Urgent and emergency care
What are our overall aims by 2028?
Urgent and Emergency Care (‘UEC’) services are stabilised and transformed so that patients are seen more quickly regardless of how they access care – whether that be the length of time that they wait for an ambulance, the waiting time at A&E, or the period of time that they stay at hospital.
UEC service resilience is strengthened through increased capacity both in terms of hospital bed and ambulance availability, in turn improving patient experience and outcomes.
Hospital discharges processes are improved with a focus on early and timely discharge to prevent patients from deconditioning, whilst promoting patient independence through reablement.
Fully integrated urgent care models are operational in each of our four Places, making it easier for people to access the right care and guaranteeing same day care for those patients who need it, in turn reducing UEC demand and releasing emergency care capacity to those who need it most.
What’s our starting point?
As a system we have made good progress against the national UEC Recovery Plan, giving us strong foundations to build on. Key achievements include:
- In 2023 we increased bed capacity via Winter Plan investment funding;
- Same Day Emergency Care Clinics and Virtual Ward models are embedded across all 3 local Acute Trusts for number of specialities. Intravenous at home services are also available through 2 of our Acute Trusts – all services helping to support patients be treated at home without the need for hospital admission or supporting earlier discharge;
- Urgent Community Response Teams are well established, and services are embedded 8am-8pm, 7 days a week. The teams work closely with 999 and NHS 111 to ensure community based interventions are put in place to avoid hospital admission and to redirect Category 3 calls conveyances where appropriate;
- A number of early discharge and admission prevention schemes have been implemented via local Better Care Fund Plans which join up health and social care;
- 3 out of our 4 Places have well established Urgent Treatment Centres.
What are some of the key links to other parts of the plan?
Collaboration and Integration and Supporting People at Home – expanding care delivered outside of hospital so that people can access the care that they need at and closer to home without the need for hospital admission will be critical in supporting the delivery of the overall aims above. As will our work to ensure that hospital discharges are safe and timely.
Improving Access to Services - Primary Care – planned activity to improve access to primary care services in line with the national Delivery Plan for Recovering Access to Primary Care, will play a key role in enabling same day care provision and supporting the delivery of the overall aims.
System Transformation – our two geographic Care Collaboratives will drive integration across services, with urgent care and out of hospital services being two of their initial areas of focus.
What will we be focusing on in the next 2 years?
Undertaking a system-wide evaluation of 2022/23 winter initiatives and performance through the Urgent and Emergency Care Board to understand how we can embed best practice and innovation, with recommendations being implemented across quarters 2 and 3 of 2023/24 in preparation for winter.
Building on the success of the local Virtual Ward Programme to date, continuing to implement our Virtual Ward Plan throughout 2023/24 to maximise utilisation.
Undertaking a review of the remote monitoring programme ‘Docobo’ in the summer of 2023 to determine future commissioning intentions regarding virtual care programmes, and evaluating how technology can be used as an enabler to work differently and deliver more care remotely.
Implementing Same Day Emergency Care (‘SDEC’) programme of work to expand provision, including referral criteria, opening hours and referral routes. As part of this work, strengthening relationships between Acute SDEC teams, paramedics, 999 and NHS 111 to improve SDEC access.
Continuing to build on the UTC assets across Coventry and Warwickshire including:
- Mobilisation of a UTC in South Warwickshire by March 2024;
- Rugby UTC adoption of ‘hub and spoke’ telemedicine model with UHCW site;
- Implementation of UHCW UTC children's streaming;
- GEH expanded operational hours.
Working more closely with Local Authorities on the Better Care Fund and the Adult Social Care Discharge Fund to maximise capacity and resilience.
Procuring and mobilising a new NHS 111 service from 1 April 2024.
Standardising hospital ‘front door’ processes to reduce pressures in Emergency Departments by maximising opportunities for admission prevention and urgent care access closer to home.
Implementing a new Community Recovery Service in Warwickshire from April 2023 to facilitate timely and improved discharge processes (see Supporting People at Home section).
Transforming acute and community pathways through the Improving Lives Programme in Coventry, with a focus on admission prevention and early supported discharge to prevent long waits and extended length of stay for frail elderly people (see Supporting People at Home section).
Improving the performance of Urgent Community Response Teams by:
- Establishing pilots and trials to look at innovative ways to develop and expand services beyond the core establishment e.g. 999 call validation, falls alarms detection and care home monitoring;
- Developing pathways with the Virtual Ward teams for frailty;
- Deploying Odyssey Triage software to improve triage times and efficacy.
Working with the regional Mental Health Ambulance Response Programme to implement the West Midlands Ambulance Service 999 High Intensity Use service.
Mobilising the new “Safe Haven” out-of-hours community based crisis service in quarter 1 20234/24, offering an alternative option to A&E for individuals experiencing mental health distress.
During 2023/24 key stakeholders will come together through the geographical Care Collaboratives – including the 4 Places, the Primary Care Collaborative and the wider Collaboratives – to redesign urgent care services and develop a robust integrated urgent care model in each Place. Key activities as follows:
- Establishing a Joint Review Group;
- Defining the scope of urgent services for the review – potentially including GP Out of Hours, GPs in Emergency Department models, Urgent Treatment Centres and other primary care based urgent care services;
- Reviewing current patient outcomes and experience;
- Reconciling current service requirements against latest national and local priorities, including the Fuller Stocktake Framework for Shared Action;
- Co-producing an updated clinical delivery model which integrates all urgent care services at Place to deliver a robust pre-hospital offer to patients;
- To inform and shape the above, undertaking a programme of public and stakeholder engagement.
There is a risk that patient demand continues to grow faster than resources – both in terms of finance and workforce.
Domiciliary and care home staffing numbers are a particular challenge for the system and work continues with colleagues through the Adult Social Care Fund and Better Care Fund to identify enhancements that can be provided – using these avenues will be key to system working and success.
Workforce plans must not only include the recruitment of new staff, but also seek to redesign current and existing roles to enhance existing skills and competencies in preparation for the future.
Key Metrics and Deliverables
A&E four hour performance of 76% and Category 2 ambulance response times to an average of 30 minutes by March 2024, with further improvement in the following year.
Reduction in 12 hours waits in A&E.
Bed occupancy rates reduced from 95% to 92%.
Reduction in length of stay by at least half a day across the system.
80% Virtual Ward utilisation by September 2023, 90% by March 2024.
Urgent Community Response Team – 70% response within 2 hours.