A&E shake-up in emergency care revolution

MAJOR changes to NHS emergency services could transform treatment for patients by streamlining care and shifting provision away from traditional accident and emergency units, a landmark review finds today.
..
.

But the recommendations by NHS England medical director Prof Sir Bruce Keogh in response to a dramatic deterioration in the performance of urgent and emergency services in the last 12 months are unlikely to be fully in place for at least five years.

More people will be treated at home, while those requiring hospital treatment will be seen in emergency centres to assess patients and start treatment, and if necessary in major centres providing specialist care for strokes and heart attacks.

Hide Ad
Hide Ad

The changes will put the future of smaller A&E units in jeopardy, with at least half in Yorkshire likely to be downgraded. Under the plans, the 111 non-emergency service will be enhanced to provide people with a “one stop” service over the phone, as part of moves to make out-of-hours services more effective.

Today’s report also proposes bringing together the current range of walk-in centres, urgent care centres and minor injury units under one banner of urgent care centres. The review also said ambulances responding to 999 calls should become “mobile urgent treatment services” and provide care at the scene in up to 50 per cent of cases.

The plans would see between 70 and 100 emergency centres developed in hospitals, alongside 40 to 70 major emergency centres.

The emergency centres would assess and start treatment for patients, arranging transfer to more specialist centres if needed.

Hide Ad
Hide Ad

Sir Bruce said “doing nothing is not an option” and it was already an “illusion that all A&Es are equally able to deal with anything that comes through their doors”.

“In many senses, our A&Es have become victims of their own success because they function as a safety net for people who are worried, frightened, anxious or in pain and therefore have problems that concern them,” he said.

He insisted the review was not about letting local A&E departments “wither on the vine”. The new emergency centres and major emergency centres would be “broadly” similar in number to existing A&E departments.

Sir Bruce said the health service as a whole, including A&E units, must also move towards seven-day working.

Hide Ad
Hide Ad

Work highlighted in the review includes a new seven-day-a-week service at Bradford Royal Infirmary where senior doctors proactively monitor patients coming into A&E to assess whether they need to be admitted or can go home and be cared for under a “virtual ward” managed by specialist nursing and other staff.

In a link-up with social care staff, rapid-response home care packages can also be provided within a matter of days to prevent readmissions to hospital.

Consultant geriatrician Maj Pushpangadan told the Yorkshire Post that 40 to 50 patients were treated at any one time under the virtual ward, accounting for about 10 to 12 per cent of admissions each month.

“The idea is to provide similar care that you would get in hospital but receive it at home,” he said.

Hide Ad
Hide Ad

A separate audit today warns pressure on intermediate community care beds – those used for patients who do not require hospital care but cannot return home – has increased.

It said last year that capacity needed to double to meet potential demand but there was little evidence of extra investment.

Prof John Young, the Department of Health’s national clinical director for integration and the frail elderly, who is also a specialist in Bradford, said provision was “still only about half of that needed”.

“This is likely to be causing poor care experiences and delays across the whole health and social care system,” he said.

Related topics: