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The Health Foundation has considered findings from analysis into the early impact of changes to urgent and emergency care services in Northumberland following the opening of the country’s first bespoke emergency hospital in 2015 – the Northumbria Specialist Emergency Care Hospital in Cramlington.

The analysis was conducted by the Improvement Analytics Unit, a statistical evaluation unit run in partnership by NHS England and the Health Foundation that helps to inform decision-making at a local and national level and ultimately improve the delivery of health care. The work was conducted in collaboration with the Northumberland primary and acute care system vanguard, which includes Northumberland Clinical Commissioning Group (CCG) and Northumbria Healthcare NHS Foundation Trust.

The report highlights that reconfiguring NHS services takes time to generate the intended results and that robust, repeat evaluation can help to inform decisions and improvement.

Key points

  • Health and care partners in Northumberland have been pursuing an ambitious programme to redesign the way care is delivered for their local population. The first phase was implemented in June 2015 and involved opening the UK’s first purpose-built, specialist emergency care hospital in Cramlington.
  • The new hospital aims to provide better care for patients with potentially life-threatening conditions by providing faster access to consultants and diagnostics and shortening length of stay. It is staffed by accident and emergency (A&E) consultants 24 hours a day, 7 days a week, and by specialty consultants 7 days a week from 8.00 to 20.00.
  • After it opened, three existing A&E departments were gradually refocused on providing care for minor injuries and illnesses. The aim was to convert these departments to be urgent care centres, staffed 7 days a week by a mix of hospital doctors, GPs and emergency nurse practitioners. However, over the period considered by this evaluation, the three existing departments were not fully converted and continued to provide A&E care, alongside hospitals in surrounding areas to which some of the population.
  • The changes to urgent and emergency care were associated with a 13.6% increase in A&E visits for people registered with a general practice in Northumberland CCG. On average, their A&E visits were 14.3 minutes shorter than would have been expected for Northumberland. Indeed, 91.8% of patients in Northumberland were admitted, transferred or discharged within 4 hours of attending A&E, compared with 85.2% in the control area. The analysis did not find evidence of impact on admission rates, and it was not possible to determine whether the changes to service delivery had any impact on length of stay.
  • Further research is needed to understand why patient activity changed in this way, as there are several possible explanations for these findings. The increased A&E activity may reflect perceived improvements in the quality of care provided, as well as the increase in the number of departments providing A&E care. This could have made A&E a more attractive or convenient place to obtain treatment. The reductions in A&E waiting times might also have reflected improvements to care processes.
  • More qualitative data on the underlying mechanisms of the care processes are needed to be able to better understand the implications of the findings for the delivery of health care. Further quantitative evaluation is also important, because complex changes to health care rarely have the intended impacts on outcomes in the short term, and further course correction is often needed.

Further reading

Improvement Analytics Unit

The Improvement Analytics Unit (IAU) is an innovative partnership between NHS England and the Health Foundation that provides rapid feedback on whether progress is being made by local health care p...

Improvement project

Comments

Simon Dodds



This is a very comprehensive piece of "big data" retrospective analysis and I commend the authors for their diligence and hard work. I am not sure I quite concur with the conclusion though because the charts on page 19 suggest that the A&E performance of the synthetic control group got worse while the study group did not. The North East has a strong history of flow improvement in the urgent care macrosystem and were consistently in the upper quartile for A&E performance before the new acute hospital was designed/built/opened - so has this advanced analysis just confirmed the declining performance of the majority of the NHS in England?



Simon Dodds



This is a very comprehensive piece of "big data" retrospective analysis and I commend the authors for their diligence and hard work. I am not sure I quite concur with the conclusion though because the charts on page 19 suggest that the A&E performance of the synthetic control group got worse while the study group did not. The North East has a strong history of flow improvement in the urgent care macrosystem and were consistently in the upper quartile for A&E performance before the new acute hospital was designed/built/opened - so has this advanced analysis just confirmed the declining performance of the majority of the NHS in England?



Arne Wolters



Thanks for your comment Simon. Yes, Northumberland has historically performed relatively well on A&E waiting times. Therefore, we created a synthetic control that had a similar history of A&E performance to Northumberland, rather than compare Northumberland with the rest of England. The difference in A&E performance between Northumberland and the synthetic control occurred after the changes to urgent and emergency care were made, leading us to conclude the difference reflects the impact of this change.

As you say, A&E performance remained stable over time in Northumberland in the figure on page 19, but dipped in the control area. The changes introduced in Northumberland may have helped to counteract some of the deterioration in A&E performance seen elsewhere in the country.

Happy to discuss this further via email, if you are interested.



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