NHS England Chief Executive Simon Stevens and the NHS Five Year Forward View partners today (Friday) announced eight new vanguards that will launch the transformation of urgent and emergency care for more than nine million people.
This comes as NHS England also revealed the success of Regional Major Trauma Networks which, after they were set up just three years ago, have seen a remarkable 50 per cent increase in the odds of survival for trauma patients revealed in a new independent audit by the Trauma Audit and Research Network (TARN).
Building on the recent success in improving trauma survival rates, the urgent and emergency care vanguards are tasked with changing the way in which all organisations work together to provide care in a more joined up way for patients.
Urgent care will be delivered, not just in hospitals but also by GPs, pharmacists, community teams, ambulance services, NHS 111, social care and others, and through patients being given support and education to manage their own conditions. Another aim is to break down boundaries between physical and mental health to improve the quality of care and experience for all.
The eight new vanguards will spearhead this work and, like other vanguards, will benefit from a programme of support and investment from the £200m transformation fund.
Six vanguards will cover smaller local systems which may include hospitals and surrounding GP practices and social care, while two network vanguards will be working with much larger populations to integrate care on a greater scale.
This will include innovative plans such as those in North-East England where services across the region will be aligned to a single joined-up system to ensure all patients including those living in remote rural locations will get the care they need, including a rapid specialist opinion should they need one.
The West Yorkshire network will launch mobile treatment services and, working with mental health providers and the police, create rapid crisis response and street triage services.
Other vanguards, such as Leicester, Leicestershire and Rutland, will focus on establishing same-day response teams with GPs, acute home-visiting and crisis response services, community nursing, an older people’s assessment unit and a new urgent care centre.
NHS England’s Chief executive, Simon Stevens, said: “Starting today, the NHS will begin joining up the often confusing array of A&E, GP out of hours, minor injuries clinics, ambulance services and 111 so that patients know where they can get urgent help easily and effortlessly, 7 days a week. That’s why we’re backing what our frontline nurses, doctors and other staff, in partnership with local communities, to radically redesign our urgent and emergency services.”
Professor Chris Moran, NHS England’s National Clinical Director for Trauma Care, said: “It’s enormously rewarding for the NHS and the people it serves that in just three years we have seen a fifty per cent increase in the odds of survival with life-threatening injuries, that’s hundreds more patients saved since the networks started.”
Professor Keith Willett, NHS England’s Director of Acute Care, who is leading the Urgent and Emergency Care transformation, said: “This proves a modern NHS needs a very different approach and shows, we can transform patient care.
“These networks and new vanguards will support and improve all our local urgent and emergency care services, such as A&E departments, urgent care centres, GPs, NHS 111 and community, social care and ambulance services, so no one is working isolated from expert advice 24 hours a day.”
“All over the country there are pockets of best practice yielding enormous benefits; but to ensure our urgent care services are sustainable for the future every region must begin delivering faster, better and safer care. Now it is time for the new urgent and emergency care vanguards to design the best solutions locally.”
Today’s launch of the vanguards comes in the face of pressure on all NHS frontline emergency services, with increased A&E attendances and emergency admissions, and both ambulance and NHS 111 services facing rising demands.
The Urgent and Emergency Care vanguards are a key element within the NHS Five Year Forward View which is a partnership between NHS England, the Care Quality Commission, Health Education England, Monitor, the Trust Development Authority, Public Health England and the National Institute for Health and Care Excellence and represent the next step in the transformation of Urgent and Emergency Care for the NHS announced by Sir Bruce Keogh, NHS England’s National Medical Director, in 2013.
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Background Information:
The Urgent and Emergency Care Vanguards – Pen profiles:
South Nottingham System Resilience Group
The South Nottingham System Resilience Group (SRG) is made up of more than a dozen local partners.
These include Nottingham University Hospitals NHS Trust, the South Nottingham and Erewash clinical commissioning groups, Nottingham City and County Councils, East Midlands Ambulance Service (EMAS ), Nottingham CityCare Partnership, County Health Partnership, Nottinghamshire Healthcare NHS Foundation Trust, Derbyshire Health United Ltd (111 provider), Nottingham Emergency Services (GP out of hours), Health Watch Nottingham and Health Watch Nottinghamshire.
The vanguard will support ambitious improvements in urgent and emergency care for the citizens of South Nottinghamshire. Partners will look at what more they can do, using innovative workforce solutions to ensure that people receive care in a timely way and closer to home – in many cases avoiding the need for assessment or admission to hospital.
Work will focus on:
Enhancing mental health services in the community to give patients the care they need, in the best place in a timely manner. This will include rolling out and extending the National Mental Health 111 pilot to provide faster and better care when it is needed.
Improving access, clinical assessment and treatment to primary care clinicians at the ‘front door’ of the emergency department so that patients are assessed and then followed up closer to home.
Enabling more direct clinician to clinician conversations so that more patients are directed to the right service, first time, every time.
The system will involve patients, carers and wider partners in its improvement to lead the way in providing ever more timely and safe emergency care.
Cambridgeshire and Peterborough Clinical Commissioning Group
Cambridgeshire and Peterborough Clinical Commissioning Group (CCG) has three System Resilience Groups and is part of the East of England Urgent and Emergency Care Network.
The CCG’s vision is to create an overarching super SRG with strong clinical leaders, as part of the existing network.
As a UEC Vanguard the CCG aims to accelerate improvements and develop a best practice model for urgent care services which helps address variations in access to services and health inequalities in the region.
The ‘super SRG’ will focus on:
Promoting self-care and management.
Helping people with urgent care needs get the right advice first time and to access the right service 7 days a week.
Providing highly responsive urgent care services outside of hospital.
Developing a workforce to meet these needs including GP Fellows, Advanced Nurse Practitioner and advanced AHP roles, developed community pharmacist roles, physician’s assistants and staff equipped to meet mental and physical health needs.
Reassessing service standards based on outcomes and redefine payment methods to incentivise system redesign.
North East Urgent Care Network
Participation by the North East Urgent Care Network (NEUCN) in the Vanguard Programme will benefit the whole of the North East region.
This covers areas around Northumberland, Tees, Esk and Wear Valley, Newcastle, Northumbria, Gateshead, Tyneside, Sunderland, County Durham, Darlington and Hartlepool – a region with a population of 2.71 million. It is made up of three major conurbations, and spreads across both urban and rural areas.
The NEUCN – which consists of all the key physical, mental health and care stakeholders and providers – already has a strong history of working collaboratively to deliver successful innovative projects to support the recommendations made in the Urgent and Emergency Care Review as well as, importantly, improving patient outcomes and experience.
This programme will enable the Network to transform the regional UEC system and its services to further improve consistency and clinical standards, reduce fragmentation and deliver high quality and responsive health and social care to patients.
It will also enable them to move at pace in terms of creating and implementing one urgent and emergency care model as well as giving strategic oversight to urgent and emergency care services across the regional footprint, providing consistent and seamless care, wherever patients present, whatever the day or hour with no difference in the clinical outcomes delivered.
Barking and Dagenham, Havering and Redbridge System Resilience Group
Barking and Dagenham, Havering and Redbridge System Resilience Group aims to create a simplified, streamlined urgent care system delivering intelligent, responsive urgent care for 750,000 residents in the most challenged health economy in the country.
The SRG believes there is a need to do things differently and that patients are confused by the many and various urgent and emergency care services available to them – A&E, walk-in centre, urgent care centre, GPs, pharmacists, out of hours services.
Becoming a UEC Vanguard will support the SRG in its ambition to streamline these points of access to just three – supported by a smart digital platform that will recognise patients and personalise the help they get as soon as they get in contact. This involves:
‘Click’ – online support and information – will help people to self-care and book urgent appointments when needed.
‘Call’ – telephone for those who need more advice, reassurance or to book-in.
‘Come in’ – where patients really need emergency care – the front door of the hospital will become our new ambulatory care centres.
This ambitious plan is being developed with patients and staff, and will be implemented by building on existing successful partnership working between NHS and social care organisations across the three boroughs.
West Yorkshire Urgent Emergency Care Network
Established in 2014, the West Yorkshire Urgent and Emergency Care Network Vanguard covers Leeds, Bradford, Calderdale, Kirklees, Wakefield and Harrogate. It serves a population of around three million people.
The Vanguard will work with partners, including five local System Resilience Groups, to build on progress already made in transforming primary, community and acute care services.
Yorkshire Ambulance Service will develop a stronger focus on becoming a mobile treatment service delivering care at patients’ homes with conveyance to hospital for those who really need to go.
Three mental health service providers will work with West Yorkshire Police to deliver major service change which will see rapid crisis response through emergency response control centres and ‘street triage’.
Other planned projects include creating an Integrated West Yorkshire Care Record and a system-wide information dashboard which reports in ‘real-time’.
Leicester, Leicestershire & Rutland System Resilience Group
The Leicester, Leicestershire & Rutland System Resilience Group (SRG) Vanguard covers the City of Leicester, Counties of Leicestershire and Rutland and surrounding towns, serving a population of 1.1 million people.
The Vanguard will create a new alliance-based urgent and emergency care system where all providers work as one network. This will bring together ambulance, NHS111, OOH and Single Point of Access services to ensure that patients get the right care, first time.
The network will include a same-day response team with GPs, acute home-visiting and crisis response services, community nursing, older peoples’ assessment unit and urgent care centres.
University of Leicester Hospitals NHS Trust (UHL) runs the largest single site A&E department outside London. In 2016, the hospital’s urgent and emergency care front door will be re-launched to include an assessment team with the ability to refer patients to ambulatory clinics, assessment beds, on-the-spot urgent care centres or primary or community care.
Solihull Together for Better Lives
Solihull Together for Better Lives Partnership comprises the Heart of England NHS Foundation Trust, Birmingham and Solihull Mental Health NHS Foundation Trust, Solihull Metropolitan Borough Council, NHS Solihull Clinical Commissioning Group, Primary Care, and lay members representative of the Solihull population.
The partnership will create an integrated health and care system that extends healthy active life and optimises preventative out of hospital care with rapid access to specialist care. This will be both in and out of hospital when needed, including access to other wellbeing services both at the hospital and in the community.
This will involve building an Urgent Care Centre within the hospital site capable of delivering a minor illness and minor injury service in line with the description of Urgent Care Centres given within the Keogh report, which includes GP out of hours, urgent primary care and minor injury services.
Redesigning care models for older people – from prevention and early intervention through to end of life care – will alter the balance of care provided in both hospital and the community, reducing pressure on secondary care services.
South Devon and Torbay System Resilience Group
South Devon and Torbay’s vanguard is led by South Devon and Torbay Clinical Commissioning Group, South Devon Healthcare Foundation Trust and Torbay and Southern Devon Health and Care Trust, on behalf of the local System Resilience Group, which also includes Torbay Council, South Western Ambulance Services Foundation Trust, Devon Doctors Ltd and community pharmacy.
The group will serve a mixed urban and rural population.
The vanguard will develop new Urgent Care Centre facilities at pace in at least two areas, prioritising those of higher deprivation to reduce inequalities.
To make the best use of the resources spent locally on urgent and emergency care and avoid duplication, primary care facilities will be co-located with A&E and Urgent Care Centres in at least two locations, and primary care records will be shared with the out-of-hours provider.
Trauma Audit and Research Network (TARN) data:
Results from the national audit by TARN www.tarn.ac.uk released today show an increasing number of patients who would have died before the introduction of Regional Major Trauma Networks in England in 2012, now survive severe injuries.
The TARN analysis suggests that the odds of a major trauma patient surviving in NHS England are 63 per cent better in 2014/15 than in 2008/09. It also shows a significant seven-year improvement trend.
Prior to the introduction of the new Regional Major Trauma Networks (2008/09 -2011/12) there had been no significant trend for improved odds of survival.
Since the Trauma Networks were established in 2012, however, there has been a remarkable 50 per cent increase in the odds of survival for trauma patients. The Networks enable the rapid and safe transfer of patients to designated Major Trauma Centres throughout the country.
As well as improving survival, a key aim of the Major Trauma Networks is to improve the quality of life in the survivors. In collaboration with a number of Major Trauma Centres, TARN is assessing the feasibility of routine collection of patient reported outcomes to plan future services based on the long term impact of major trauma on patients.
For further information and interview requests, contact: Jamie Brown, Media Relations Office, Faculty of Medical and Human Sciences at Manchester University. Tel: 0161 275 8383 or 07887561318. Email: brown@manchester.ac.uk
Statistics showing the increasing pressures on Urgent and Emergency Care:
Demands on A&E soar over the past decade:
There were 22.4million A&E attendances last year – 600,000 more than in 2013-14.
Attendances are 1,852,000 or 9% higher than 5 years ago (2009-10) when there were 20,512,000 attendances.
The growth in A&E attendances on 10 years ago (2004-05, when the total was 17,837,000) is up 4,527,000 or 25%.
There were a total of 5,483,000 emergency admissions 2014-15 – that is 210,000 MORE than in 2013-14.
Emergency admissions for 2014-15 are up 392,000 or 8% on the total of 5,091,000 in 2011-12
Ambulances face rising demands:
The number of calls where a Category A ambulance arrived at the scene has increased 25%between 2011.12 and 2014/15
The highest number of calls per day, 9,779, was recorded in December 2014 – more than in any other month, since this series began in 2011.
Calls per day where a Category A ambulance arrived at the scene were:
6,856 in 2011-12
7,431 in 2012-13
7,847 in 2013-14
8,576 in 2014-15
NHS 111 service under increased pressure:
NHS 111 received 4.1million MORE calls than in 2013-14. In 2014-15 it handled more than 12million calls and this is expected to rise to around 16million this year.
NHS 111 dealt with 4.6 million calls this winter (2014/15 Nov-Feb) – around one million or 27% up on the 3.6m calls handled for the same period last winter.
In handling 12 million calls, NHS 111 offered treatment to over two million people who would otherwise have visited A&E, and another 600,000 who would have dialled 999 for an ambulance, reducing a significant amount of unnecessary pressure on our urgent care services.
The latest NHS 111 follow-up surveys, for the year ending September 2014, show that 30% of callers would have gone to A&E, and 17% would have contacted the 999 ambulance service, had NHS 111 not been available. Of actual NHS 111 calls over the same year, 8% were recommended to attend A&E, and 11% had an ambulance dispatch.
The total number of calls offered to NHS 111 in England:
2010/11: 187,630
2011/12: 616,155
2012/13: 1,894,057
2013/14: 8,785,341
2014/15: 12,880,769
2014/15 had 47% more calls than 2013/14 as the NHS 111 service was gradually rolled out across England, reaching completion in February 2014.
April 2015 (1,130,894 calls) was 5% more than April 2014 (1,080,893), and May 2015 (1,184,177) was 6% more than May 2014 (1,112,633).
* For further information, contact the NHS England national media team on nhsengland.media@nhs.net and 0113 8250958 or 07768 901293