A new vision for Urgent and Emergency Care

By Professor Keith Willett, director for acute episodes of care, NHS England:

We have just emerged from another winter where Accident and Emergency Departments up and down the country have been under unprecedented scrutiny.

There was a great deal of expectation that the system would simply collapse due to the ever increasing demands placed on it.

That it hasn’t has been down to a combination of the exceptional hard work done by A&E staff and robust planning that started back in May. A mild, albeit very wet, winter has also helped.

But it’s a common misconception that A&E teeters on the brink just in the winter. In fact, the pressures it faces are all year round. We all know that things can’t go on like this.

A&E has been a critical concern for policy makers and the public for too long now. Tinkering round the edges isn’t the answer to secure its long-term future. Wholesale reform is, and that’s been a priority for NHS England this year through its Urgent and Emergency Care Review.

The Review, and the extensive professional and public engagement that was a part of it, has since generated recommendations that will have a profound effect on the way in which urgent and emergency care is delivered in the next three to five years.

In essence, by the end of the decade the service will be unrecognisable from today, having undergone the transformational change necessary to meet the demands of the future.

We know that up to one million emergency admissions were avoidable last year; and up to 50 per cent of 999 calls could be managed at the scene. So the first change you’ll see is more people who can be will be cared for using highly responsive, effective and personalised services outside of hospital and in or as close to people’s homes as possible, minimising disruption and inconvenience for patients and their families.

And, second, for those people with more serious or life threatening emergency needs we should ensure they are treated in centres with the very best expertise and facilities in order to maximise their chances of survival and a good recovery.

These will either be Emergency Centres – capable of assessing and initiating treatment for all patients, or Major Emergency Centres – larger units, capable of assessing and initiating treatment for all patients and providing a range of specialist services.

A&E departments up and down the country offer very different types and levels of service, yet they all carry the same name. To differentiate hospital services in this way will ensure patients are directed to the service that can best treat their problem.

Just look at the nation’s two biggest killers – heart attacks and strokes. The evidence shows that survival rates improve significantly by taking patients to specialist centres that provide the best available hospital treatment.

Having come forward with the recommendations, NHS England is now working at national and local levels, with the service, stakeholders and patients, to deliver this change and a timescale for change will be published on NHS Choices in the next couple of months.

The pace by which things have moved on this issue has been astonishing. It’s easy to say that something must be done about urgent and emergency care to give it a more sustainable future. But the scale of the challenge has proved too daunting for most.

NHS England is taking the challenge head on. It stuck its neck out and made a case for change and is bringing people together to deliver it.

Keith Willett

Professor Keith Willett is the Director for Acute Care to NHS England and is the Professor of Orthopaedic Trauma Surgery at the University of Oxford. An NHS consultant surgeon for 24 years he has extensive experience of trauma care, driving service transformation and healthcare management.  He has taught surgery and leadership extensively across the NHS and internationally.

In 2003 he founded the Kadoorie Centre for Critical Care Research and Education focusing on the treatment of critically ill and injured patients. This year IMPS, a children’s safety charity he launched, celebrated 20 years and over 250,000 children trained in risk awareness, first aid and life support.

He was the co-founder of the unique 24-hour consultant-resident Oxford Trauma Service at the John Radcliffe Hospital in Oxford in 1994. Building on that model, in 2009 he was appointed the first National Clinical Director for Trauma Care to the Department of Health and was charged with developing and implementing government policy across the NHS to radically improve the care of older people with fragility hip fractures and to establish Regional Trauma Networks and Major Trauma Centres. By 2012 both re-organisations and care pathways were successfully in place and are now credited with marked improvement in patient care and survival.

In his current role, he has the national medical oversight of acute NHS services ranging from pre-hospital and ambulance services, emergency departments, urgent surgery, acute medicine, children’s and maternity, armed forces, and health and justice services and national major incidents. He is now leading the transformation of the urgent and emergency care services across the NHS in England.

He was awarded a Commander of the Order of the British Empire (CBE) in the New Years Honour’s List in 2016 for services to the NHS.  On receiving this honour he said “I have been exceptionally privileged to build a career as part of the collective commitment of so many dedicated individuals and friends who are our NHS”.