There are eleven emergency departments across Cheshire and Merseyside. In common with departments across the country, all face unprecedented levels of pressure due to rising demand, workforce challenges and patients presenting with more complex conditions.
Total attendances at A&E are going up, the proportion of patients seen within 4 hours has fallen at a rate greater than the national average, whilst patients seen between 4 and 12 hours has increased at almost three times the national average.
Delayed transfers of care have increased at a rate significantly greater than the national average. This may be due, in part, to the rising numbers of elderly patients presenting and being admitted through A&E meaning more elderly patients in inpatient beds. This then places a greater reliance on integrated working with social care.
Services are not clinically, operationally or financially sustainable in the long-term without transformational intervention, and our Partnership has a vision for how our urgent and emergency services need to be delivered in future.
The Urgent and Emergency Care (U&EC) programme brings together a wide range of people, including clinical leaders from across Cheshire and Merseyside.
Our vision is for a “sustainable Urgent Care System providing the best care in the right places”. This will mean a fully integrated service, with alternatives provided to A&E to significantly reduce admssions. Our key pieces of work that offer the best opportunities to reduce demand in our busy A&E Departments are:
- Integrated Urgent Care – In particular how the 111 service can advise patients on how to safely avoid attending hospital
- Urgent Treatment Centres and Primary Care Hubs – Developing these as an alternative to A&E
- Primary Care, specifically the delivery of seven day services from your GP
- Ambulance services and how they can deal with issues safely out of hospital
- Cardio-Vascular Disease and Mental Health initiatives which can help people before they need to attend an A&E
What will effective change look like?
- The NHS Improvement initiative ‘Model Hospital’ identifies potential opportunities for improvement when compared to others. All hospitals need to aspire to be the ‘Best in Class’ to ensure that local people have access to high quality and sustainable services
- There will be no standard model. It is important that local communities have access to an Urgent & Emergency Care system that meets their local needs, but we will ensure that there is some consistency with overall design principles and an agreed set of clinical standards agreed by the experts.
- Solutions to the current problem need to be more than just hospital improvements; they need to focus on the system as a whole, with a particular emphasis on out of hospital solutions.
- Small hospitals can still work very effectively. There are a number of small hospitals who are highly rated by the CQC, so we will learn about how that has been achieved, and whether it can be applied locally.
- Any proposals however will have to be aligned to realistic workforce constraints. Recruiting into the NHS is extremely difficult at this present time.
- Whilst there may be some be some inconvenience to patients, we will ensure that there is no clinical disadvantage caused through any change to services.
The lead for this programme is Andy Davies, Clinical Chief Officer at NHS Warrington CCG