URGENT CARE & EMERGENCY CARE

Alex Berry – Chief Commissioning Officer

CONTENT:

• What do we mean by urgent and emergency care?

• Pressures on the service.

• What is the position locally?

• What are we doing about it now and in the

future?

URGENT & EMERGENCY CARE

Terms such as ‘unscheduled care’ ‘unplanned care’ ‘emergency care’ and ‘urgent care’ are often used interchangeably. Emergency care – is an immediate response to a time critical health care need. Unscheduled care/urgent care – involves services available to access without prior arrangement where there is an urgent actual or perceived need for intervention.

PATIENT EYE – URGENT CARE – ‘I NEED HELP’

Variety of routes for patients to access urgent and emergency care: • 111 • GP • OOHs • Ambulance • ED (A&E) • Walk in centres • Specialist nurses

PRESSURES ON URGENT AND EMERGENCY CARE SERVICES

• Rising demand – growth in new forms of urgent care have failed to reduce A&E.

• Changing needs of an ageing population. • Changing expectations and experiences of patients as a

result of a 24/7 culture. • Highly fragmented and generate confusion and how and

where to access care. • Poor sharing of information.

PRESSURES ON URGENT AND EMERGENCY CARE SERVICES

• General practice provides the majority of urgent care – 95% of urgent care is accessed in primary care with 5% in secondary care.

• Increasing demand in EDs across the country – ‘waiting target missed in major A&Es 'for whole year‘ BBC 18 July 2014. Last three years alone, attendances have increased by 1million

• The pressures in emergency care will not be relieved by focusing on a single aspect of the problem in isolation – it requires a co-ordinated response across the whole health system.

WHAT’S THE LOCAL PERFORMANCE

4

5

0

4

5

1 1

-4

-2

ED attandances (all type) Non-elective admissions % of ED attendancesresulting in admission

National South Portsmouth

WHAT’S THE LOCAL PERFORMANCE – THE CHALLENGE

LOCAL PROVIDER PERFORMANCE IN CONTEXT

WHAT’S HAPPENING LOCALLY

Given current pressures, the following was agreed:

• Working to the CE of Portsmouth Hospital Trust leading a system-wide urgent care working group.

• Conduct a rapid diagnostic of the issues around urgent care performance.

• To identify the blockers to driving change and improvements.

• Develop a recovery plan to deliver rapid but sustainable improvements across the system for urgent care.

WHAT DID THE DIAGNOSTIC TELL US LOCALLY?

WHAT DID THE DIAGNOSTIC TELL US LOCALLY?

• Admissions are lowest at the weekend. • A&E admissions are lowest between 4am and 10am. • There are a high number of 31-65 year olds attending the department. • Patients admitted via MAU have a longer length of stay than those admitted via

ED. • 18% of beds are occupied by patients ready and awaiting discharge. • 95% of patients leaving PHT return to their own home, of these 15% require care

packages established or restarted. • Discharges peak at 3pm whereas pressure on beds peaks at 1pm. • Breaches relate to bed availability, clinical specialty review and clinical exceptions.

SOURCE OF ATTENDANCE

0

5000

10000

15000

20000

25000

Attendance Source

MODE OF ARRIVAL

ATTENDERS BY DAY OF THE WEEK

MAJORS VS MINORS

ATTENDANCE BY AGE GROUP

NEXT STEPS AND IMMEDIATE ACTIONS

FUTURE REQUIREMENTS

Emerging principles from the national urgent and emergency care review in England outline a system that:

1. Provides consistently high quality and safe care, across all seven days of the week;

2. Is simple and guides good choices by patients and clinicians;

3. Provides the right care in the right place, by those with the right skills, the first time;

4. Is efficient in the delivery of care and services.

SYSTEM DESIGN SYSTEM DESIGN OBJECTIVES (1):

1. Make it simpler for me or my family/carer to access and navigate urgent and emergency care services and advice.

2. Increase my or my family/carer’s awareness of early detection and options for self-care and support me to manage my acute or long term physical or mental condition.

3. Increase my or my family/carer’s awareness of and publicise the benefits of ‘phone before you go’.

4. If my need is urgent, provide me with guaranteed same day access to a primary care team that is integrated with my GP practice and my hospital specialist team.

5. Improve my care, experience and outcome by ensuring early senior clinical input in the urgent and emergency care pathway.

6. Wherever appropriate, manage me where I present (including at home and over the telephone).

SYSTEM DESIGN OBJECTIVES (2): 7. If it's not appropriate to manage me where I am present (including at home and over the telephone), take or direct me to a place of definitive treatment within a safe amount of time; ensure I have rapid access to a highly specialist centre if needed.

8. Ensure all urgent and emergency care facilities are capable of transferring me urgently and that the mode of transport is capable, appropriate and authorised.

9. Information, critical for my care, is available to all those treating me.

10. Where I need wider support for my mental, physical and social needs ensure it is available.

11. Each of my clinical experiences should be part of a programme to develop and train the clinical staff and ensure their competence and the future quality of the service are constantly developed.

12. The quality of my care should be measured in a way that reflects the urgency and complexity of my illness.

FUTURE REQUIREMENTS FOR URGENT AND EMERGENCY CARE?

NEXT STEPS

Focus on addressing the short and immediate issues to improve ED

BUT

Develop a clear vision and approach that simplifies the urgent care pathway and addresses the strategic objective arising from the urgent care review.