Transforming urgent and emergency care services in England

Sir Bruce Keogh, Medical Director at NHS England, has today recommended a wide ranging reconfiguration of urgent and emergency services in his phase 1 review of urgent and emergency care. We provided evidence to this review, outlining tried and tested innovative techniques that have been introduced in healthcare settings across the UK to help improve emergency care.  

I'm pleased that the need for change across the whole system has been acknowledged and that our work and recommendations have informed the review, as well as the recent Health Select Committee report on Urgent and Emergency Services published in July 2013. Let me highlight some of the important learning from our work that we’d like the next stage of the review to take on board…

With an increasing ageing population and a freeze on funding the current model of care delivery is rapidly becoming unsustainable. Our Flow Cost Quality programme showed that by fully understanding the actual demand on services – how patients move through the healthcare system and where the bottlenecks are – it is possible to appropriately redesign processes and systems to improve quality and costs.

We know that poor systems deliver poor results. We have shown that by giving organisations and staff the time to examine patient flow through the emergency pathway, they can identify and implement improved ways in which capacity can be better matched to demand. This saves money and lives.

As a result of Flow Cost Quality, Sheffield Teaching Hospitals NHS Trust created a Frail Elderly unit at the front door and a system of ‘discharge to assess’. This ensures swift assessment and onward movement through the emergency pathway by having senior assessors available to make decisions, treat promptly and transfer patients back in their homes as soon as they are medically fit (with appropriate support) or refer them on for the correct specialist treatment. By recognising that blockages in A&E are actually a symptom of the wider healthcare system failures, they were able to reduce costs, save lives and move care to where it most suits the patient. 

From today's review, we also welcome the recognition of patients' expertise and the value of supporting patients with long-term conditions to better manage their own health and healthcare. On balance, evidence shows that where people are proactively supported to do this it can reduce demand on emergency services.

I have several hopes for the next stage of the review. Among them, that the wider learning from Flow Cost Quality is reflected and that the unique experiences of frail older people within the healthcare system are addressed. Also that it will outline how the NHS will support people to develop their knowledge, skills and confidence in their ability to better manage their conditions.

It’s a financial and moral imperative that these issues are addressed across the health and social care spectrum.

Jane Jones is an Assistant Director at the Health Foundation.