New analysis shows impact of redesigning urgent and emergency care in Northumberland

Today, the Health Foundation publishes analysis examining the early impact of changes to A&E and urgent care services in Northumberland following the opening of the country’s first bespoke emergency hospital in Cramlington in 2015.

The study found that people in Northumberland attended A&E departments 13.6% more frequently in the year following the opening of the new hospital than would have been expected. They also spent on average 14 minutes less time waiting in A&E and urgent care centres than would have been expected, with just under 92% of patients admitted, transferred or discharged within 4 hours of attending A&E.

Read the report now

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 improve the delivery of health care. The work was conducted in collaboration with 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.

In March 2015, a primary and acute care system (PACS) was established in Northumberland comprising Northumberland CCG, Northumbria Healthcare NHS Foundation Trust and partners. The Northumberland PACS sought to improve care and reduce costs by reducing over-reliance on hospital care and the associated high use of A&E, high levels of hospital admission and lengths of stay.

In June 2015, the Northumberland PACS started centralising emergency care by opening a new hospital in Cramlington, the Northumbria Specialist Emergency Care Hospital. This was the first stage of an extensive change programme. At the same time, they sought to convert three existing A&E departments into walk-in centres for urgent care. However, during the period analysed by the Improvement Analytics Unit, the three hospitals run by Northumbria Healthcare NHS Foundation Trust at North Tyneside, Wansbeck and Hexham were not fully converted to walk-in centres and continued to accept A&E patients. A minority of patients in Northumberland also accessed A&E and urgent care provided by other trusts.

The analysis examined the impact of the changes to urgent and emergency care for people registered with a GP in the Northumberland CCG catchment area in the 12 months from August 2015 to July 2016. The highly innovative analysis compared data from Northumberland CCG with a control area. The use of a control area allowed the Improvement Analytics Unit to identify what impact the reconfiguration of services had on hospital use.

Adam Steventon, Director of Analytics at the Health Foundation and one of the report authors, said:

'This study provides useful insight into how reconfiguring urgent and emergency care in Northumberland affected patient activity in the first year after the opening of the new hospital in Cramlington. Our study shows that an unintended consequence of the changes to A&E and urgent care services was an increase in the number of patients attending A&E.

'Further research is needed to understand why patient activity changed in this way. After the opening of the new hospital, local people may have chosen to use A&E over other alternatives if they felt it was more convenient or likely to provide better quality care.

'There is nothing in our evaluation to suggest that the people of Northumberland did not receive high quality urgent and emergency care during the period we studied, indeed, the faster access to urgent and emergency services we found is a good thing for patients.

'We know that large scale change projects take time to generate results. The Northumberland team is planning further changes to primary and community care which may reduce hospital pressures in future. Two and a half years after the new hospital opened, it would be useful to look again at the impact of the PACS and whether the way local people are using hospitals has evolved further.'

Read the report now

Media contact

Creina Lilburne

creina.lilburne@health.org.uk

020 7257 8024

Notes to editors

• The Improvement Analytics Unit was set up in 2016 to provide robust and timely information to health care providers and commissioners on whether new approaches to delivering NHS care are having an impact for patients, in order to inform national and local decision-making and support ongoing improvement.
• The Improvement Analytics Unit’s analysis compared data from Northumberland CCG with a control area that was formed by combining data from several other CCGs in England and was very similar to Northumberland across a range of factors (eg age profile of the population, levels of socioeconomic deprivation and health characteristics) but had not experienced a similar reconfiguration of A&E and urgent care. Differences in hospital use in the control area and the Northumberland population were used to calculate the results.
• For the Northumberland evaluation, the way the four-hour wait in A&E was calculated relates to the CCG population as a whole and has been risk adjusted. The Improvement Analytics Unit found that 91.8% of patients from Northumberland CCG who attended A&E between August 2015 and July 2016 waited less than four hours. This figure will differ from the NHS performance statistics that are published monthly by NHS England due to differences in the way that the waiting times have been measured and the fact that the performance statistics relate to acute trusts, not CCG populations. The Improvement Analytics Unit’s figures are also risk-adjusted to allow for changes in the characteristics of patients attending A&E over time.
• The aim of Primary and Acute Care Systems (PACS) is to join up services to allow better decision-making, more sustainable use of resources and better care, with a greater focus on prevention and community care, and less reliance on hospital care (see The PACS framework, Sept 2016). PACS are one of five new care models being delivered by health care ‘vanguards’ as part of the Five Year Forward View.