Urgent and Emergency Care Review
Keith Willett
Director of Acute Care
www.england.nhs.uk
Annual National Crisis Care
Concordat Summit
November 2015
Annual National Crisis Care Concordat Summit
• update on UECR review
• establishment of UEC Networks
• Crisis Care access & waiting time standards
• winter readiness programme
• UEC vanguards to lead the way
www.england.nhs.uk
Urgent and Emergency Care Review Vision
For those people with urgent but non-life
threatening needs:
• We must provide highly responsive,
effective and personalised services
outside of hospital, and
• Deliver care in or as close to people’s
homes as possible, minimising
disruption and inconvenience for
patients and their families
For those people with more serious or life
threatening emergency needs:
Mental and physical health
www.england.nhs.uk
• We should ensure they are treated in
centres with the very best expertise and
facilities in order to maximise their
chances of survival and a good
recovery
UEC Review – 5 key system changes
1. Provide better support for people to self-care
Mental health
2. Help people with urgent care needs to get the right advice in
the right place, first time
3. Provide highly responsive urgent care services outside of
hospital so people no longer choose to queue in A&E
4. Ensure that those people with more serious or life
threatening emergency needs receive treatment in centres with
the right facilities and expertise in order to maximise chances of
survival and a good recovery
5. Ensure that the urgent and emergency care system becomes
more than just the sum of its parts through the creation of urgent
care:
create UEC networks
www.england.nhs.uk
Helping people help themselves
Self care:
• Better and easily accessible information about self-treatment options
– patient and specialist groups, NHS111 on a digital platform as part
of NHS Choices (nhs.uk)
• Accelerated development of advance care planning
• Right advice or treatment first time - enhanced
NHS111 - the “smart call” to make:
• Improve patient information for call responders (ESCR, care plan)
• Comprehensive Directory of Services (mobile application)
• Greater levels of clinical input (mental health, dental heath,
paramedic, pharmacist, GP)
• Booking systems for GPs, into UCCs, dentists, pharmacy
6
Highly responsive urgent care service
close to home, outside of hospital
• Faster, convenient, enhanced service:
• Same day, every day access to general practice, primary care and
community services advice
• Harness the skills of community pharmacy, minor ailment service
• 24/7 clinical decision-support for GPs, paramedics, community teams
from (hospital) specialists – no decision in isolation
• Support the co-location of community-based urgent care services in
Urgent Care Centres and Ambulatory Care,
• Develop 999 ambulances so they become mobile urgent community
treatment services, not just urgent transport services
• Single Point of Access with Community and Social Care
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From life threatening to local – where
is the expertise and facilities?
• Identify and designate available services in
hospital based emergency centres
• Urgent Care Centres – primary care, consistent, access to network
• Emergency Hospital Centres - capable of assessing and initiating
treatment for all patients
• Emergency Hospital Centres with Specialist services - capable of
assessing and initiating treatment for all patients, and providing specialist
services: transfer or bypass access, 24/7 specialist network support
• Emergency Care Networks:
• Connecting all services together into a cohesive network
overall system becomes more than just the sum of its parts
8
Parity of
esteem for
mental health
Emergency
Centre with
Specialist
Services
UEC Review: arriving here
• Three phases to the programme 2013-15:
Phase 1 DESIGN
Jan – Oct 2013
Phase 2 PRODUCT
DELIVERY
Nov 13 – Dec 14
Phase 3
IMPLEMENTATION
Jan 15 – now
• Examined the challenges the UEC system
faces, and what principles and objectives
a new system should be based on
COMPLETED
• Translation of ‘what’ needs to happen
into ‘how’ these ideas can be
operationalised
COMPLETED
• NOW the final phase is focused on
implementing those new models of care
and ways of working
UEC national enablers:
• Self-care initiatives
Realising the value, ‘Self-care for Life’
• NHS 111 as portal to out-of-hours integrated
service
mental health key component of clinical hubs
• New system-wide indicators and measures
UEC outcomes for both mental/physical health
• Local capacity planning tool
testing with vanguards: includes mental health
UEC products – published help
‘Transforming urgent and emergency care in England’
• Role & establishment of UECNs, published
• Safer, Faster Better published
• Clinical models for ambulance service
publication end 2015
• Improving referral pathways between
urgent and emergency services in England
publication pending
• Financial modelling methodology publication end 2015
• Commissioning guidance for Urgent Care Centres, Emergency
Centres and Emergency Centres with specialist services
publication end 2015
The four greatest challenges
1. Payment system reform
2. Information sharing
3. System measures
4. Workforce and skills shift
13
Proposed new payment model
• A coordinated and consistent payment approach across all parts
of the UEC network
• Making use of three elements:
Quality
Core – Facilities and service
standards
Capacity - Core
Fixed in-year cost
“always on”
Volume
variable
• future-proofed
Volume - Process measures
formative not summative
Acting throughout
payment
Incentives and Sanctions –
Patient outcome
measures (ToC, PROMs)
Patient safety and
experience measures
(mortality, SAEs, PREMs)
mental health included in all UEC networks and payment approaches
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Summary Care Record: Creating the records
• SCRs are an electronic record of
key information from the
patient’s GP practice
• As a minimum contain medication,
allergies and adverse reactions
• Improved functionality with
additional information including
crisis care plans GPs need to
obtain consent
55m
> 2.5m
SCRs
created
contacts in last
year
(96%)
To find out more or enable SCR:
scr.comms@hscic.gov.uk
12 secs
or
@NHSSCR
Mobile access to the Directory of Services
• Testing with vanguard sites during winter 2015/16
System wide
outcomes
Outcomes,
standards
and specifications
• Shift to outcome measurement for whole system
• List of indicators developed under 3 domains:
• Clinical Pathway
• Patient Experience
• Staff Experience
• All will measure physical and mental health
www.england.nhs.uk
Establishing Urgent and Emergency Care
Networks – the purpose
• 24 networks based on geographies required
to give strategic oversight of urgent and
emergency care on a regional footprint
• 1 - 5million population based on population
rurality, local services
• To improve consistency of quality, access and
set objectives for UEC by bringing together
SRG members and other stakeholders to
address challenges that are greater than a
single SRGs can solve in isolation
•
•
•
•
•
Access protocols to specialist services
Ambulance protocol
Clinical decision support hub
NHS 111 services
Uniform approach to mental health crisis
www.england.nhs.uk
Programme: 2015/16: Crisis Care access standards
Where do people present with urgent MH needs and what response should be
expected in the first 24 hrs? (Phase 1)
SELF MGT & CARE PLANNNG
USE OF DIGITAL TECHNOLOGY
ACCESS standards developed
 Primary care response
(in and OoH)
 111 (and the DoS) and 999
 24/7 MH crisis line (tele-triage
& tele-health) and 24/7
community-based crisis
response
 Blue light response, transport
hub, S135/136 response &
health based places of safety
 Urgent and emergency
Liaison MH services
(+ alcohol care teams)
during 2016, not ‘just’ a waiting time’,
but setting up the system to:
1. Describe the standards – access
time + NICE concordant care
2. Agree how to measure
3. Where are we starting from?
- a baseline
4. What will it take to get to where
we need to be? - gap analysis
5. How? - commissioning guides
6. Drive quality improvement
7. Adapt the workforce
8. Build a payment model
9. Report openly
Ensure joined up approach for people with co-existing MH and substance
misuse conditions…
19
UEC winter readiness
• Assurance process for System Resilience Groups
(8 high impact interventions) SRGs provided detailed capacity plans:
• Community care beds (nursing residential and dementia beds,
specialist Elderly Mental Infirm beds) intermediate care (bed-based
and home-based), district nurses and community matrons, and
allied health professionals
• From this year, 5 mandatory mental health indictors included for
first time:
 Join up between SRGs and local Concordat groups
 24/7 crisis resolution and home treatment teams
 24/7 on site urgent and emergency liaison mental health
 S.136 health-based places of safety
 Up to date mental health Directories of Service
www.england.nhs.uk
UEC vanguards
•
Focus on i) local health systems with strongest network progress and ii)
addressing greatest operational challenges
•
Accelerate pace of change
•
Drive new ways of working across organisation boundaries
•
Tripartite support for implementation, help remove barriers
•
Test beds for new UEC initiatives (relationships, workforce, clinical decision
support hubs, payment model, new indicators, mental health)
•
Meet explicit requirements on implementing best practice and national policy
expectations
•
£4m pump prime investment to UEC vanguards to test and evaluate
innovative models of mental health crisis care for children and young
people, and incorporating mental health crisis in testing of payment models
www.england.nhs.uk
A new strong consumer offer to the public:
NHS urgent care starts to look like what the patients tell
us they want, not what we have historically offered
• A single number – NHS 111 – for all your urgent health needs
• Be able to speak to a clinician if needed
• That your health records are always available to clinicians
treating you wherever you are (111, 999, community, hospital)
• To be booked into right service for you when convenient to you
• Care close to home (at home) unless need a specialist service
• Provide specialist decision support and care through a network
…….. we will change patient and staff behaviour through experiential learning
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Urgent and Emergency Care Review
the new offer
It’s great to share
so much with this
group about my
depression
I’m so pleased
my mum got
specialist
care really fast
and I didn’t lose
her
23
It’s like
everyone
knows all about
my problem
I feel so much better
for not having to go all
the way to hospital
every time I need help