Urgent and Emergency Care Programme - February 2019

Update from Cheryl Hardisty, Programme Director

As you might expect, the past month has been extremely busy, but positive in many ways.

Winter performance

The hard work of partners and frontline staff across Staffordshire and Stoke-on-Trent has led to a much improved performance this winter. The system has been commended by NHS Improvement and NHS England for the strong progress made this year in comparison to 2017/18. An example of this is the number of 12-hour trolley breaches in the system. Between November 2018 and January 2019 there have been zero 12-hour breaches - this is compared to the same period last year when there were 384 breaches. We’ve also seen a continued improvement in four-hour A&E performance across the system.

The system is working well together to understand the issues in respect of urgent care and to effectively plan and deliver against its commitments. This is evidenced not only through the improved urgent care provision but also through the January 2019 follow-up to the CQC’s review of older people’s services in Stoke-on-Trent which reported that “system leaders should be commended on the progress they have made to build relationships and enable more effective communication across the system…. the CQC’s review found a system that was working together more effectively and improving care for people across Stoke-on-Trent”.

Whilst the work to date has been recognised both regionally and nationally, we remain focussed on building on this in order to deliver services for local people that are comparable to the highest performers nationally.

Successful pilot

A two-week pilot project involving West Midlands Ambulance Service (WMAS), Royal Stoke Hospital and Midlands Partnership NHS Foundation Trust (MPFT) was held, aimed at patients identified by ambulance crews as not needing to go to A&E, but still requiring urgent care. The paramedics were able to call a dedicated phone line to determine whether services in the community are available to support the patients, rather than them being taken unnecessarily in to A&E.

The pilot tested what alternative services are available and if paramedics are able to handover patients in a timely manner. The initial findings have been very positive, with a significant number of people involved having been able to receive support in the community rather than needing to go to hospital. The pilot has highlighted the importance of successful collaborative working between different organisations in the best interests of patients. Further work is taking place on reviewing the findings in more detail, including following up on the progress of the patients involved. 

Integrated urgent care services

Patients often feel confused about where to go when they have an urgent need for medical help or advice. We also know that some patients go to A&E when they are unsure, or if they feel their needs will be met more quickly than other services, e.g. an appointment with a GP.

This is a national problem and the NHS has produced this short video to describe what a more integrated urgent care system will look like as it develops over the next few years.

In Staffordshire and Stoke-on-Trent, we are working hard to develop a more integrated approach to urgent care, so that patients know where to go for advice and help and can be treated in the right place and at the right time.

As part of this a base Clinical Assessment Service (CAS) is now live in Staffordshire and Stoke-on-Trent, meaning that patients calling NHS111 between 10am-6pm Monday to Friday will be able to access clinical support over the phone if clinically required. The service has a senior clinical workforce, including Consultant-level Emergency Medical Doctors, GPs, Advanced Nurse Practitioners and prescribers. Since going live, there has been an increase in the percentage of patients that have spoken to a clinician and we await a report on the outcomes.

We are providing paramedics with a direct line to this service to support patients to stay at home if they have an urgent clinical need rather than a life-threatening need that requires attendance at A&E.

Click on the link below to watch an introduction to the Urgent and Emergency Care programme: