Major plan to recover urgent and emergency care services

The NHS and the government will publish a new blueprint today to help recover urgent and emergency care services, reduce waiting times, and improve patient experience.

Frontline capacity will be boosted further thanks to 800 new ambulances, including 100 specialist mental health vehicles, and 5,000 more sustainable hospital beds backed by a £1 billion dedicated fund.

The two-year delivery plan for recovery comes amid record demand for NHS services, with the latest data showing more A&E attendances than ever before, growing numbers of the most serious ambulance call outs, and millions of NHS 111 calls a month over winter.

Urgent care provided in the community will be expanded to ensure people can get the care they need at home, without the need for a hospital admission.

These services will run for at least 12 hours a day – responding to calls normally requiring an ambulance crew – and will mean people who have fallen or are injured can get care and treatment at home within two hours.

Same day emergency care units, staffed by consultants and nurses, will be open in every hospital with a major A&E, helping to transform patients’ experiences and allowing thousands of people each week to avoid an overnight hospital stay.

Freeing up space in hospitals and speeding up discharge for those who are medically fit to leave are key parts of the blueprint, which will see pilots of a new approach to NHS step down care across the country – where patients will receive rehabilitation and physiotherapy including at home.

This scheme will ensure people have a smooth transition out of hospital, reducing the chances of re-admission while also potentially reducing long term demand on social care.

The success of ‘virtual wards’, where patients receive high-tech care in their own home is set to grow, with 7,000 virtual ward beds already in the community and up to 50,000 patients a month expected to benefit by the end of 2023/24.

Proven measures backed by clinicians and introduced as part of NHS winter planning will be expanded all year-round, with scaled-up falls response services and 24/7 system control centres 365 days a year, to help local areas track and quickly respond to pressures throughout the year.

Changes aimed at growing and better supporting the workforce will give NHS staff greater flexibility, making it easier for them to move between hospitals and work in services like 111, with more options for call handlers to work from home.

The number of emergency medical technicians will also be expanded, providing another entry route to working in the NHS, alongside greater use of student and apprentice paramedics and training more staff in mental health.

The two-year plan aims to stabilise services to meet the NHS’s two major recovery ambitions, to help achieve A&E four-hour performance of 76% by March 2024 and improve category two ambulance response times to an average of 30 minutes over the next year, with further improvement in the following year.

These ambitions represent one of the fastest and longest sustained improvements in emergency waiting times in the NHS’s history.

NHS chief executive Amanda Pritchard, Prime Minister Rishi Sunak, and Health Secretary Steve Barclay will today set out the plans to deliver better patient experiences, in an A&E department in the North East.

NHS chief executive, Amanda Pritchard, said: “The NHS has been under more pressure than I have ever known in my 25 years working in the service – the threat of the ‘twindemic’ of flu and covid became a reality and that was alongside huge demand for all services – from ambulance and A&E services to mental health and GP appointments.

“We are incredibly grateful to the NHS staff who work day-in, day-out to deliver care to hundreds of thousands of people and for the extensive preparations put in place ahead of winter.

“We introduced more call handlers, more beds and 24/7 system control centres to manage increased demand, and this new plan sets out how we will boost that progress and help improve the experiences of patients who will benefit from quicker, better care, in the right setting.

“The front door to the NHS is often where we can see the pressures build up – and to relieve that pressure, we will continue to work with social care colleagues to free up space in hospitals so that people who are well enough to leave can be discharged and get the care they need at home or in the community.

“The history of the NHS is one of change and innovation and so, while striving to meet the needs of today’s patients, we are also looking to the future of the NHS and will shortly set out our workforce plan – which is a once in a generation opportunity to put the NHS on a sustainable footing.”

The government is making up to £14.1 billion available for health and social care over the next two years, on top of record funding to improve urgent and emergency, elective, and primary care performance to pre-pandemic levels and to help alleviate the impact of inflation.

Prime Minister Rishi Sunak said: “Cutting NHS waiting times is one of my five priorities. Urgent and emergency care is facing serious challenges but we have an ambitious and credible plan to fix it.

“It will take time to get there but our plan will cut long waiting times by increasing the number of ambulances, staff and beds – stopping the bottlenecks outside A&E and making sure patients are seen and discharged quickly.

“If we meet this ambition, it will represent one of the fastest and longest sustained improvements in emergency waiting times in NHS history. I am determined to deliver this so that families across the country can get the care they need.”

The NHS, local government and the social care sector will continue together to improve access to social care and ensure patients can be discharged safely and on time.

Health and Social Care Secretary Steve Barclay said: “Every day of every week, tens of thousands of people receive safe, high quality urgent and emergency care. However, with the NHS under unprecedented pressure from high covid and flu cases and the backlog from the pandemic, too many people are waiting too long in A&E or for ambulances.

“Today’s plan, which is backed by record investment, aims to rapidly cut waiting times, helping to deliver on one of the government’s five priorities, while giving patients the confidence that health and social care services will be there for them when they need them.

“Building on the extensive preparations the NHS put in place ahead of this winter, the plan will boost the number of hospital beds, get more ambulances on the road, grow and support the workforce, ensure people are able to leave hospital in a timely way when ready, and expand new services in the community so people can be treated closer to home.”

Matthew Taylor, chief executive of the NHS Confederation, said: “Health leaders welcomed the opportunity to contribute to this important roadmap which comes as emergency and urgent care services continue to respond to record levels of demand from patients.

“The NHS is already innovating and taking forward a number of these initiatives to reduce the pressure on hospital beds and provide more targeted care for patients in the community. These include through virtual wards and same day emergency care units, which this plan will extend.

“Success over the next two years will not only depend on NHS staff continuing to go above and beyond, but also on concerted action to reduce the numbers of people needing to come into contact with emergency and urgent care services in the first place.”

Miriam Deakin, director of policy at NHS Providers, said: “This is a positive first step in the long journey to sustainable recovery.

“Trust leaders will welcome its incremental approach to recovering core standards, the acknowledgment that current pressures need system-wide solutions, and the dedicated focus on increasing capacity in ambulance services, growing bed numbers and reducing bed occupancy.

“Sustainable recovery will also be dependent on funded workforce planning, so we look forward to the publication of the long-term workforce plan.”

Dr Adrian Boyle, President of the Royal College of Emergency Medicine, said: “This plan is a welcome and significant step on the road to recovery and we are pleased to see it released.

“We are supportive of the majority of the proposals in this plan, the focus on reducing hospital occupancy is correct. Ambitions to increase capacity, grow the workforce and improve discharge are very sensible; delivering on these would undoubtedly improve conditions in emergency departments and hospitals.

“We also greatly welcome further commitment to publish 12-hour delays from time of arrival on a more regular basis, which will help us better identify where more support is needed and improve care. As with any plan, the implementation and results are what really matter, and we look forward to seeing it delivered for the sake of our patients.”

Daren Mochrie QAM, Chair of the Association of Ambulance Chief Executives (AACE), said: “AACE welcomes the focus being given to recovery across urgent and emergency care in NHS England’s plan published today and the opportunity the ambulance sector has had to inform its content.

“The impact of pressures across urgent and emergency care is being acutely felt by NHS ambulance services, their patients and their employees, and the renewed effort and focus outlined in NHS England’s recovery plan is welcomed, alongside a commitment to boost frontline capacity for our member trusts.”

Tim Cooksley, President of the Society for Acute Medicine, said: “We welcome the UEC Recovery Plan published today. Winter 2022 was very difficult for both patients and staff in urgent and emergency care so it is pleasing that actions are being taken, particularly the recognition of the need for more hospital and intermediate care beds.

“High quality acute medical units enable patients to receive timely, first-class acute care in good environments and facilitate prompt discharge or onward transfer to an appropriate care setting, and well-functioning same day emergency care and evolving hospital at home programmes collaborating with primary care and community teams are a key part of the vision.

“We are committed to delivering the highest standards of care for acutely unwell medical patients and look forward to continuing to work closely with NHS England, to not only help deliver the improvements for the upcoming winter but imperatively longer term plans, including workforce, that ensure UEC recovery delivers the high quality of care for patients which all staff wish to provide.”

Tracy Nicholls, Chief Executive of the College of Paramedics, said: “The College of Paramedics welcomes the UEC Recovery Plan and is pleased to see a strong focus in the recovery of those people in the Category 2 cohort who we know need more urgent attention during this challenging time.

“The plan has been thoughtful in its approach of its inclusion of social care as an integral part of the solution and we hope that this will go some way to improving the flow through the system.

“The current situation is not acceptable and paramedics and ambulance clinicians have spoken out loud and clear about the impact on the public and themselves.”

Louise Ansari, National Director of Healthwatch England, said: “Patients and the public have been calling for a clear and understandable plan on how and when emergency care will get better, and this announcement is full of much-needed practical changes that should mean the health system can support more people in the way they need it over the coming months.

“No one wants to go to A&E or be admitted to hospital if they can avoid it, particularly at a time when services are so incredibly busy. So seeing people in their own homes, and getting those who need hospital treatment back to where they live faster is a very positive development.

“Healthwatch will of course continue to listen to people about their experiences of care to monitor these changes and suggest further areas for improvement.”

Professor Adam Gordon, President of the British Geriatrics Society, said: “Many people, especially older people with frailty and complex conditions, are facing long waits in emergency departments and on wards before being discharged from acute hospital.

“We at the British Geriatrics Society are pleased to support NHS England’s ‘Urgent and Emergency Care Recovery Plan’ which addresses system-wide issues that go far beyond the hospital front door. The emphasis on care closer to home, alternatives to hospital admission, rehabilitation and person-centred care is very welcome.

“With the right funding, workforce and clinical leadership, it should make a real difference for users of health services, and start to make inroads on the delays and shortages that prevent timely discharge and community-based support for rehabilitation and recovery.”

Rachel Power, Chief Executive of the Patients Association, said: “We’re pleased to see this plan published and look forward to learning more about how it will be put into practice.

“We’re very aware of how the current pressures have affected patients’ experience of urgent and emergency care services. It’s so important that the experiences of these services improve for patients, as currently, many are having a very difficult time.”

Professor Dame Helen Stokes-Lampard, Chair of the Academy of Medical Royal Colleges, said: “The NHS has long needed a realistic plan to improve Urgent and Emergency Care and we fully support the steps that are being taken here.

“Patients and staff deserve better than they’ve been getting so we’ll welcome the way the plan focuses on the areas of the health and secondary care eco-system that are most under pressure. But, what has been set out must be seen as a step towards recovery, not the end point and it must be properly resourced if it is to succeed.”

Dr Fiona Donald, President of the Royal College of Anaesthetists said: “We welcome this plan to address the significant challenges our members and their colleagues are facing in providing urgent and emergency care in the NHS in England.

“It is particularly important that there is appropriate long-term investment in both the infrastructure and workforce that will be needed to achieve these ambitions and meet the needs of patients now and in the future.”

Dr Adrian James, President of the Royal College of Psychiatrists, said:  “We welcome the publication of this plan. The NHS has successfully rolled out 24/7 liaison psychiatry services in every emergency department across England.

“However, referrals have been steadily increasing back to pre-pandemic levels and so it is more important now than ever that A&E can provide a safe and therapeutic environment for people with mental health needs presenting with medical emergencies, or in a mental health crisis. We hope and expect this plan will bolster these services further.”

Case studies

  • ‘Housing with Care’ flats across Norfolk are being used to support people who are medically fit but need care at home to leave hospital. People will temporarily move from a hospital bed to a flat in a ‘Housing with Care’ scheme for up to four weeks. They will receive 24/7 care and support before moving back to their home. Developed as a partnership between Norfolk County Council, the landlords (Broadland Housing Association and Saffron Housing Trust), NorseCare, Country Kitchen Foods Norfolk and NHS Norfolk and Waveney Integrated Care Board.
  • Hull Fall First is a falls pick up and wellbeing response service, involving the local ICS, fire and rescue service, ambulance service, local authority and community services provider. A team of firefighters received clinical training from healthcare experts, along with safeguarding training and safety awareness. The service has reduced the number of A&E attendances and provided a better patient experience for those who have had a fall. Since April the service has attended 622 people, avoiding ambulance call out and potential A&E attendance, and provided follow up care and support on falls prevention to people living in their own homes and local care homes.
  • In North Lincolnshire and North East Lincolnshire, the 7-day Same Day Emergency Care ward is an Acute Frailty Assessment service and two integrated hospital discharge Hubs have also been established. Work has been undertaken to ensure patients who require support on discharge are supported by the most relevant team in a timely manner, ensuring they have prompt access to the services they require to enable them to leave a hospital bed.
  • The inpatient ward at Rothbury Hospital in Northumbria was transformed earlier this month into a residential care home, with the provision of flexible NHS beds. The flexible NHS bed provision will be available for patients who need longer-term recuperation and rehabilitation and end-of-life care. A team of district nurses, GPs and nurse practitioners will provide clinical support alongside healthcare currently delivered in the community and in peoples’ homes.
  • Harvest View is a brand new £14m, 80-bed re-ablement centre which opened in November and is a partnership between Black Country ICB and the local authority. The facility has been purpose built to take people who are medically fit to leave hospital but need a bit more support to get fully fit to go home.
  • South East Coast Ambulance Service rolled out their new community falls service, led by their Community Resilience Team in January 2022 and have since seen a reduction in the length of time someone who falls waits for a response. The community falls team provide immediate care to reduce risks, and if safe to do so, will assist the patient from the floor using specialist lifting equipment.
  • The Same Day Emergency Care Unit at King’s Mill Hospital, Sutton-in-Ashfield, provides high-quality diagnostic tests, treatment and care that would previously have required a short hospital admission or been managed within the hospital’s already busy emergency department. Since opening in June 2021 the unit has helped over 15,000 patients.
  • Leicester, Leicestershire and Rutland ICB run a Two-Hour Urgent Community Response service which aims to improve patient outcomes by meeting their urgent care needs at home or usual place of residence, which could include a care home, in a timely way. Providing crisis care within the community aims to prevent avoidable hospital admissions and support people to remain independent for longer.
  • At Milton Keynes Hospital a number of existing teams run same day emergency care services for patients in their Maple Centre, including an Ambulatory Emergency Care Unit, Bridging Clinic, OPAT and VTE Clinic, as well as Emergency Surgical Clinic.
  • Since its launch in 2020, King’s College Hospital NHS Foundation Trust has had more than 300 referrals to its ‘Safely Home’ service, a scheme enabling safe and timely discharges from hospital. It provides free house cleans, pest control, furniture moves and furniture disposal at inpatients’ homes if needed.
  • In October 2022, London Ambulance Service rolled out a pilot where paramedics and nurses from community health providers in south-west London respond to elderly and frail patients at home. By 8 Jan 2023 the new team had treated 838 patients with around 35% taken to hospital, compared to the usual 70%, freeing up resources for those who most need to be in A&E. The scheme is now set to be expanded to parts of north London.
  • Lancashire Teaching Hospitals NHS Foundation Trust has recently taken over a 96-bed care facility in Preston to help free up hospital beds occupied by around 450 patients who don’t need to remain in hospital, but who can’t leave because of a lack of appropriate social care provision. The new beds, some of which opened in November, have already significantly improved flow through the hospital.
  • St Helens and Knowsley NHS Trust has purchased 30 beds in local care home, Broad Oak Manor, to help discharge patients faster and improve flow through the hospital which had previously been running at 97% bed occupancy.
  • Oxford University Hospital NHS FT’s Hospital at Home and Ambulatory Assessment Unit based at the John Radcliffe Hospital in Oxford is reducing the number of patients admitted to hospital and aims to get emergency patients home the same day. They use a range of point of care diagnostic technology, allowing clinicians to look after people with more complex acute illness who previously would be taken straight to hospital. The team sees approximately 70 patients a day and has cared for around 70,000 people in the last five years.