To:

• Urgent and emergency care tier 2 and 3 integrated care board (ICB) chief executives and chairs

cc.

• NHS England regional directors

Dear all,

UEC Recovery Plan delivery and improvement support

Today, we are launching the first of our NHS Improving Patient Care Together (NHS Impact) Programmes relating to the UEC Recovery Plan.

NHS Impact is our national programme to support the use of evidence-based quality improvement in every system and provider. We have developed this universal support offer for the UEC Recovery Plan following feedback from regions, systems and providers to assist you with improvement across the integrated UEC (iUEC) pathway.

The delivery plan for recovering urgent and emergency care (UEC) was published in January 2023 and set two key ambitions for 23/24:  

• Patients being seen more quickly in emergency departments: with the ambition to improve to 76% of patients being admitted, transferred or discharged within four hours by March 2024, with further improvement in 2024/25.  
• Ambulances getting to patients quicker: with improved ambulance response times for Category 2 incidents to 30 minutes on average over 2023/24, with further improvement in 2024/25 towards pre-pandemic levels.  

We know that there has been good progress in developing local plans and ICBs have been working with colleagues across the system and with regional teams to prioritise local improvements to deliver these ambitions. 

Following our letter in May confirming your tiering allocation, we are now able to launch our universal support offer. The offer aligns all of our iUEC improvement offers, including EECIST and GIRFT and has been co-produced with regional, system and provider colleagues, building on learning from and feedback on last year’s Winter Improvement Collaborative.

Supporting the UEC Recovery plan there are 10 high impact initiatives that evidence shows will enable systems to make significant progress in advance of winter in the delivery of improved iUEC performance (Annex A). We ask that systems select four of the ten priority initiatives, at each place level, where engagement will help them to make substantial progress in maturity in advance of winter. Systems may choose more or fewer of the priority initiatives in consultation with the region.

The offer 

The universal offer, delivered via the new NHS Impact programme, presents an opportunity for systems and their providers to engage in a customised improvement programme aligned with implementing the UEC Recovery Plan. 

The universal offer has four core components: 

1. Self-assessment: We have developed, working with local areas and building on identified clinical and operational best practice, a “maturity matrix” for nine of the ten high impact interventions. The tenth (care transfer hubs) has already been self-assessed recently. This will enable systems to conduct self-assessments of their services in order to identify the four priority high impact interventions where, through participation in the programme, they will make significant improvements in advance of winter.    

Given that the maturity self-assessments for care transfer hubs have already been submitted, systems are not required to repeat this. They should agree with regional discharge leads the maturity level for their care transfer hubs and include this level in their return.

ICBs are asked to submit the maturity self-assessments for all ten high impact interventions, and to highlight the four place-based priorities. Please find here the form to be completed and returned by 12pm on 28 July 2023 to england.uecassessment@nhs.net 

2. Delivering iUEC Improvement: Once you have assessed and determined high impact actions, you will receive an invitation to participate in the priority modules you have identified for your system. These modules will provide valuable resources such as showcasing good practice, instructional NHS Impact ‘how to’ guides and workforce solutions, and other essential tools to support improvement efforts including expert and peer support. Modules that work across the interface between health and social care will be jointly delivered by the NHS and social care colleagues.

Full details on this will be provided in due course following the self-assessment.  

3. NHS Impact website: The website will be available to systems, to access all the materials used throughout the programme. This will include good practice ‘how to’ guides and support forums. In addition to the modular program, you can expect support through resources including webinars and support surgeries. These resources will be developed and delivered by our clinical multidisciplinary team and operational improvement experts, involving colleagues from regions, systems and providers as appropriate to ensure that these are co-produced. Collectively these components will combine to provide an inclusive and tailored support offer that will assist your wider iUEC recovery.

The programme will operate through to March 2025, with new modules being developed and further opportunities to participate in modules not initially prioritised by systems. The programme will iterate based on feedback from participants about what works best and the evidence on what has the most impact.

4. Recovery Champions and building capability: Many systems have expressed concerns about the opportunities for staff development in recent years, partly due to the pressures of the pandemic. To address this, we will provide targeted assistance and support to people throughout the system who play a role in delivering improvement across iUEC Pathways.    

Here we have outlined further information on these ‘recovery champions’ and the process for selecting staff. We encourage a diverse approach to champion selection, involving various roles within the multi-disciplinary team (MDT), including patient and non-patient facing positions. We recommend having around 10 champions for smaller systems, while larger systems may have up to 20 champions. Systems are requested to designate an executive-level point of contact, who will serve as the primary liaison for the system. 

Please send the names, job titles, email addresses and employing organisations of your nominated champions to england.uecassessment@nhs.net by 12pm on 21 July 2023. 

The recovery champions will then be invited to attend virtual development sessions, on-line, in areas of core improvement skills such as Leading Change, Demand and Capacity, Learning from Best Practice, Measurement for Improvement. 

We know systems and all the teams within them are working hard to deliver the improvements set out in the UEC Recovery plan. We look forward to continuing this work through your participation in the universal offer, enabling us all to achieve our ambitions. 

If you should have any further questions on the details included in this letter, or any of the individual components please send them through to england.uecassessment@nhs.net. 

Yours sincerely,

Sarah-Jane Marsh, National Director of integrated Urgent and Emergency Care and Deputy Chief Operating Officer, NHS England
Dr Vin Diwakar, Medical Director for Secondary Care and Transformation, NHS England  

Annex A – 10 high impact interventions

1. Same Day Emergency Care: Reducing variation in SDEC provision by providing guidance about operating a variety of SDEC services for at least 12 hours per day, 7 days per week.
2. Frailty: Reducing variation in acute frailty service provision. Improving recognition of cases that could benefit from specific frailty services and ensuring referrals to avoid admission. 
3. Inpatient flow and length of stay (acute): Reducing variation in inpatient care and length of stay for key iUEC pathways/conditions/cohorts by implementing in-hospital efficiencies and bringing forward discharge processes for pathway 0 patients.
4. Community bed productivity and flow: Reducing variation in inpatient care and length of stay by implementing in-hospital efficiencies and bringing forward discharge processes.
5. Care Transfer Hubs: Implementing a standard operating procedure and minimum standards for care transfer hubs to reduce variation and maximise access to community rehabilitation and prevent re-admission to a hospital bed.
6. Intermediate care demand and capacity: Supporting the operationalisation of ongoing demand and capacity planning, including through improved use of data to improve access to and quality of intermediate care including community rehab.
7. Virtual wards: Standardising and improving care across all virtual ward services to improve the level of care to prevent admission to hospital and improve discharge. 
8. Urgent Community Response: Increasing volume and consistency of referrals to improve patient care and ease pressure on ambulance services and avoid unnecessary admission.
9. Single point of access: Driving standardisation of urgent integrated care coordination which will facilitate whole system management of patients into the right care setting, with the right clinician or team, at the right time.
10. Acute Respiratory Infection Hubs: Support consistent roll out of services, prioritising acute respiratory infection, to provide same day urgent assessment with the benefit of releasing capacity in ED and general practice to support system pressures.

Publication reference: PRN00585