• NHSE/I sets out plan for “rapid” roll out of new A&E standards in autumn
  • Move part of major shake-up of the NHS’s urgent and emergency care system
  • New metrics have not been published and do not have public backing from ministers
  • Plans are however backed by Royal College of Emergency Medicine and other colleges

NHS England is planning to roll out new emergency care standards, designed to replace the four-hour A&E target, before winter, according to plans published today.

A paper discussed at today’s NHSE/I board meeting says local NHS systems will be asked to adopt the new measures “rapidly, learn from this process and implement improvements in a dynamic learning cycle over autumn”.

However, the new standards have not been published or consulted on and do not have official sign-off from ministers.

The new metrics, which are expected to be introduced in a phased approach, are to be set out in the long-awaited Clinical Review of Standards document. The review, which HSJ understands was ready for publication before the lockdown in March, will be published “soon”, the paper says.

The controversial plans to introduce the measures before winter do however have the Royal College of Emergency Medicine’s backing,which lobbied for the move this month, as well as other royal colleges.

The NHSE board paper, titled The future of UEC services, says: “The additional pressures of covid-19 create a need for an immediate paradigm shift and systems will be asked to adopt new measures rapidly, learn from this process and implement improvements in a dynamic learning cycle over autumn.”

It adds: “Experience during testing has shown that quality improvements are driven through the use of a wider set of metrics used together and not as individual performance measures. We know that changing behaviours is complex.

“The roll out of new standards would need to be part of the wider transformation of urgent and emergency services… This will require sufficient resource, with national oversight, regional support and assurance, and local leadership.”

The Department of Health and Social Care however told HSJ that “no proposals have been made yet and any recommendations will be closely scrutinised across government and subject to public engagement”.

The DHSC statement added: “NHS England is investigating whether improvements could be made to emergency care access standards as part of its ongoing clinically-led review, which will also consider any adaptations required to meet the continuing challenges of covid-19.”

RCEM president Katherine Henderson told HSJ: “We also welcome a recognition that current performance measures do not capture the complexity of [urgent and emergency care] and there is an opportunity to reconfigure both the system and the way we measure what we do to drive positive change.”

She said such a move would help guard against the “unacceptable” prospect of crowded departments. But she added many EDs would require “investment in their facilities to be able to manage the significant infection prevention and control challenges from endemic covid going forward”.

King’s Fund chief analyst Siva Anandaciva told HSJ the changes “may determine how people access emergency care for decades to come” and it was therefore “crucial the proposals are supported by a compelling evidence base that the public and NHS staff have a meaningful chance to scrutinise”.

He also warned that “rapidly changing how A&E performance is measured during Autumn will be no mean feat”. Alongside practical issues, like changing IT systems and staff changing how they approach their jobs, he pointed out that roll out will be happening with the system preparing for a second wave of covid-19, “all of which will put considerable calls on the already limited time of A&E staff”. 

December deadline looms for local systems

The wider transformation plans are also set out in the paper. It says a “minimum specification” for the NHS’s new “111 First” urgent and emergency care model is under development which all systems must implement by December.

The proposals follow HSJ’s exclusive revelation earlier this month that system leaders wanted to introduce the call before you walk A&E model by winter.

The paper says system leaders will identify one “early mover” system in every region to trial “call before you walk” emergency departments imminently. Progress made by the “early movers” will be assessed by a formal evaluation “commissioned for September”.

A source familiar with the plans told HSJ the evaluation will underpin the “minimum specifications” expected for every system to have in place by December.

The paper says: “The ambition [is] that all systems will have implemented a minimum specification of the model by 1 December 2020.”

“[NHSE/I is] now developing a campaign to encourage people to use 111 First, before they walk into an ED. This pairs developments in the NHS 111 service, such as booking into an ED time slot, which will be available across the country from December, with a national, regional and local communication push through public and stakeholder messaging. This will feature national advertising, which we hope to go live in December.”

Some of the £450m of capital funding allocated to the NHS as part of ministers’ covid-19 recovery package will be allocated to support projects which will “improve flow, increase cubicle capacity or enable more same day emergency care”.

The bidding process for funding has not yet been made public but the paper recognsises that the plans will require significant investment at a local and national level (See box: Transforming access to UEC services: a ‘111 First’ model)



 Transforming access to UEC services: a ‘111 First’ model

The paper says: “Patients will still be able to choose to attend ED without having gone through 111 First. However, 111 First will improve the offer to patients and is proving popular in trials through:

  •  Investment in clinical capacity within local clinical assessment services
  • Investment in NHS 111 call handling capacity
  • Improved profiling of all local services on the national Directory of Service
  • Establishing NHS 111 to ED referral processes
  • Development of processes and IT enablers to appropriately stream low acuity unheralded patients to alternative non-ED settings.
  • Local patient communications and engagement

At a national level there are also several initiatives that will be delivered for the benefit of all IUC systems. These include:

  • Ongoing development of NHS Pathways
  • Development of other technologies
  • Potential development of the recently established national COVID Clinical Assessment Service (CCAS)
  • National coordination of patient and public communications.


UPDATED: This story was updated at 21:26 on 28 July to include a statement from the Department of Health and Social Care