Professor Jonathan Benger, National Clinical Director for Urgent Care for NHS England, updates on the Urgent and Emergency Care Review:
In November last year we received an extremely positive reception to the End of Phase 1 Report on Urgent and Emergency Care in England.
Sir Bruce Keogh outlined proposals for a radical shift in care, with more extensive services outside hospital and a change in the way patients access emergency care.
Since then, a lot of hard work has been going on behind the scenes to put the wheels in motion via the Urgent and Emergency Care Delivery Group made up of senior representatives from more than 20 different clinical, managerial and patient associations.
The group has been meeting regularly to begin Phase 2 of the review – implementing our proposals.
Over the coming weeks and months as we progress through Phase 2 and into the implementation stage, I will be keeping you up-dated in my blog on the ‘behind the scenes’ work.
Firstly, it’s important to recap on the reasons for the Review. Over the last 15 years, patients admitted to hospital as an emergency have increased by almost 50 per cent.
Yet through hard work and innovations survival rates have increased year-on-year and bed days have reduced from 37 million to 32 million. But this is not enough. Our system is under extreme pressure and is unsustainable in its current form.
Over the next three to five years we are going to enact major changes to provide highly responsive, effective and personalised urgent care outside of hospital.
Secondly, we will designate two types of hospital-based emergency facilities: Emergency Centres and Major Emergency Centres.
Emergency Centres will assess and initiate treatment for all patients and safely transfer them when necessary. Major Emergency Centres will be larger units, capable of assessing and starting treatment for all patients as well as providing a range of highly specialist services.
We are planning around 40 to 70 Major Emergency Centres across the country. However, the overall number of Emergency Centres and Major Emergency Centres will be about equal to the number of current A&E departments.
Our main message is clear – no single organisation can deliver these proposals: change is required right across the system. And no more so than in primary and community care which must be developed and enhanced to provide the vast majority of urgent and emergency care outside hospital settings.
So we are working with NHS Improving Quality to identify and prepare demonstrator sites which will trial and refine the new system, and the networks that will underpin the delivery of urgent and emergency care.
We also have many other strands of work going on, and the Programme Board meets every couple of months to review progress and discuss risks and issues.
Currently eight distinct packages of work are under-way: Whole System Planning and Payment, Commissioning and Accountability; Primary Care; Smart Call/111; Data, Information and Care Records; Community Pharmacy; Emergency Departments and Networks; Ambulance Treatment Service; Workforce.
They sit beneath the Review’s five key changes, and will help to support the achievement of these.
Each of these packages have a wide team working beneath them to join up existing pieces of work at grass roots and consider new bespoke work needed. While there are dozens of examples I could give for each of these, I’ve decided to choose just a couple to illustrate the type of work being done.
For example, within the stream of work on the Ambulance Treatment Service we are looking at how Ambulance Services can be developed and commissioned as a treatment as well as a transport service. Increasingly the capabilities of ambulance staff have expanded, so now they can treat many patients at the scene, reducing unnecessary visits to hospital and accessing alternative pathways of care.
We are looking at incentives, standards and targets to underpin the new role as well as exploring how GPs and other clinicians in the control room can provide support on the phone and to crews on the ground to reduce the number of journeys – particularly for frail and elderly patients, those with mental health needs and children.
And in workforce, for example, there is also much we can do. It’s no secret there are many workforce pressures in Emergency Departments, and a shortfall of Emergency Medicine Consultants.
Health Education England has the statutory responsibility in this area and we are working closely with HEE to influence the direction of travel and deliver the workforce we need for the future, developing the knowledge, skills and abilities of a range of healthcare professionals. In this way we are shifting our focus from a purely medical lens and building on plans for a wider workforce including advanced practitioners, paramedics and pharmacists. If their skills are fully utilized it will make a huge contribution to delivering urgent and emergency care in community settings, and preventing avoidable admissions.
We need change, we need it now and we are forging ahead with these critical plans to keep the wheels of our NHS turning.
Jonathan is the Director of the Academic Department of Emergency Care at the University of the West of England, Bristol and a Consultant in Emergency Medicine at University Hospitals Bristol NHS Foundation Trust. He also has extensive experience of pre-hospital care, having previously contributed to the establishment of a pre-hospital critical care team for Great Western Ambulance, and does regular clinical work in both the Emergency Department and ambulance service.
Jonathan has led or collaborated on 28 grant-funded research projects with a total value in excess of £8million, and has authored more than 100 peer-reviewed publications. His main research interests are the evaluation of new technologies and techniques, service configuration and workforce, emergency airway management, resuscitation and pre-hospital care.
Until May 2013, Jonathan chaired the Clinical Effectiveness Committee of the College of Emergency Medicine, and served on the Council and Executive of the College. He has been closely involved with guideline and policy development in the UK, alongside international initiatives to define and improve the quality and safety of emergency care.