NHS England asks patients, the public and staff to help shape the future of urgent and emergency care

NHS England is today asking patients, public and NHS staff to help shape the future of urgent and emergency care services.

Professor Sir Bruce Keogh’s Urgent and Emergency Care Review was announced in January this year. Its aim is to develop a national framework to build a safe, more efficient system, 24 hours a day, seven days a week.

Those using and working in the NHS have from 17 June to 11 August to feedback on an evidence base for change and emerging principles that will guide the Review, also published today.

The terms of reference, evidence base and emerging principles, along with details on how to contribute and get your views heard, are all on the NHS England website.

This Review is just one part of a national approach to improving the way NHS services are delivered so that patients get high quality care from an NHS that is efficient now and secure for future generations.

Professor Sir Bruce Keogh, National Medical Director for NHS England, said:

“The Urgent and Emergency Care Review has provided us with an excellent opportunity to improve the way we offer care between our hospitals, primary and community care and social services.

“We have seen clear improvement in A&E performance across the country coming into the summer, but the issues will not just simply go away.

“Over the past few months, we have been building an evidence base of guidance, reports and data to inform our review – and it is clear that the way we currently deliver urgent and emergency care needs to change.

“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 discussion. We must keep pace with medical progress and make sure everyone has the best chance of receiving the most appropriate care.

“We now need to hear your views on our work so far, and what you want from your local health services to ensure high quality and safe care in the right place and at the right time for those who need it.”

The Review Steering Group is chaired by Professor Keith Willett, National Director for Domain Three: Acute Episodes of Care, with representation from professional bodies, a patient and public organisation, providers and commissioning organisations.

Professor Keith Willett, National Director for Acute Episodes of Care for NHS England, said:

“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.”

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.

For the short term, NHS England has already announced plans to strengthen performance in urgent and emergency care across the country to help hospital A&E departments meet demand and tackle waiting time pressures.

Please note that comments submitted on this page will not be added to the review.  To take part in the review, please complete our questionnaire.


  1. Peter Handslip says:

    I agree with the above.Reduction of numbers of DGH sites as suggested by certain Medical Politicians advice to Government and offering A&E services on fewer sites, will no doubt exacerbate the problem.Highly specialized services occupy a small amount of activity within A&E departments, yet are being used to infer that care would be better on fewer more specialized departments.The vast majority of care resulting in Acute Medical and Surgical Admissions requires excellent generalist skills and can be provided by most DGH’s with catchment populations of 200 to 250,000 population base.We need a move back to more generalist skills before it is too late. Concentrating care on fewer sites will mean further to travel for acutely ill patients and specialist departments with much larger catchments will be unable to cope as they become clogged up with Acute on Chronic patients.
    The increase in Emergency workload given the increasing age of the population and the complexity of care required has been entirely predicatable and of no suprise to the profession, we have simply been unable to obtain the resources to deal with it. The inability of care outside of hospital to cope with the level of discharge required to meet the demand for admissions with a 4 hour turnaround for admssions and anything from 2-4 weeks to discharge a medically fit patient, inevitable leads to a blocking of admissions and A&E gridlock. Primary care really has to be brought back into 24/7 care, where there expertise is vital to ensuring appropriate admissions and discharge of patients, to pretend that primary care has nothing to do with resolving the problem would be ludicrous. Government needs to start listening to the frontline clinicians that deal with these problems every day of the week instead of Medico politicians with vested interests.

  2. Chris Morgan says:

    This is a really important consultation as it signals a potential further re-configuration/transofrmation of healthcare but I fear that this presentation is not user friendly enough to engage most of the public. Public and the ensuing political opinion will determine how far and how well any future change happen so availability and accessibility is crucial. I only picked up this consultation as I currently work with the NHS as a Lay member so am signed up for news alerts but otherwise might never have seen it.

    I am interested to know if there are any other more accessible versions going into shops, supermarkets, GP surgeries, pharmacists, schools, Sure Start centres, offices, leaflets into households, adverts on buses etc as the public need to be really informed and have an opportunity to express their views.

  3. Chris Rickard says:

    1. A&E is subject to too much abuse as too many cases it sees are neither “accidents” nor emergencies. This will persist without changes to out of hours care or a charging mechanism but there should be greater priority to “accidents” and “emergencies” so routine cases just have to wait longer.
    2. There are too few A&E depts as operations are increasingly complex & costly leading to hospital consolidation. A&E is the feeder for these specialist conditions. All hospitals should have A&E but there should be flexibility in referring patients on for further specialist care.
    3. People are not ill Mon-Fri 9-5 so consultants should work nights & weekends to ensure the right skills are available for patient care.
    4. Too much time is spent dealing with drunks at the weekend. They should have to pay for care for “self inflicted” medical conditions.
    5. Above all, out of hours care needs to become effective so fewer cases get to A&E. GP contracts should be amended so that hours worked include an appropriate proportion of weekend & nighttime care. This can be done without increasing GP hors by reducing to the administrative & bureaucratic burdens they currently bear.

  4. Michael Vidal says:

    The time allowed for responding is too short for such a complex subject. It also is being run at the same time as the CQC is running a consultation on the new fundamental standards. This would mean that this important subject is at risk of not receiving the attention it deserves as people with limited time may not be able to respond to both at the same time. As Cabinet Office guidance recommends a minimum of 12 weeks and bearing in mind the summer holiday period can we have a two month extension in the time to respond as it is more important to get things right than to keep to a self imposed timetable.

    Michael Vidal

    • Seth Edwards says:

      Thanks for your comments. The Cabinet Office guidance referred to ( does not specify a minimum amount of time to be attached to engagement exercises such as this. It says, instead, that timescales “should be proportionate and realistic to allow stakeholders sufficient time to provide a considered response”. The engagement period on the Urgent and Emergency Care review lasts for eight weeks, which we believe gives reasonable time to formulate and submit responses.

      • Michael Vidal says:

        Seth – With all due respect the very first footnote in the document contradicts what you say and says that the compact between the government and the voluntary sector should be respected and para. 2.4 of that compact provides for a minimum of 12 weeks. Where a shorter period is proposed then a clear explanation needs to be given. In view of NHS England’s stated aim to engage with patients NHS England should follow the compact.

        • NHS England says:

          Thank you for your comments, and your interest in this work.

          The purpose of this engagement exercise is to test the evidence base and emerging principles that the Urgent and Emergency Care Review’s Steering group has developed. We are at the end of the first phase of this review and are not consulting on firm proposals for future change at the moment – but we want the views of the public as to whether we are heading in the right direction.

          We believe that engaging for eight weeks provides the public with a great opportunity to help us with our work. We have received over 300 responses to the engagement exercise already, many of which are from individuals from a variety of backgrounds.

          We would encourage you to take part in the engagement exercise and give us your views on the evidence base and emerging principles.