National evaluation of urgent community response

Integrated urgent and emergency care (IUEC) improvement champions can use the initial findings from the national evaluation of urgent community response (UCR) as a resource while undertaking their UCR improvement projects as part of the universal support offer for UEC.

NHS England commissioned the Strategy Unit at Midlands and Lancashire Commissioning Support Unit to conduct a multi-year, two-part evaluation. This national evaluation is the first of its kind to try to demonstrate the impact of an urgent at-home care service and will build evidence of what works best.

This initial phase of the evaluation includes a process evaluation and report and an economic modelling tool, which are the key outputs from the first year and a half of the evaluation. The initial qualitative findings report is now available on the Strategy Unit’s website. Key findings include:

• support from the sites around the 2-hour waiting time standard for UCR and operating service model due to its perceived benefits in preventing deterioration among patients, reducing pressures on other health services, providing care in the community and enhancing cross-system working
• the sites took different approaches to the way they set up their teams, data collection, and use of resources to deliver at-home care within a two-hour timeframe. All the sites that were evaluated built their UCR service from existing provision
• the physical co-location of teams was identified as a key success factor for delivery by enabling better communication and decision-making.

The final phase of the evaluation will be published in spring 2024 and includes:

• key learnings from implementing UCR
• proposals for policy changes to support integrated care boards to understand what works best
• an updated economic model
• an impact evaluation, which will focus on how UCR has met the needs of individuals and prevented further clinical deterioration as well as UCR’s impact on UEC.

Discharge

• Improvement guidance for writing a criteria led discharge policy: guidance on writing a patient discharge policy on criteria led discharge
• Rapid improvement guide: criteria led discharge: easily accessible approaches and principles for the implementation of criteria led discharge
• Hospital discharge and community support guidance: this guidance sets out how NHS bodies and local athorities can plan and deliver hospital discharges.
• Ten best practice initiatives: initiatives that demonstrably improve flow and improve discharge
• Managing transfers of care – A high impact change model: support for local system partners to improve health and wellbeing, minimise unnecessary hospital stays and encourage them to consider new interventions.

Same day emergency care (SDEC)

• What is same day emergency care? Video describing the principles of same day emergency care.

Winter Improvement Collaborative

• Urgent and emergency care improvement guide to contact hubs for primary, ambulance and clinical calls
• Urgent and emergency care improvement guide to direct access
• Urgent and emergency care improvement guide same day emergency care flow
• Urgent and emergency care improvement guide same day emergency care pathways
• Urgent and emergency care improvement guide specialty support to the urgent and emergency care pathway/internal professional standards

Workforce

• Transfers of care hub: staff action cards: action card for transfers of care hub teams.

Other

• Virtual ward resources: multiple resources to support virtual wards.
• Project reset in emergency medicine: patient FIRST: patient FIRST is a support tool designed by clinicians, for clinicians. It includes practical solutions that all emergency departments could consider.
• Provider collaboration review: Urgent and emergency care: review to show the best of innovation across systems under pressure to drive improvement.