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NHS seeks views on next steps for assessing urgent care
Patients, clinicians and the public are being invited to give their views on a comprehensive set of indicators for urgent care.
The updated standards aim to capture what matters clinically and to patients, end hidden waits and reduce the risk of spreading COVID-19.
This is the next stage in a developmental process first initiated in 2018. The proposed bundle of measures takes account of changes in the way that urgent care is delivered such as the roll-out of Same Day Emergency Care and strengthening of NHS 111.
Hospitals will be expected to see and assess patients within 15 minutes, one of 10 indicators.
Local health systems could receive a rating that reflects the whole patient journey under the bundle, developed as a result of testing those first published in the interim Report of the clinically-led review of NHS access standards.
Integrated care systems would be scored on measures including 111 performance, ambulance response times and patient handovers, timely assessments and time spent in emergency departments (EDs).
Data on individual trusts’ performance would still be published each month.
Taken together the measures, developed with clinical leaders, will improve patient flow to prevent crowding and ensure A&Es function more efficiently and effectively than the current set of standards which date back 15 years.
The coronavirus pandemic has made it more important than ever that patients get the right care, in the right place, at the right time and can socially distance while they do so.
NHS National Medical Director, Professor Stephen Powis said: “After a decade and a half it is only right that we look at how we measure urgent and emergency care with fresh eyes.
“There have been many innovations in urgent treatment in that time and it is important that they are reflected in how we assess patient care from start to finish.
“The coronavirus pandemic has only made it more important that we update the way we measure urgent care to ensure NHS services deliver what matters most to patients and clinically.”
The consultation is backed by the Academy of Medical Royal Colleges, Royal College of Emergency Medicine, Healthwatch, Doctors’ Association, College of Paramedics , Patients Association, Stroke Association, Royal College of Physicians, UK Sepsis Trust, Royal College of Psychiatrists, Association of Ambulance Chief Executives, NHS Clinical Commissioners (NHSCC) on behalf of NHSCC and NHS Confederation.
In 2018, Professor Powis was asked by the Prime Minister to review the NHS access standards to ensure they measure what matters most to patients and to clinical outcomes.
The review seeks to align with the ongoing transformation programme of urgent and emergency care by addressing the importance of patient flow into, through and out of emergency departments; good patient flow prevents ambulances queuing outside of hospital EDs, prevents overcrowding of departments and the associated risk of hospital- acquired infection and reduced quality of care for patients, and prevents delays in patients being discharged or admitted to a bed on the appropriate ward for ongoing care.
These indicators have been developed with a number of acute NHS trusts and through consultation with an extensive group of clinical and patient representative stakeholders.
People can have their say until Friday 12 February 2021
Professor Helen Stokes-Lampard, Chair of the Academy of Medical Royal Colleges said: “We strongly support these proposed changes. They are long overdue and when taken together will give us a much clearer view of what’s going on in our hospitals. Hopefully this brings an end to metrics which actually tell us very little about the quality of care or how good a hospital is at managing patients through the entire care pathway.”
Dr Katherine Henderson, President of the Royal College of Emergency Medicine said: “We are pleased that this review is now out for consultation. We welcome the explicit recognition about the harms of overcrowding for patients attending emergency departments. These proposals will offer a better framework on which to improve care. The proposed metrics provide greater insight into the causes of delay and what we can do to improve care for all patients within urgent and emergency care”.
Imelda Redmond, National Director of Healthwatch England said: “Conversations with patients and the public repeatedly show that it’s not the total time people wait, but the quality of the care they receive that shapes their experience of A&E. The proposed new measures break down the patient journey in much more detail and can help to highlight pinch points where people’s needs and expectations can be better met. However, the key to improving people’s experiences will be in how these metrics are used to help the NHS do things differently, not just count differently. This will see greater emphasis on speedy initial assessments, fast care for the most sick and better communication with all patients to keep them fully informed. We therefore welcome this consultation which we hope will stimulate a constructive conversation between doctors and nurses, policy makers and the public.”
Dr Samantha Batt-Rawden, President of the Doctors’ Association UK said: “The four-hour target is considered by many frontline doctors as not fit for purpose, with patients continuing to wait hours in emergency departments this winter. We are pleased that NHS England is launching this consultation in partnership with frontline staff to develop alternative patient-focused targets; going forward we must ensure that these are backed up with the staff and resources to achieve them.”
Tracy Nicholls, CEO of the College of Paramedics said: “We welcome the report and the opportunity for the forthcoming consultation to include the whole patient pathway, including the role paramedics, ambulance clinicians and control room staff can play in supporting and improving patient care. The College recognises the need to avoid significant handover delays and its impact on patients, our members in the ambulance sector and the emergency department teams. By working together as a unified whole system, these new proposed standards for care will contribute to continued improvements for patients. We look forward to responding to the consultation in due course on behalf of our members”.
Rachel Power, Chief Executive of the Patients Association said: “We know that patients’ understanding and expectations of the care they will get in an emergency situation matters in shaping their experience, so we welcome this consultation on changes to how performance is assessed and managed in urgent and emergency care. We look forward to hearing patients’ views on the proposals, and working with NHS England and Improvement to help ensure these inform any future changes.”
Dr Rubina Ahmed, Associate Director of Systems Engagement at the Stroke Association said: “We welcome this NHS review into the set of indicators used to assess urgent care. It’s essential that any new indicators accurately show the ‘health’ of urgent and emergency care, and support improved performance. We hope that the review will lead to a new set of measures that help stroke patients get the right treatment quickly, and makes sure that A&Es can deliver the best possible care.”
Professor Andrew Goddard President of the Royal College of Physicians said: “Anyone attending emergency departments or acute medicine units over the past few years will be well aware of the pressures the NHS are under. The current four-hour standard is simple but doesn’t allow us to recognise where we can best improve the system on a day-to-day basis. The CRS proposes new measures that should improve patient experience and safety by improving flow and helping patients to be in the part of the hospital that best suits their clinical needs.”
Dr Ron Daniels BEM, Executive Director of the UK Sepsis Trust said: “Sepsis and severe infections are one of the leading causes of deterioration in both the community and in our hospitals. We welcome this consultation from NHS England around what is certainly a step change in the way in which we assess performance of our emergency departments. We are confident that this set of changes will keep the patient at its heart and enable us to improve our systems for all our public”.
Dr Adrian James, President of the Royal College of Psychiatrists said: “A&E can be a stressful environment for any patient but particularly for those with a mental illness. We welcome this review of standards as a means of improving care for patients with urgent mental health needs. We are very pleased to see a strong commitment to parity of esteem, with the standards applying equally to mental and physical health. With the mental health consequences of COVID-19 increasing, delivering the right urgent care for patients at the right place, at the right time is more important than ever.”
Daren Mochrie QAM, Chair of the Association of Ambulance Chief Executives said: “This is a vital piece of work that we believe could significantly improve the way patients experience healthcare from the NHS, both in terms of speed and clinical quality, and crucially through the elimination of handover delays at hospital emergency departments, which has become a growing problem in recent times. Ambulance services already play a vital role in offering the most clinically appropriate response to patients, including telephone advice or treatment at scene. However, we believe these new proposed developments could see further improvements in wider urgent and emergency care provision, drawing on what has been learned during the COVID-19 pandemic and by changing the way that the urgent and emergency care system is both perceived and accessed by the patient, as well as reducing the risk to patients by minimising unnecessary healthcare contacts. The ambulance service playing its part by offering the most clinically appropriate response to patients, including telephone advice or treatment at scene, is key to the success of this new proposed model. However, we welcome any further initiatives by our partners within the NHS to improve patient flow within emergency departments, and ultimately therefore prevents our ambulances queuing outside hospitals which can cause harm for both the patients in the queue and for patients in the community who are waiting for an ambulance response. We look forward to responding to the consultation and will work closely with our members to ensure that a comprehensive response is provided by the ambulance sector.”
Dr Graham Jackson, Chair of NHS Clinical Commissioners (NHSCC) on behalf of NHSCC and NHS Confederation said: “We welcome the wider clinical involvement in developing these proposals, which we will consider in detail with our NHSCC and NHS Confederation members. This feels like an important step forward to setting a more thoughtful and detailed way of ensuring accountability to patients seeking urgent and emergency care. There is also a strong interest in how the standards can continue to be developed to be truly system-wide, as primary and community services resilience to prevent admission and ensure timely discharge are hugely important factors in system flow.”