Consultation opens on urgent care reform


The days of the four-hour A&E waiting target for hospitals in England are numbered as NHS England publishes its report based on the findings of the Clinically-led Review of Standards (CRS) and the learnings from the pandemic to transform urgent and emergency care. A public consultation is now open, inviting views on the comprehensive set of indicators released in the report: ‘Transformation of urgent and emergency care: models of care and measurement’.

This is the next stage in a process that was initiated in 2018 when the Prime Minister asked the National Medical Director of NHS England & NHS Improvement, Professor Stephen Powis to lead the review. The aim is to ensure that the standards against which A&E and urgent care performance are measured capture what matters both clinically and to patients. 

Professor Stephen Powis says: “After a decade and a half it is only right that we look at how we measure urgent and emergency care with fresh eyes. There have been many innovations in urgent treatment in that time and it is important that they are reflected in how we assess patient care from start to finish.”

The intention is to reduce waiting times - including ‘hidden waits’ that are not captured presently as total waiting times are not measured - improve patient flow, ensure patients receive appropriate and timely treatment in the right place with priority given to those who are the sickest or the most urgent, and improve the overall patient experience. 

The pandemic has lent another dimension to this work programme, and that is limiting unnecessary healthcare contacts to reduce the risk of spreading COVID-19.

The review seeks to align with the ongoing transformation programme of urgent and emergency care by addressing the importance of patient flow into, through and out of emergency departments. Good patient flow prevents ambulances queuing outside of hospital EDs, prevents overcrowding of departments and the associated risk of hospital- acquired infection and reduced quality of care for patients, and prevents delays in patients being discharged or admitted to a bed on the appropriate ward for ongoing care.

These indicators have been developed with a number of acute NHS Trusts and through consultation with an extensive group of clinical and patient representative stakeholders.

The proposed bundle of measures takes account of changes in the way that urgent care is delivered such as the roll-out of Same Day Emergency Care and strengthening of NHS 111. Hospitals will be expected to see and assess patients within 15 minutes; this is one of 10 indicators.

Local health systems could receive a rating that reflects the whole patient journey under the bundle, developed as a result of testing those first published in the interim Report of the clinically-led review of NHS access standards. Integrated care systems would be scored on measures including 111 performance, ambulance response times and patient handovers, timely assessments and time spent in emergency departments (EDs). Data on individual Trusts’ performance would still be published each month.

Taken together, NHS England believes these measures, which have been developed with clinical leaders, will improve patient flow to prevent crowding and ensure A&Es function more efficiently and effectively than the current set of standards which date back 15 years.

The consultation is backed by the Academy of Medical Royal Colleges, Royal College of Emergency Medicine, Healthwatch, Doctors’ Association, College of Paramedics , Patients Association, Stroke Association, Royal College of Physicians, UK Sepsis Trust, Royal College of Psychiatrists, Association of Ambulance Chief Executives, NHS Clinical Commissioners (NHSCC) on behalf of NHSCC and NHS Confederation.

The consultation is open until Friday, February 12, 2021. Click here to view the full report and have your say.

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