Pressures on Urgent and Emergency Care: Has Anything Changed?

Last month NHS England announced plans for an overhaul of A&E targets. With four-hour performance goals becoming harder and harder to achieve, NHS bosses claim that these targets are becoming outdated. The goal of seeing 95% of patients within four hours hasn’t been met nationally since 2015 with only two hospitals hitting it in February 2019. These new plans would prioritise the most critical patients for quick treatment and aim to drop targets of seeing and treating almost all A&E patients within four hours.

These new plans will be piloted this year and could be introduced more widely across the NHS in 2020. The new targets could include ensuring patients with heart attacks, sepsis, acute asthma and strokes are cared for within an hour.

However, meeting four-hour performance goals is only one of an array of issues facing the urgent and emergency care sector. Year on year the challenges remain the same and A&E’s are often at crisis point when dealing with winter pressures. During our conference, we are aiming to address these problems and discuss practical insights and solutions for tackling the ongoing crisis faced by emergency services.

What are the problems?

The key problems faced by urgent and emergency care departments are all linked to growing patient demand. This has impacted patient flow, patient safety, effective discharge, response times and waiting times. Whilst patients often feel the impact of these increased pressures in the care they receive, NHS staff are also affected. So it is becoming more and more important to introduce strategies for maintaining a sustainable workforce.

How are we addressing these problems?

At the Urgent and Emergency Care Conference we will be hosting speakers and sessions to try and address the key issues being faced by the sector. Our sessions will focus on key themes and try to provide solutions to problems such as: creating a sustainable workforce, improving patient flow, relieving pressures on emergency departments and improving standards and quality of care.

Professor Stephen Powis the National Medical Director from NHS England will be outlining the long-term plan for urgent and emergency care. Patrick Mitchell from Health Education England will be speaking about ensuring a sustainable workforce. Dr Sally Johnson from Greenbrook Healthcare will be sharing how they have successfully relieved pressure on emergency departments through primary care led UCC’s. Professor Suzanne Mason from University of Sheffield will be discussing the new Ambulance Response Programme.

 

To hear from all these speakers and more about solutions to the ongoing issues being faced in urgent and emergency care book on to The Urgent and Emergency Care Conference 2019.

This article was written by Tatiana de Berg

A&E at Crisis Point: Experience a Simulation of a Day in A&E

We all know it’s important to raise awareness of the current issues in emergency care. But, there’s something of a dichotomy in the way we do so. While countless media headlines deplore the “NHS winter crisis” and puts the state of the NHS firmly in the public consciousness, they rarely do justice to the real problems frontline staff have to contend with. Where the mainstream media fall short, we need to not only keep the conversation going, but to ensure it remains relevant, practicable and impactful in the real world.

Introducing Crisis Point: A Day in A&E

This includes encouraging peripheral organisations in their attempts to add to the conversation. Specialist lawyers Bolt Burdon Kemp recently released a new interactive challenge titled “Crisis Point: A Day in A&E”. The project attempts to simulate life in A&E to highlight the immense pressures that emergency staff are under every day. You’re placed in a nondescript emergency department in the UK and asked to make the right patient care, staffing and triage decisions to keep the emergency department running smoothly. As you play, an ‘A&E status’ indicator (based on the OPEL system and the fated 4 hour government targets) tracks your progress.

Highlighting Issues in Emergency Care

The simulation touches on a fair few issues that emergency care staff would be intimately familiar with. We’ve highlighted a couple of them below:

A Dangerous Patient-to-Staff Ratio

A report by the Kings Fund found data from NHS England suggested occupancy across England was at unmanageable levels the majority of the year. We know from experience that patient attendance at A&Es are increasing every year.

What is lacking, however, is the staff infrastructure to cope with this increased demand. A lack of qualified staff presents a dangerous situation within emergency care, where critical patients or conditions might be missed or neglected despite the efforts of over-stretched staff.

Hiring more people would be the obvious solution, but this is easier said than done. Any recruitment efforts would need to consider why staff are leaving just as much as it focuses on recruiting new candidates.

Ill-Conceived Government Targets

When first introduced in 2003, the four-hour government targets saw a dramatic, encouraging drop in patient wait times. In the present day, however, these targets have become less effective.

Out of 139 NHS England trusts, only 3 stayed within the 4-hour target for the whole of last year. When patients are reduced to a number on a flashing board, it can distract staff from what they were trained for: delivering excellent frontline care to critically ill or immensely worried patients.

We need an institutional rethink in our approach to patient care in emergency departments, while simultaneously ensuring crucial provisions and funding are made available earlier. As the 2017/18 NHS review of winter 2017/18 noted, “Funding for winter, though immensely helpful, arrived in late November making it harder for trusts to plan [ahead].”

Of course, no simulation can truly encapsulate the complex, varied and indelible issues that currently permeate life in emergency care. We need to take a holistic approach to solving the “NHS crisis”, taking into account every single touchpoint within every department. The Urgent and Emergency Care Conference 2019, held in London on 2 July 2019, aims to provide a platform to do just that. We invite NHS providers, emergency care staff and other healthcare professionals within (and outside of) emergency care to come together to explore all those issues in detail. Book your place here: https://erc.pmgltd.co.uk/Store/Register/2685.

This blog was written by Hasna Haidar, a freelance copywriter, covering topics in education, health and technology. All insights for this campaign are coming from A&E staff members working in London and the UK, which have agreed to contribute anonymously with insights based on their experience.

Tackling NHS Winter Pressures in the Urgent and Emergency Care System

The 2017/18 NHS winter crisis has been one of the worst on record, with daily headlines emerging of the unprecedented pressures being faced by NHS Trusts seeking to meet patient demand. NHS figures have revealed that over 100,000 patients have had to wait in an ambulance for more than half an hour this winter and that A&E waiting times have now reached the worst levels on record.

For all Trusts and CCGs the long term solution to tackling winter demand and averting these struggles in the future lies in a fundamental rethink of how care is delivered and how all services can work towards increased productivity and efficiency to improve provision.

A Redesign of Health and Social Care

Across the NHS the move towards health and social care integration, community services and self-care will be critical in alleviating the pressure on A&E departments.

150 Urgent treatment centres have been rolled out already which will contribute to local 4 hour waiting targets. These GP-led services are already working to offer support for some of the most common reasons for A&E attendances.

The NHS’ Vanguards programme is also trialling a number of schemes seeking to implement new models of care which support successful health and social care integration. The development of community based schemes and the use of technology are becoming increasingly vital in preventing delayed discharges and unnecessary hospital admissions.

Improving Ambulance Service Provision

The effective deployment of ambulances is vital to any urgent and emergency care system and the roll out of the NHS’ new Ambulance Response Programme (ARP) with new response times will be key to improving performance. The NHS predicts this system will result in faster treatment for stroke and heart attack patients and will lead to a more immediate response for 750,000 callers annually. The core ambition is to improve operational efficiency, which means that Trusts will also need to address wider questions of staff deployment, handover procedures and the relationship of ambulance services with community providers.

Patient flow

Of course, there is still major work to be done in ensuring that A&E departments themselves are being run as efficiently as possible and a vital component of this is improving patient flow.

A&E departments must constantly assess how ambulance handovers are conducted, the role of clinicians in managing patient demand, how patients are screened and streamed on entry and how staff can be most effectively deployed if hospitals are to deliver the best outcomes for A&E patients next winter.

To explore solutions to addressing patient demand and supporting improved outcomes in A&E departments, join NHS England, The Care Quality Commission and The Royal College of Emergency Medicine at the Annual Urgent and Emergency Care Conference 2018 taking place on Tuesday 15th May 2018 in Central London.

*For further details and booking information click here*

Written by Callum Clark, The Urgent and Emergency Care Conference 2018