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What does the Long Term Plan mean for urgent and emergency care delivery?

The National Director of the Elective and Emergency Care explains how the NHS will deliver on the urgent and emergency care objectives in the Long Term Plan

The Long Term Plan published in January this year outlined the NHS’ ambitious commitment to continue the transformation of urgent and emergency care services. Over the next 10 years, NHS organisations will work together to ensure that patients get the right care, in the right place, at the right time, thereby improving clinical outcomes for all patients.

I recognise that the scale of this vision can seem daunting in the operational reality of challenged capacity, higher demand, and an ageing population with increasingly complex health needs. In the short term, translating this vision into reality means:

  • Promoting a 24/7 urgent care service, accessible via NHS 111, which can refer directly to more appointments in Urgent Treatment Centres (UTCs), general practice (in and out of core hours), and other community services (pharmacy etc.);
  • Maximising the number of patients who can be treated without being admitted to hospital overnight via same day emergency care, resulting in a better experience for patients and reducing pressure on inpatient beds;
  • Focusing efforts to reduce length of stay for all patients and paying particular attention to why patients are remaining in hospital for longer than 21 days, improving patient flow and reducing the risk of harm by providing care in the most clinically appropriate setting;
  • Continuing to stream patients to the most appropriate service at the front door of emergency departments to ensure patients are managed by the correct service;
  • Working with ambulance and out-of-hospital services to safely reduce the number of patients who call 999 and don’t need to be taken to A&E;
  • Working closely with primary and community care services to ensure an integrated, responsive healthcare service helping people stay well longer and receive preventative or primary treatment before it becomes an emergency.

During the last few years I have had the opportunity to visit the majority of Emergency Departments and I have had the privilege of meeting staff from across the hospital and systems, both of which are an integral part of emergency care. I know just how busy everybody is, and that staff feel that recent months have been relentless. With winter fast approaching systems are working hard to prepare for what may be a difficult time of year with the potential challenges of a tough flu season and the possibility of operating in a post EU exit landscape.

To help achieve these immediate priorities we have offered support through the regional and national programme teams and the Emergency Care Intensive Support Team (ECIST), as well as providing tools and guidance for use locally via the NHS England and NHS Improvement website and dedicated communications campaigns such as the recent reducing long stays campaign urging frontline staff to ask ‘Why not home, why not today?’ for every patient.

Moving into the medium term our vision for transforming care asks that local urgent and emergency care services increasingly operate as an integrated network of community and hospital-based care, hand in hand with primary care services. By working as part of this extended network, services can collectively reduce pressure on emergency departments, ambulance services, and general practice. To do this we will keep working with systems across the country to enhance the Clinical Assessment Service so that it is a central element of our out of hospital approach.

While it is easy to focus on the challenges that lie ahead, it is also important to pause and celebrate what has already been achieved over the past few years as new services have been established and older services improved. In recent years we have:

  • Supported a digital first approach, rolling out the ability to access urgent care advice through the NHS111 online service across the country;
  • Expanded the NHS111 telephone service so that more than half the number of people calling now receive a clinical assessment on the phone and can be offered immediate advice or referral to the appropriate service for a face-to-face consultation;
  • Began roll-out of urgent treatment centres across the country, providing a locally accessible and convenient service offering diagnosis and treatment of many of the most common reasons people attend A&E;
  • Introduced new standards for ambulance services to ensure that the sickest patients receive the fastest response, and that all patients get the response they need first time;
  • Introduced a national Same Day Emergency Care (SDEC) model for hospitals, building on existing Ambulatory Emergency Care (AEC) efforts and reducing the number of patients admitted overnight for an emergency;
  • Established an Acute Frailty programme to ensure the identification of frail patients within a few hours of their arrival to hospital and enable prompt, targeted management based on a comprehensive geriatric assessment approach.

Transforming services for the long term while dealing with day to day pressures isn’t simple. The progress achieved to date is a testament to the tremendous commitment of all our staff to give every patient the best possible care. I’m committed to making sure our national and regional teams continue to support you, in all of our efforts.

Pauline Philip

National Director for Emergency and Elective Care.

Pauline has been the National Director of Urgent and Emergency Care since December 2015, acting on behalf of both NHS England and NHS Improvement. Prior to this she was Chief Executive of Luton and Dunstable University Hospital Foundation Trust.

A nurse by background, Pauline has previously also worked for the World Health Organisation, has an international track record in patient safety, and has led the successful performance of Luton’s hospital services for a number of years.

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