Domain 3: Helping people to recover from episodes of ill health or following injury

NHS Commissioning Assembly logoThe content on this page has been co-designed and developed by NHS England’s Clinical leaders and local commissioners, who are members of the Quality Working Group and tasked with leading the development of the Quality agenda for the NHS Commissioning Assembly

Key issue

There has been an ever-increasing demand on our hospitals over the past 10 years – a 35% increase in people being admitted to hospital as an emergency and a 65% increase in the episodes of care in hospitals for over 75s. Patients in our hospitals are older and frailer, and around 25% have a diagnosis of dementia. Care that is not joined up, particularly between health and social care services is causing increased admission and readmission amongst those with long term conditions and the elderly.

And the outcomes of care vary significantly across the country, for example return of spontaneous circulation rates following cardiac arrest vary from 13-27%.

If people do experience an episode of ill health or suffer an injury, the NHS should treat them effectively and support them to recover and restore their maximum independence as quickly as possible.

Areas of Action

We have identified a set of key areas for action.  These are actions which will need to be taken forward in partnership between NHS England, Clinical Commissioning Groups across the whole commissioning system, and other partners such as Local Government

Local case studies

Please click on the links below to access examples of good practice that area teams and local CCGs have supplied. Note:  we will be continually updating and building this list of case studies with examples of good practice supplied by local CCGs

  1. Nottingham GP’s: Cardiology Discharge Project
  2. Rushcliffe: Urgent Community Support Service
  3. South East Staffordshire & Seisdon Peninsula: Vasectomy Services
  4. Stoke-on-Trent & North Staffordshire: Orthotics
  5. North Derbyshire: Patient Experience
  6. North East Essex: GP Urgent Visiting
  7. North East Essex: Surge Management Meetings
  8. West Essex: The Princess Alexandra Hospital trust-Urgent Ambulatory Care
  9. South London: Accident & Emergency Service Policy
  10. HomeFirst: Rapid Response Service
  11. East Anglia: Major Trauma
  12. Ipswich & East Suffolk: Unplanned Care emergency assessment unit
  13. Coventry & Rugby: NHS Referral support service
  14. South Worcestershire: GP Working with the ambulance Service
  15. South Warwickshire: Member Practice Engagement in Commissioning
  16. NHS England: My Shared Pathway

Key resources to support local plans

  • NHS Outcomes Framework and CCG outcomes indicators
  • NHS Indicator portal – access CCG outcome indicators data here, for each domain
  • CCG outcomes tool and explorer – The CCG outcomes tool allows users to view maps, charts and tables of individual outcome indicators across CCGs, and to view a spine chart of all the outcomes for one or more CCGs. The CCG outcomes explorer allows the user to explore the relationships between two outcomes or between demographic information and outcome

Further resources are currently in development and will be coming on-line here from mid-October


Keeping people out of hospital when appropriate

In order to provide the best care in hospitals for people, we need to ensure all admissions are appropriate and enable hospital resources to be targeted towards providing safe and effective care.  Health services in the community, such as general practice should be supporting people to maintain their wellness and independence.  The appropriate response to episodes of illness or injury ranges from advice on self-help, through on-scene or in home care or local community facility treatment, to definitive care in hospital. To offer efficient delivery of such a comprehensive programme of support we need to move to a coordinated pre-hospital and out-of hours system of urgent care with senior medical support for the key care decisions.

Effective interfaces between primary, secondary and community care

High quality care from the perspective of patients is care that is coordinated.  Patients will benefit from greater partnerships between clinicians and multidisciplinary hospital and community teams. Primary care doctors should be able to benefit from same day specialist advice to help them manage patients with complex needs. Similarly, GPs and community teams should be involved in secondary care, preparing patients for planned admission to hospital and providing advice and coordinating a patient’s discharge and support in the community.

Patients must have ready access to urgent and emergency care when they need it. The NHS emergency care system needs to be standardised, based on patient need, so that it is easily understood, connected to wider health and care services and universally provides high quality care.

High quality, efficient care for people in hospital

Everyone should be able to expect high quality care regardless of where they live, however currently the quality of and outcomes from hospital care varies across the country. Through the Urgent and Emergency Care review and a focus on implementation of seven day a week services, we will ensure rapid access to consultant care after emergency admission regardless of day and time of arrival at hospital (consultant presence on the acute medical unit is associated with a reduced 28-day readmission rate). Certain specialist services, such as stroke care, will benefit from reconfiguration to ensure optimal intensive specialist care is immediately available in the first critical hours.

Within hospitals, patients must receive the appropriate level of care, with regular consultant oversight during their stay, and particularly within a few hours of their arrival in hospital. This level of care should be provided seven days a week, regardless of when someone is admitted to hospital.  To support services providing coordinated and high quality care for patients, there must be inter-operable systems and information which follows the patient.  National clinical audits  and Patient Reported Outcomes reporting at national, provider, CCG, GP practice and individual specialist level will support clinicians to improve by measuring and benchmarking the quality of care they are delivering.

Co-ordinated care and support for people following discharge from hospital

Care must be coordinated to support people to leave hospital and continue their recovery in the community, improving outcomes of care and reducing cost to the NHS from readmissions.  Hospital clinicians should proactively involve general practitioners in discharge planning for their patients – GPs can actively inform the process so that the most appropriate community support is arranged in a coordinated way prior to a patient’s discharge.  Rehabilitation services should be delivered so that they are tailored to the needs of the individual patient.