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NHS leaders promise boost for urgent care to ease A&E pressure

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Comprehensive same-day care for the seriously ill and walking wounded will soon be available at most major accident and emergency departments, under moves designed to ease pressure on England’s struggling hospitals.

The reforms – set out on Monday in the NHS Long Term Plan – should mean patients in need of urgent treatment spend just hours in hospital, rather than being admitted overnight.

“The same day emergency care model should be embedded in every hospital”

NHS Long Term Plan

The move is among a series of measures in the plan that are designed to reduce pressure on over-stretched emergency departments especially during the difficult winter months.

Other measures include the establishment of acute frailty teams to look after elderly patients, initiatives to divert more people in need of urgent care away from hospital, and more work to ensure speedy discharge.

The plan highlights various steps that have been taken in the past two years in an effort to reduce pressure in emergency care, including increasing the availability of evening and weekend GP appointments, improvements to the NHS 111 service and the development of more urgent care centres.

However, it acknowledges more needs to be done to tackle the “very substantial pressures” across the NHS.

The plan advocates wider use of “same day emergency care” – also known as ambulatory emergency care – designed to reduce the proportion of emergency cases needing to be admitted to hospital overnight.

According to the plan, the model, which was co-developed by the Royal College of Physicians and the Society of Acute Medicine, is now being successfully deployed in an increasing number of hospitals.

“Smaller hospitals have significant challenges around a number of areas including workforce”

NHS Long Term Plan

However, there are “large differences” in the extent to which the model has been adopted by individual settings.

Under the long-term plan, every acute hospital with a major A&E department will be expected to move to a “comprehensive model” of same day emergency care (SDEC). “The SDEC model should be embedded in every hospital, in both medical and surgical specialties during 2019-20,” said the plan.

Key milestones set out in the document include the fact that all hospitals with a major A&E department should provide SDEC services for at least 12 hours a day, seven days a week by the end of 2019-20.

In addition, hospitals will also be expected to reduce avoidable hospital admissions by setting up acute frailty services so elderly patients can be assessed, treated and supported “by skilled multi-disciplinary teams delivering comprehensive geriatric assessments in A&E and acute receiving units”.

Hospitals with major A&E departments should provide an acute frailty services for at least 70 hours a week and will “work towards achieving clinical frailty assessment within 30 minutes of arrival”, stated the plan.

Meanwhile, the plan promises improvements in care pathways to ensure timely treatment for patients with the most serious illness and injury including stroke, heart attack, major trauma, severe asthma and those with sepsis.

In addition, it promises a new dedicated model of delivery for smaller acute hospitals in rural areas, which have struggled to meet generic national standards.

“Smaller hospitals have significant challenges around a number of areas including workforce and many of the national standards and policies were not appropriately tailored to meet their needs,” said the plan.

“We will work with trusts to develop a new operating model for these sorts of organisations, and how they work more effectively with other parts of the local healthcare system,” it added.

“The clinical assessment service will also support health professionals working outside hospital settings”

NHS Long Term Plan

Core to the reforms is the creation of a new multi-disciplinary clinical assessment service (CAS), which will sit within a service that also includes NHS 111, ambulance dispatch and GP out of hours services.

The service, to be introduced from 2019-20, will provide specialist advice treatment and referral from a wide range of healthcare professionals encompassing physical and mental health in a bid to divert people away from attending A&E.

It will also support healthcare professionals when it comes to making decisions about care and treatment and GPs, community teams and ambulance staff will be able to use the service to make referrals to rapid response community teams – flagged up elsewhere in the plan – whose roles is to prevent frail and elderly patients needing to be admitted to hospital where possible.

“The CAS will also support health professionals working outside hospital settings, staff within care homes, paramedics at the scene of an accident and other community-based clinicians to make the best possible decision about how to support patients closer to home and potentially avoid unnecessary trips to A&E,” said the plan.

By 2023, the aim is for CAS to act as “the single point of access for patients, carers and health professionals for integrated urgent care and discharge from hospital care”.

The plan will see the rollout of urgent treatment centres across England by 2020 to ensure all areas have an accessible alternative for those patients who need swift treatment but don’t need to go to hospital.

It also promises further work with ambulance services to look at ways to boost performance such as reducing hospital handover delays and schemes that see skilled paramedics treat more people at home or in non-hospital settings.

Meanwhile, the plan sets out new targets for reducing delayed discharge from hospital. The goal over the next two years to achieve and maintain an average delayed transfer of discharge figure of 4,000 or less delays with the aim of reducing that further over the next five years.

Moves to support this will include placing therapy and social work teams in hospitals so they can start planning for discharge as soon as a patient arrives.

The expectation will be “that patients will have an agreed clinical care plan within 14 hours of admission, which includes an expected date of discharge”, said the document.

The new 10-year plan for the health service was published yesterday at 12pm, after being delayed since the end of last year – reportedly due to the chaos around Brexit.

The blueprint sets out how the £20.5bn annual budget increase for the health service, which was promised last summer by prime minister Theresa May, will be spent.

Ahead of its publication, some of the main aims and innovations to be included in the plan were revealed in a statement by NHS England.

Maternity care, children’s services, cancer care, mental health and heart disease were all highlighted as being set to benefit, along with funding boosts for community care, digital technology and prevention.

The last time a 10-year strategy document was drawn up covering the whole health service in England was the NHS Plan, which was published in 2000 by the Labour government under Tony Blair.

  • More details on the NHS long-term plan can be found on a website created by NHS England along with the document itself.
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