Classification: Official
Publication reference: PR2034

To:

• All integrated care board and trust
  • Chief executives
  • Medical directors
  • Chief nurses
  • Directors of finance
  • Chief people officers
  • Chief operating officers

cc:

• ICB and trust chairs
• Regional:
  • directors
  • directors of commissioning
  • directors of system transformation

Dear colleagues

Delivery plan for recovering urgent and emergency care services

Today we have published the joint NHS and DHSC Delivery Plan for Recovering Urgent and Emergency Care Services, a key commitment in the government’s Autumn Statement.

We want to begin by thanking you and your teams for your continued tireless efforts to provide the very best care for patients at a time of unprecedented challenge for the NHS and in an increasingly difficult environment.

Developed with the expertise and experience of a wide range of health and care partners, the plan sets out urgent actions to meet the current challenges facing the NHS, and also the first steps in transforming urgent and emergency care.

Our ambition is a health system that provides more and better care in people’s homes, gets ambulances to people more quickly when they need them, sees people faster when they go to hospital and helps people safely leave hospital having received the care they need.

Ultimately, we want everyone to get the very best urgent and emergency care, but we will particularly raise standards of quality and safety for the most vulnerable patients and their families, including older people living with frailty, children and young people, people with disabilities and people with mental health needs. And we recognise that meeting this ambition will mean increasing the size of the workforce, but also improving conditions for staff and enabling people to work more flexibly to meet the needs of patients.

The plan includes two ambitions for the next two years – a 30-minute mean response time for Category 2 ambulance and 76% performance in A&E wait times, measured through the 4-hour target. Meeting these ambitions on their own will not be enough. We need to make improvements across the patient pathway, including on 12-hour waits from arrival and on discharge from acute, community and mental health hospital settings.

In delivering this plan, we would expect all systems to move towards meeting these two performance ambitions, and for those systems already meeting the ambitions, we would expect to see continued improvement.

While we will need to increase capacity in hospitals and in UEC services, delivering this plan will need a truly cross-system approach, including in primary and community services, mental health, intermediate care and social care. It will require joint working across health and care, to ensure patients get the best care and to ensure patient flow through hospitals and into social care when needed.

Building on the experience from this winter, the plan sets out actions across five key areas:

1. Increasing capacity – investing in more hospital beds and ambulances, but also making better use of existing capacity by improving flow.
2. Growing the workforce – increasing the size of the workforce and supporting staff to work flexibly for patients.
3. Improving discharge – working jointly with all system partners to strengthen discharge processes, backed up by more investment in step-up, step-down and social care, and with a new metric based on when patients are ready for discharge, with the data published ahead of winter.
4. Expanding and better joining up health and care outside hospital – stepping up capacity in out-of-hospital care, including virtual wards, so that people can be better supported at home for their physical and mental health needs, including to avoid unnecessary admissions to hospital.
5. Making it easier to access the right care – ensuring healthcare works more effectively for the public, so people can more easily access the care they need, when they need it.

To support the recovery plan, the government has committed to additional targeted funding including:

1. £1 billion of dedicated funding for 2023/24 to support capacity in urgent and emergency services, as set out in Planning Guidance, and to increase their overall capacity and support their staff.
2. £1.6 billion of additional funding in the Adult Social Care Discharge Fund in 2023/24 and 2024/25, to be pooled into the Better Care Fund

Delivering this plan over the next two years will mean putting in place the fundamentals for improvement: accountability at every level, genuine transparency, on-the-ground support, and effective spread of best practice and innovation.

The actions set out in the plan provide the opportunity to take a cross-system approach to improving patient care, ensuring patients are able to access the right care, in the right place, in a timely way.

At a national level, implementation will be led by our new National Director of Urgent and Emergency Care and Deputy Chief Operating Officer, Sarah-Jane Marsh, working closely with key partners nationally, regionally and locally. However, delivery of the plan will depend on the leadership of local health and care organisations and their partners. Through this year’s planning round we have asked all systems to develop plans for UEC recovery. We look forward to working with you over the coming weeks as we develop the operational detail to ensure delivery of this plan.  

Yours sincerely

Sarah-Jane Marsh, National Director of Urgent and Emergency Care and Deputy Chief Operating Officer
Professor Sir Stephen Powis, National Medical Director
Dame Ruth May, Chief Nursing Officer, England
Sir David Sloman, Chief Operating Officer