Daily Insight: Review ends in tiers

Five integrated care systems face increased scrutiny from NHS England after a “deterioration” in their emergency care performance.

NHS England has revealed the latest list of ICSs which are receiving support after being deemed off target in their urgent and emergency care recovery – particularly for four hours accident and emergency performance and ambulance response times.

Following a review in December, a total of 18 ICSs are now receiving either the most intensive “tier one” interventions from national NHSE teams, or “tier two” support from regional teams. This is up from 14 ICSs in June.

Shropshire, Telford and Wrekin ICS has been escalated from tier two to one as a result of the review, while Bath and North East Somerset, Gloucestershire, Lincolnshire and Northamptonshire ICSs have entered “tier two”.

Sarah-Jane Marsh, NHSE national director for urgent and emergency care, told ICS CEOs their level of tiering had increased to “[reflect] the increased challenge in achieving the targets for this system” and “a deterioration” in their performance.

North East London ICS was moved from “tier one” to “tier two” because of a “sustained improvement in performance” and “clear commitment to culture change and empowering your frontline clinical and operational leaders,” Ms Marsh said in a letter.

The “tier“ groups are mainly based on performance against the four hours target and category two ambulance response times. But other metrics such as 12-hour A&E waits, ambulance handovers and delayed discharges are also considered.

Resilience rehomed

Major incidents such as a terrorist attack or a major crash are always going to challenge the NHS – and, in particular, ambulance services which may be faced with difficult conditions and dozens of injured patients.

The Manchester Arena bombing inquiry highlighted some of this and is likely to lead to more staff needing to be trained in responding to hazardous situations. For 13 years, the National Ambulance Resilience Unit has led on this and fostered interoperability between ambulance trusts – several of which may be called upon for the most serious incidents.

But now it has a new “host” with London Ambulance Service Trust taking over the contract from West Midlands Ambulance Service University Foundation Trust. It’s not yet clear what this change will mean – although HSJ understands a new name for the service may emerge – but a strategic review of training is expected. Much of the training currently takes place at military premises near Sailsbury.

Nor is it clear what will happen to staff based at the unit’s headquarters near Coventry. Many will be TUPEd to LAS from WMAS but will they need to move to a new base – and will vital knowledge be lost if they leave?