The publication of the Delivery Plan For Recovering Urgent and Emergency Care Services comes at a time of immense pressure for those working on the frontline. The ongoing threat of Covid combined with seasonal pressures have seen record numbers within hospitals, rising ambulance waiting times as well as wider knock-on effects across health and care.
The plan heralds a vision aligned with the principle of right care, right setting and right time with two overarching goals. First, for patients to be seen and discharged more quickly, and second, to improve ambulance response times.
To achieve these ambitions, proposals outline initiatives in a number of areas with a major focus on innovation, integration and digital technology. Here, in this short primer, we take a look at the key digital takeaways.
"New digital technologies provide the opportunity to change the way in which services are provided, but also transform the way in which people access services." - Delivery Plan For Recovering Urgent and Emergency Care Services (NHS England & DHSC)
Growth in system control centres
NHS England outlines the expanded use of system control centres (SCCs) for the purposes of intelligent bed management. Such centres have supported near real-time management of resources and capacity during the winter months, underpinned by data and other digital tools.
This enables decisions to be made more quickly informed by clinical expertise, and resources redirected to support patients and staff in areas most in need. Operating 24/7 within integrated care systems and integrated care boards, this data-driven concept can also help to facilitate wider system working.
"They (SCCs) will ensure the highest quality of care possible for the population in every area by balancing the clinical risk within and across acute, community, mental health, primary care, and social care services." - NHS England & DHSC
NHS England will now work with integrated care systems to further embed these ‘pioneering’ models year-round with electronic bed management systems expected to be in place in trusts by summer 2023. While an Admissions Forecasting Tool will also be rolled out in the future.
Provision of discharge data
To tackle delayed discharge, a key priority will be the generation of greater data insights between discharge-ready dates and the actual date of discharge.
A new metric will be specifically introduced for this purpose to ensure patients that are ready to leave hospital are able to do so when appropriate. This metric will be considered by the Care Quality Commission in its assessment of integrated care systems and their performance, as well as the Office for Local Government’s assessment of local authorities.
To measure “the whole patient journey in hospital,” the system will also see greater development and publication of data on A&E including time of arrival, time spent and 12-hour waits. This comes alongside working with partners in social care on a measure of discharge. All this data will be available to inform future capacity planning.
NHS England and the Department of Health and Social Care will also seek to develop a greater understanding of possible reasons for delay in discharge by providing clearer insights in this area.
"This data will facilitate a focus on the combination of NHS and social care capacity needed for domiciliary care, home-based reablement, stepdown care and long-term residential care, together with the more specific capacity needed for people with more specialist needs such as those with dementia needs." - NHS England & DHSC
Continued growth of virtual wards
The plan earmarks the increased use of virtual wards to expand new services in the community and bridge “the gap between hospitals and patients homes.” This includes an extra 3,000 beds building on the 7000 already in the community. Particular focus areas include scaled services for acute respiratory infection, frailty and heart failure.
Within this model, patients are cared for and remotely monitored out-of-hospital where possible in effort to reduce avoidable admissions. While ongoing support can be provided for the patient’s physical and mental health needs in their place of residence.
"We know that up to 20% of emergency admissions are potentially avoidable with the right care in place." - NHS England & DHSC
Particular examples of best practice highlighted include an integrated frailty model combining a dedicated assessment service involving virtual wards and community nursing with hospital-based secondary care expertise. This is said to have produced “a 50% reduction in ambulances conveying patients aged over 75 to emergency departments.”
While a ‘Hospital at Home’ model that has delivered a range of digital-enabled care with a multidisciplinary clinical team is estimated to have saved over 2,000 bed days in ten months.
Utilisation of 111 and clinical assessment services
NHS 111 continues to see an increasing number of calls and a level of growth the plan estimates at 6% a year. At the same time, the plan concedes an increased percentage of 111 calls were abandoned over winter.
The role of NHS 111 is highlighted as an integral component of ensuring people access the right care at the right time, and reducing emergency care demand. To that end, future workstreams include the integration of 111 online with the NHS App, in an effort to make it even easier for patients to access. Mental health support will also be made universally available through 111 by April 2024.
Additional initiatives include the expansion of information on care options, self-care and management. While a planned review of 111 services will also explore the potential for AI and machine learning to be integrated within NHS 111 in the future.
The role of clinicians within NHS 111 is also highlighted for its benefits in providing clinical advice to patients and the most appropriate services for their needs.
An integrated care system clinical assessment service utilising experienced clinicians from general practice, urgent care, mental health is noted as a best practice example in this regard. The service has generated results such as 94% of patients who would have received a Category 3/4 ambulance response being clinically assessed as able to have their care needs met elsewhere in the community.
"We are looking to better use clinicians in 111 for the patients who will benefit most. New technologies should help people to get clinical advice and be directed to the most effective care". - NHS England & DHSC
Further information
The above article is a summary of some of the major digital workstreams. The full plan is available via the NHS England website.
How Livi supports urgent care
Livi can support NHS 111 and clinical assessment services with digital clinical capacity as well as managing cases from emergency departments that can be treated remotely.
We focus on building optimal pathways between urgent and primary care. Taking just one of clinical assessment service partnerships as an example, we helped to prevent 5,000 emergency department attendances, protected over 1,000 clinical hours, and exceeded the consult-and-complete target by 12% in just five months during the busy winter period.
To find out more about how we can help you, contact: partnerships-uk@livi.co.uk.
