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Statement from Professor Keith Willett, National Director for Acute Episodes of care, NHS England, on NHS England’s Review of Urgent and Emergency Care
I welcome the opportunity to appear before the Health Select Committee to lay out the evidence behind NHS England’s Review of Urgent and Emergency Care.
Together with senior colleagues Professor Sir Bruce Keogh and Dame Barbara Hakin, we are not only taking our message to Parliament and talking to MPs, but this is also a chance for us to keep in the public eye our fundamental steps towards shaping the future of these key services.
This is just one stage of the consultation process that we wish to have with as many people as possible. And it’s not just politicians who need to hear the evidence of what we are doing to tackle issues and drive up standards – it is the general public, patients and their families that need to hear it too.
It is important the message is driven home that we are not only looking to clinical experts to bring about changes that build a safe, more effective and efficient system that provides excellent service 24/7, 365 days a year, but we are also asking patients, the public and all our staff to help develop a national framework.
This is your chance to help shape the future of urgent and emergency care services.
The challenges in delivering frontline care, now and in the future, are at the forefront of everyone’s minds. Over recent months it has been widely reported that A&E services in England are under considerable pressure.
There is little doubt that A&E departments are the pinch point of the health and care system; when there are problems elsewhere in the system, they are usually found here. NHS staff working in A&E continue to deliver quality and safe care despite the sharp rise in the number of patients they are seeing over the last decade.
The fragmentation of different parts of the health service means that patients do not always know where to go to get the most appropriate urgent or emergency care.
We know that those patients who have suffered a heart attack and life-threatening injury or need very specialist urgent care are now best treated in specialist centres without delay, yet people continue to rely on their local A&E. We also recognise that where possible people wish to be treated at or as close to their home as possible; no one wishes to travel long distances, so we need to define what is better treated in your local community.
We know that a lack of understanding of alternatives to A&E, poor management of long term conditions and difficulties in some areas with access to primary care all result in more people going to their local A&E department.
And that is what we are trying to address. With your help we can make it simpler, faster and better for you to receive the care and treatment you need, in the right place, at the right time.
Professor Sir Bruce Keogh announced a review of urgent and emergency care in January this year that would identify the problems and develop solutions to them. At its heart, this review is about bringing together the expertise from across the health and care system to determine how best to organise emergency care in future.
We know that A&E is the pinch point of the health and care system and that staff are working very hard to provide the care they know the public need. To relieve the pressure and design a system that is sustainable and fit to meet future challenges, we need as many patients, doctors, nurses and NHS colleagues as possible to get involved. But we also need the public and patients and families to help us too.
Over the past six months we have been developing an evidence base for improving urgent and emergency care made up of national guidance, best practice, data and reports from clinical bodies including the College of Emergency Medicine, Royal College of General Practitioners, Primary Care Foundation and others.
We now need to hear your views on the evidence we will be using to develop long term solutions that will improve care and outcomes for patients, and enable staff to be rested, alert and safe practitioners.
No single set of data or one group of professionals gives us a perfect picture. We need to bring together experience and expertise from across the NHS and beyond to determine how best to organise urgent and emergency care in future.
This will mean that changes have to made – but they will be made using evidence of what works best for patients. A compelling case for change can only be built on evidence and, while not always comfortable reading, it is the only way to have a truly honest, open and transparent discussion.
The evidence base and emerging principles, along with details on how to contribute and get your views heard, are on the NHS England website.
The urgent and emergency care review is aimed at developing a national framework to build a safe, more efficient system, for
We are taking these commitments, with patients and staff, as our guide.
The Urgent and Emergency Care Review will develop a national framework and associated guidance for clinical commissioning groups in 2015/16 to help them commission consistent, high quality urgent and emergency care services across the country within the resources available.
During the whole of this session, the 3 senior members of NHS England gave no information on emerging thinking on crisis/emergency access to mental health services. Indeed, one could be forgiven for forming the impression that MH is not part of this work. However, the Minister during the previous week made clear that it is and encouraged participation in it. There is a strong evidence base to show the effectiveness of MH liaison services placed within acute hospitals, working in collaboration with local MH services.
Terence Lewis Patient Governance. ‘IT HAPPENS WHEN IT MATTERS AT THE TOP’
I have worked in hospital care including A&E (ED) for 35 years and cared for patients in the corridors during the 90’s purchaser / provider era. To my mind ED is more of a barometer of a system or part of a system in distress/failing than a pinch point. The over focus on ED is more like treating a headache while the system is having a stroke.
There are a number of principles which will deliver what we all want, patients and staff alike:
1. Keep it simple. Politicians and the DOH are the principle problem, not the solution, in building a system so complex not even the staff working in it understand how it works.
2. Evolution not revolution. A belief by repeated governments the NHS must be reformed, needing yet another structural change before the previous change has been embedded is at the very heart of the problem. Count the number of structural changes since the Griffiths report I have lived through, even in a career from 1977 with ten years to run.
3. Compelling stories gain commitment. Even with a ‘pause’ dismantling Primary Care Trusts was an exceptionally poor decision, and with so many staff against the reforms, social movement theory would tell you without a compelling story commitment would not be achieved. They are dismantling the very institution they tell us we all must be so proud of, and the only government policy required is to de-politicise the NHS to save it.
4. Compassionate organisations build compassionate care. Business thinking is not the answer – in fact it’s dead wrong’ Jim Collins Good to Great in the Social Sector. Engaging staff in the right way, building trust between clinicians and mangers is the only way. Not superficial targets for political gain e.g. CQUIN for Friends and Family test. Trust, pride, belief, hope, commitment, energy, training, team work and great leaders build great organisation with compassionate care. Great organisation of care are not built through unannounced CQC taking staff away from doing their jobs, asking obscure questions, leaving staff in distress, crying and feeling criticised for trying to do their best within limited resources. The CQC are ethically failing patients by removing staff from doing their jobs. If the CQC want to make a difference, come and look, listen, read walk along-side staff to learn while working with staff while caring for patients. Then write a report.
Take care with openly being critical of hospitals in public, while patients have no choice in an emergency but go to the hospital publically critisied. This must cause great anxiety in patients, has an impact on staff and harms recrutiment, retention and young people choosing the NHS as a career.