Urgent and Emergency Care (UEC) update from Cheryl Hardisty, Programme Director
Urgent care performance
The successful management of winter pressures and tangible progress made in improving performance has been commended by NHS England and NHS Improvement.
This is demonstrated in the reduction in 12-hour breaches at University Hospital of North Midlands NHS Trust (UHNM) from 508 in 2017/18 to 3 in 2018/19; with zero 12-hour breaches since October 2018.
This is particularly impressive, considering the number of people attending A&Es in Staffordshire and Stoke-on-Trent is on the increase – with a forecasted 8.4% rise in attendances at A&E departments locally this year compared to 2018/19. Similarly, there is also an upward trend in emergency admissions.
One of the key priorities of the programme is to support people to make the right decision about where to go to meet their needs and to only attend A&E departments when absolutely necessary. This includes working more effectively as a system, rather than as individual organisations.
Integrated urgent care
The new national specification for an integrated urgent and emergency care system has been commissioned locally. This specification is nationally mandated for delivery from 1 April 2019, which we are very pleased to have achieved.
Commissioners have worked successfully with the current provider to implement the specification, including the NHS111 and GP out of hours services now being co-located in Staffordshire and operating as a single service. It means NHS111 can directly book patients into out of hours and patients should be dealt with by one service, rather than having to potentially wait in more than one queue.
An enhanced Clinical Assessment Service is now in place which means that a senior clinician (e.g. a GP) has oversight of patients in the NHS111 queue 24/7. They can also utilise the expertise of other clinicians for specific issues; for example, advanced nurse practitioners and dental nurses.
It is early days, but we are hopeful it will lead to a more streamlined service and experience for patients using NHS111. The aim is to have NHS111 as the gateway for supporting patients and our clinicians to access appropriate urgent and emergency care where it is not life threatening. We expect this will lead to a reduction in A&E attendance and more appropriate alternatives to patients and clinicians are offered and available through NHS111.
A ‘test of change’ in February 2019 supported by West Midlands Ambulance Trust, UHNM and MPFT was very positive. The aim of this 12-day test in North Staffordshire and Stoke-on-Trent was to support the ambulance service with access to alternative existing pathways.
It demonstrated that 75% of referrals were able to be accepted by community services and 64% of all referrals remained at home after seven days. This indicated the potential for approximately 30-50 ambulance patients per day to go in to community services - supporting patients to remain in their own homes as opposed to attending A&E.
In addition, a care co-ordination test of change is being planned with NHS111 and community services to determine the proportion of patients coming through 111 who could potentially be directly booked and treated by community services as opposed to advising patients to attend A&E or their own GP practice.
The local urgent care system has seen significant improvements over the last year by working more effectively together. There is still further work to do, but we are committed to making improvements and delivering the care that as individuals we would want for families and loved ones.