Wide support for more comprehensive urgent care indicators

Patients, clinicians and the public have welcomed proposals for a comprehensive set of indicators for urgent care.

The updated standards aim to capture what matters clinically to patients, end hidden waits and reduce the risk of spreading COVID-19.

The proposed bundle of 10 measures takes account of changes in the way that urgent and emergency 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 which also include 111 performance, ambulance response times, through to time spent in Emergency Departments.

In an NHS consultation four out of five respondents said they would welcome a bundle of measures.

The specific proposals were endorsed by two thirds, 67%, of respondents and opposed by just 13%.

Of those who expressed a preference the updated measures were backed by patients and members of the public by three to one.

There was also widespread support for each of the 10 measures that could be introduced, including nine tenths of respondents supporting patients receiving their initial assessment within 15 minutes of arrival at A&E and more than two thirds supporting the recording of NHS 111 calls that receive clinical input.

In 2018, the then Prime Minister asked the NHS medical director to review the access standards to ensure that they measure what matters both to patients and clinically.

Developed with clinical leaders, the proposed measures – which come 15 years after the existing targets were introduced – aim to improve patient flow to prevent crowding and ensure A&Es work more efficiently and effectively than the current standards.

The NHS has been working with a number of acute hospital trusts and in consultation with an extensive group of clinical and patient representatives to develop and test the standards in practice.

Consultation on the standards ran from December to February and received 354 responses from the public and stakeholder groups.

The standards have been welcomed by the Royal College of Emergency Medicine, Academy of Medical Royal Colleges, the Patients Association, Healthwatch England, NHS Confederation, Mind and the College of Paramedics.

Professor Stephen Powis, NHS national medical director said: “Since the previous standards were introduced in 2004, there have been many innovations in urgent treatment and care, so it is right we listen to patients, the public and other experts to ensure NHS services deliver what matters most to patients as well as what is most important clinically.

“Welcomed by the public, NHS staff and patients alike, these new indicators set out how the sickest and most clinically urgent patients could be given priority as well as improving the overall experience of our patients.

“The pandemic has only made this work even more vital – patients need to get the right care, in the right place, at the right time and in a COIVD safe way while they do so.”

Professor Helen Stokes-Lampard, Chair of the Academy of Medical Royal Colleges said: “The results of this consultation underpin what the medical royal colleges have long argued, our patients want more accessible and appropriately targeted urgent and emergency care. These proposals, which set out better ways to measure what is happening, are long overdue. We now need to see all these new indicators fully adopted so that doctors and their teams are supported to deliver the right care at the right time and in the right setting.”

Dr Katherine Henderson, President of the Royal College of Emergency Medicine said: “The consultation results make it crystal clear that there is significant support for improving the pressured urgent and emergency care system. We support an implementation of a bundle of metrics, that will provide better information than the four-hour target. More work is needed around thresholds and frequency of reporting, but the consultation report is a significant step in the right direction of transforming care for the better.”

Rachel Power, Chief Executive of the Patients Association, said: “We welcome the proposed new indicators for urgent and emergency care. Patients told us clearly that they support the new bundle of measures, and that they perceive the existing four-hour target as bringing down-sides as well as benefits. We hope to see the new indicators driving improvements for patients who need urgent and emergency care when they are introduced.”

A Healthwatch England spokesperson said: “It’s positive to see patient experience being put front and centre of these new performance measures. Throughout the review process, the Healthwatch network has engaged with more that 12,000 people about their experiences of and views on A&E to help NHS England understand what matters. This has translated in to much greater focus on speedy and meaningful assessments upon arrival, prioritising of urgent cases and preventing very long waits. The key now will be in the implementation, and it is clear everyone wants to see this result in meaningful change in the way emergency departments, and wider health systems, deliver care to those in need.”

Geoff Heyes, Head of Health Policy and Campaigning at Mind, the mental health charity, said: “We welcome this move to provide a clearer picture of what happens to people when they seek support in an emergency. People with mental health problems often have to wait too long to get the help they need when they go to A&E but these new indicators promise to help shine a light on where systems can improve the care they provide. Importantly, they will also mean that whole systems will need take responsibility for how people with mental health are treated in their areas.”

Danny Mortimer, chief executive of the NHS Confederation, said: ‘The NHS is absolutely focused on improving the services it offers our patients, and the development of these new standards has been built through engagement with our members and their clinical teams.  There is widespread agreement amongst our members on the need for significant change to the existing standards and we look forward to working with NHS England to fully understand what additional support will made available to the health service in order to implement these new indicators and to help managers and clinicians continue to deliver excellent patient care. It is important to acknowledge the ongoing challenges to delivery as the NHS continues to grapple with the fall-out from the COVID-19 pandemic, alongside the pressing need for a long-term plan and significant investment in our workforce and in social care.”

Tracy Nicholls, CEO of the College of Paramedics said: “We were pleased to add the voice of our membership to this consultation, particularly in the light of the huge efforts paramedics, ambulance clinicians and operational control centre staff have made to keep patients safe through recent periods of extremely high demand.  It is vital that we seize this opportunity to work collaboratively to avoid ambulance handover delays, overcrowding in EDs and the pressure on primary and urgent care. We would now welcome clear implementation guidance for all professions to enable the continued effective care of patients as we eventually emerge from the pandemic.”

Daren Mochrie QAM, Chair of the Association of Ambulance Chief Executives said: “We welcome these new standards which 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 is a significant problem. Ambulance services already play a vital role in offering the most clinically appropriate response to patients, including telephone advice or treatment at scene. These new changes could now see further improvements in wider urgent and emergency care provision, drawing on what has been learned during the COVID-19 pandemic, and making the whole experience better for patients.”

Jenny Vaughan, Chair of the Doctors’ Association, said: “New indicators for urgent and emergency care should provide clearer  information than a blanket four hour target. Transforming care so that it is safer for patients is vital and we hope that these measures will allow healthcare staff to more appropriately focus care on those patients who need it most at the right time.”