have been lower than usual;
• seasonal illnesses such as flu and norovirus;
• patients attending A&E who are more ill than usual leading to more acute admissions;
• hospital processes around efficient admittance and discharge leading to a delay in beds being available;
• delays in discharge as local primary, community or social care services are not in place.

A&E services are commissioned by clinical commissioning groups (CCGs), led by local GPs. NHS England oversees CCGS while Monitor and the NTDA oversee NHS providers.

NHS England has made meeting the four-hour wait in A&E a standard contractual requirement for NHS hospitals.  It has added a new standard requirement that no A&E patients should wait more than 12 hours on a trolley.

NHS England has also stepped up the monitoring of people’s experience in A&E departments, adding to the picture on performance.

Since 1 April 2013, hospitals have been asking patients: “How likely are you to recommend our A&E department to friends and family if they needed similar care or treatment?” Results will be published monthly from July.

For further information, please e-mail the NHS England media team at nhscb.media@nhs.net or call 07768 901293