Urgent and Emergency Care (UEC) demand continues to increase year on year, regardless of the demand strategies that have been put in place.
Whilst initiatives will continue to be trialled and developed to encourage the public to make wise choices to access the right type of care, sufficient levels of UEC capacity should be developed to keep pace with rising demand. These initiatives should be designed to future proof for further demand given the long lead in times to change services and expand physical estate and to recruit and train staff.
With pressures mounting on local NHS services, doctors in County Durham are asking the public not to just turn up to A&E but to think pharmacy, GP and 111 first.
Our priorities are therefore:
- To develop a condensed Urgent and Emergency Care strategy using this OGIM (objectives, goals, initiatives and metrics) as an action plan to delivery.
- Implement the Integrated Care Partnership winter plan initiatives.
- To achieve the right balance of UEC service provision; to meet growing demand; ensure fairness in equity of access; and is appropriately responsive.
- To develop effective communications to help patients and the public navigate UEC services to enable them to obtain the right service for their clinical need, recognising there are a range of choices when it comes to UEC services as there are multiple access points. Our objective is to educate the public around what to do if you are unwell and signpost patients to the most appropriate service for their health needs, ensuring A&E is only used for those most in need of urgent /emergency services.
- England will be covered by a 24/7 integrated urgent care service, accessible through NHS 111 or online.
All hospitals with a major A&E department will:
- Provide same-day emergency care services at least 12 hours a day, 7 days a week.
- Offer an acute frailty service for at least 70 hours a week, working towards achieving clinical frailty assessment within 30 minutes of arrival.
- Aim to record 100% of patient activity in A&E, urgent treatment centres and same-day emergency care services through an emergency care data set.
- Test and start implementing the new emergency and urgent care standards from the Clinical Standards Review.
- Further reduce delayed transfer of care, in partnership with local authorities.
- By 2023, the clinical assessment service will usually be the single point of access for patients, carers and health professionals for integrated urgent care and discharge from hospital care.
- Work with all tertiary services to improve patient pathways for example the Urology pathway.
- Through surge management and escalation, continue to manage the ongoing Covid-19 demand by separating emergency patients, both in the Emergency Department and the Acute Medical Units, using isolation strategies, as well as managing other emergency demand working in partnership with all partners including the ambulance service, mental health, the county councils and Clinical Commissioning Groups.
- Develop and expand services to optimise capacity to cope with increasing levels of emergency demand (both Covid-19 and non Covid-19) as well as sustain high levels of elective activity to continue to reduce backlogs and waiting times.
- To actively work across the system to put in place services that meet best practice standards and benchmark well nationally, in terms of their environment, levels of service provision and staffing resource.
- To achieve safe and responsive 24/7 urgent and emergency care made up of a comprehensive range of services.
- To provide urgent access to primary care illness and injury services in the community, effective triage and signposting services (i.e. NHS 111 online, NHS 111 Clinical Assessment Service, Clinical Advice Lines in secondary care), timely emergency/crises response services including ambulance, community and mental health crises, robust acute emergency and trauma care.
- To have in place real-time and accurate intelligence and information datasets to inform surge responses, forecasts, and future planning.
- Adults, children, and young people experiencing mental health crisis will be able to access the support they need – single point of access through NHS 111, access to crisis care 24/7 and intensive follow-on to reduce future use.
- Ambulance services, to be at the heart of the urgent and emergency care system, providing timely responses with patients treated at home or in more appropriate care settings outside of hospital. Ambulance staff will also be trained and equipped to respond effectively to mental health crisis, including mental health transport, mental health nurses available for ambulance EOC, and mental health training for front-line crews.
- To improve responsiveness of community health crisis response services to deliver the services within two hours of referral in line with National Institute for Health and Care Excellence (NICE) guidelines.
- To ensure all parts of the County are delivering reablement care within two days of referral.
- To provide enhanced health in care homes – upgrade NHS support to all care home residents who would benefit by 2023/24.
- To continue to provide evening and weekend GP appointments in place through Extended Access Services and work together with our hospitals to integrate services where appropriate.
- To ensure all hospitals with a major A&E department have enhanced models of Same Day Emergency Care at least 12 hours a day, every day, in both medical and surgical specialties; and provide an acute frailty service for at least 70 hours a week achieving clinical frailty assessment within 30 minutes of arrival.
- To implement the findings of the Clinical Standards Review to focus on patients with the most serious illness and injury.
- To extend digital services beyond care homes to vulnerable patients in their own homes.
- To ensure appropriate approaches to self-management are considered by the Personalised Care Steering Group, which may positively impact on UEC services.
- Provide an overall better patient experience – monitored via feedback.
- Our emergency services will meet patient demand.
- Decrease our waiting times – UEC and specialities.
- All patients will receive the right care in the right place.
- We will achieve the new emergency department measures.
- Patients and the public will know what to do if they are unwell and only use emergency departments where appropriate.
- Improve patient transport.
Find out more about this subject in the related Objectives, Goals, Initiatives and Metrics (OGIM) document on Durham County Council’s Committee Services website under the Heath and Wellbeing Board meeting agenda item for 24 November 2021.
We are keen to hear your views on the content of the plan, including our priorities and the measures we have identified to understand if we are making a difference. Please complete the form below, to provide your views and comments, and these will be passed to the person responsible for this chapter.