A buddy system for poorly performing urgent and emergency care systems will be introduced this winter in an attempt to help the ‘most challenged’ areas.
In a letter sent yesterday to clinical commissioning group leads and provider chief executives, NHS England, the NHS Trust Development Authority and Monitor set out plans to cope with the increased pressure on accident and emergency departments that usually occurs in winter.
NHS England aims to “expand and enhance” the emergency care intensive support team’s work by buddying “challenged” systems with higher performing ones.
It will also provide “additional capacity” to struggling systems “to help embed and sustain performance improvements”. An NHS England spokesman said the “additional capacity” would not include extra funding but would incorporate “clinical, operational and analytical expertise”.
- Winter A&E analysis: More ambulance queues and cancelled operations
- Best practice resources on urgent and emergency care
The support team will be expanded to include experts from social care. The national bodies will set up four “learning collaboratives” where trusts can share improvements and provide support.
There will be no additional funding this year in response to winter pressures on top of the allocations already in CCG budgets. The letter says that “with money now in CCG baselines, there is no additional resilience funding for this year and the focus is now on implementation”.
The letter says trusts “should be confident of the severity of any incident that may warrant a major incident declaration” this winter. Revised guidelines for preparing for an emergency will be published in October.
System resilience groups have been asked for feedback on the progress made in adopting a number of measures called for by NHS England in April.
These include discharging 35 per cent of discharges to be carried out before midday, senior clinicians leading a daily review of inpatients seven days a week, and reducing the delayed transfer of care rate to 2.5 per cent.
System resilience groups will be expected to take responsibility for providers’ performance against the cancer waiting standards - “in particular, the 62 day cancer standard given the need to drive better and sustained performance” - which was announced in July.
All system resilience groups have been asked to “gauge” acute and non-acute capacity and demand ahead of winter.
NHS England has been working with consultancy KPMG and a number of system resilience groups to develop a capacity and demand tool for use nationwide. It will now be tested with the urgent and emergency care vanguards and a larger number of system resilience groups before national rollout.
New orders for ambulance services
Ambulance services have been told by NHS England to take action to cut delays and reduce pressure on A&Es this winter. These include:
- All services should develop urgent care “clinical hubs” available 24 hours, which could include input from pharmacists, dentists, midwives, mental health crisis and liaison psychiatry, end of life care, respiratory, paediatrics, elderly care, drug and alcohol services, social care, and secondary care expertise.
- Ambulance services should have plans to allow patients direct access to community health and social care rapid response teams, including falls services, as an alternative to transporting a patient to A&E.
- Paramedics and nurses should be “empowered” to refer patients they have assessed in person to other parts of the urgent and emergency care network such as urgent care centres and ambulatory emergency care units to avoid an A&E visit.
- Paramedic practitioners could undertake home visits instead of GPs “to avoid unnecessary admissions and admission surges”.
- The ambulance workforce, particularly paramedics, should receive extra training so patients can be treated at the scene without having to attend A&E. Ambulance services should also employ a wider range of health professionals including nurses, midwives and pharmacists.
- “Alternative” vehicles should be used to transport patients “whenever it is safe and appropriate to do so” to free up frontline ambulances.
- Handover delays should be reduced by reviewing patient conditions en route to A&E and alerting acute staff to any special requirements or circumstances. Ambulance trolleys should not be used for patients who are able to walk.
- Implement electronic patient handovers and sharing predicted activity levels with acute trusts on an hourly basis.
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