People Requiring Urgent and Emergency Care
Population Outcome: People Requiring Urgent and Emergency Care in Suffolk and North East Essex Stay Well
The best urgent and emergency care, when and where people need it, is essential if everyone in Suffolk and North East Essex is to live well. Preventing deterioration in the health of people with health conditions, access to prompt treatment in the right setting, and effective planning for care and recovery, means people and their carers and families can avoid the need for urgent care and receive the best care when they do need it.
Emergency Department Data
- Emergency Departments provide a service for life threatening illnesses or accidents which require immediate, intensive treatment
- Around 250,000 Emergency attendances in the last year in SNEE – around half of these classified as ‘Majors’
- Over 77,000 ambulance journeys in the last year – an average of about 6.5 thousand a month. In winter months it is over 7,000
- According to The Health Foundation’s analysis, emergency admissions have grown 42% in the last 12 years
- In 2015/16, one in three emergency patients admitted for an overnight stay had five or more health conditions, up from one in ten in 2006/07
- Biggest increase for older patients, up by 58.9% since 2006/07 for people aged 85 years or older
Urgent Treatment Centre Data
Urgent Treatment Centres usage has seen an increase in the last three years
NHS 111 Data
- NHS 111 has clinicians and call advisors to give patients advice, book patients in to be seen at their local emergency department, or an urgent treatment centre, emergency dental services, pharmacy or another more appropriate local service – as well as send an ambulance should the patient’s condition be serious or life-threatening.
- Not all people are seeking help elsewhere before going to ED – people are still often unaware of alternatives
- People often report the difficulty in accessing alternative services when they need them
- Some people will still attend an Emergency Department anyway, as they consider that it offers easier access into health care than other services or see them as the most convenient option for them
The Story Behind the Outcome
Primary care response to emergency
Extending access to primary care
Treating minor injuries
Waiting for emergency care
Supporting A&E and freeing up beds
Living with back pain
Being heard, and staying well after ill-health
Reducing demand on A&E
Obtaining urgent advice quickly
The need for joined up thinking
Accident and Trauma
- More people accessing A&E – 25 million attendances in 2019/20 compared to 21.5 million in 2011/12.
- More emergency admissions to hospital, combined with fewer available beds.
- Delays in transferring patients out of hospital
- Advances in medical practice, meaning more people can be treated in A&E rather than being admitted.
- Staff shortages throughout the urgent and emergency care system
A&E attendances are twice as high for people in the most deprived areas as in the least deprived.
The King’s Fund highlights that research shows:
- people living in deprived areas are more likely to prefer A&E departments over their GP to get tests done quickly
- people in areas of deprivation find it more difficult to get an appointment with their GP and think A&E doctors are more knowledgeable than GPs.
- people who frequently attend A&E often face housing insecurity, homelessness and mental health issues.
Demography and Inequality
- Poorer people make more use of NHS services – especially emergency services
- People from the most deprived areas tend to have more health problems, making them more likely to require admission to hospital
- People living in the most deprived fifth of neighbourhoods in England have nearly two and a half times as many preventable emergency hospitalisations as people living in the least deprived fifth
- Nuffield Trust compared indicators measuring the quality of NHS care for the 10% of people living in the most deprived areas and the 10% of people living in the least deprived areas of England to see how the results differ
- 4th from top inequality on list of inequality scores (after avoidable mortality and smoking) is the rate of admissions for ambulatory care-sensitive conditions. The gap between the most and least deprived hasn’t changed in over 10 years
Accident and trauma - children
- Between 23 March and 23 April 2020, 10 children with suspected abusive head trauma were seen at Great Ormond Street, which is 15 times higher than the average for the same period over the previous three years.
- Between April and October 2020, Ofsted had over 300 serious incident notifications, almost 40% of these were about babies, over a fifth more than for the same period the previous year. Over half of the cases about babies related to non-accidental injuries.
- Between April and September 2020, there was a 31% rise in incidents of death or serious harm to children under 1 when compared with the same period in 2019.
The NSPCC reported that increased risk factors for non-accidental injuries heightened by Covid 19 included:
- Social isolation from the support that friends and family usually provide to parents and carers.
- Less access to services including health visits, childcare and mental health services. Social distancing also reduced the ability of professionals to pick up on early warning signs.
- Financial uncertainty linked to an increase in abuse and mortality from non-accidental head trauma.
The Impact of Long Term Conditions
“patients who were most able to manage their health conditions had 38% fewer emergency admissions than the patients who were least able to. They also had 32% fewer attendances at A&E, were 32% less likely to attend A&E with a minor condition that could be better treated elsewhere and had 18% fewer general practice appointments” (The Health Foundation)
- Close to half of all emergency admissions are in those aged 65+
- Evidence suggests that in middle aged and older adults, frailty is significantly associated with multimorbidity in those with four or more long term conditions.
- Long term conditions associated with frailty include multiple sclerosis, chronic fatigue syndrome, chronic obstructive pulmonary disease, connective tissue disease and diabetes.
- Between 2017 and 2035, the number of people aged 75 over admitted to hospital due to a fall is expected to rise by 70%.
- The older population with immobility, incontinence and self-care limitations is predicted to rise significantly
Children With Long Term Conditions
In 2017 The Nuffield Trust found children and young people with asthma, diabetes and epilepsy from the most deprived areas are consistently more likely to go to A&E and to need emergency hospital treatment than those from the least deprived areas. Emergency admission rates in the most deprived areas was:
- Asthma: double the rate of the least deprived among school-aged children (2005/6)
- Diabetes (all types): twice as likely among 20–24-year-olds (2015/16).
- Epilepsy: improving, with the most progress in reducing unplanned admissions for the most deprived groups.
Suggested causal factors included:
- The effect of wider social determinants of health and deprivation: housing, pollution, smoking, nutrition, educational attainment, and health literacy.
- Less timely recognition of illness and inadequate community management of illness: quality and accessibility of services; children and families’ ability to self-care and seek appropriate support.
- Deprived populations are less likely to access primary care: lower level of GP registration (particularly during adolescence), greater difficulty in getting a GP appointment, and poorer perception of the quality of primary care.
- Short term – health policies that engage and focus on families living in deprivation.
- Long term – reducing economic and material deprivation and improving the social determinants of health
- Each stroke is different and a person’s risk of stroke can depend on a number of things.
- Research is yet to find signals specific to stroke that can easily and accurately predict if someone will have a stroke.
- Certain health conditions, like high blood pressure, high cholesterol and diabetes increase the risk of stroke.
- By giving people the right treatment and advice, we can help them manage these conditions to reduce their risk of stroke.
After a stroke, you are at an increased risk of another stroke. When you’re coping and adapting to life after stroke, it can be particularly hard to take action to avoid another stroke, like doing physical activity.
As a result the Stroke Association has developed an online resource, selfhelp4stroke.org which covers:
- keeping well (including sleep and managing stress)
- being active, emotional support (including relationships)
- coping with setbacks by recognising and managing early warning signs such as lack of motivation, stress, or not managing daily living as usual.
The Charter includes rights to a quality standard of care, and to accurate information, but also highlights the need for equality in society:
- The Right to live without fear of discrimination, exclusion or prejudice.
- The Right to an education system and childcare provision that is informed, trained in allergy awareness, and can manage the healthcare needs of pupils living with allergic conditions.
- The Right to clear and accurate information needed to make safe food choices to confidently eat in or out of the home without the fear of allergic reaction.
- The Right to travel with confidence knowing that the needs of those living with allergy will be catered for.
- The Right to carry the medication needed to respond to allergic reactions at all times.
- The Right to access emergency medicines at all times and in all places.
- The Right to live in a society that understands the lifelong impact of allergic disease.
- The Right to live in a society that takes allergy seriously.
Crisis Mental Health
Main benefits of the alternative care pathways and assessment facilities:
- More appropriate environment for assessment – calmer, better ‘front door’ to mental health services, less time pressure for mental health assessors.
- Reduced emergency department workload – less pressure on acute hospital staff.
- Greater accessibility of mental health expertise – especially for children and young people.
The main drawbacks:
- Risk of physical illness being overlooked – including misinterpreting delirium and brain injury as mental illness.
- Potential increase in the stigmatisation of mental illness by acute hospital staff – reinforcing these people are ‘different’ and ‘not theirs’.
- Staffing – less multidisciplinary care, de-skilling of A&E staff, splitting MH resources across sites requires extra staff.
- Delays in the emergency mental health care pathway – time taken transferring patients between sites.
- Need to clarify legal status of patients in mental health settings – are they inpatients or outpatients?
References & Further Reading
What we know matters and why
|I can prevent the need for urgent and emergency care||I can prevent the need for urgent and emergency care Advice on how to look after my physical and mental health and prevent a crisis means I can stay well. |
Health and social care support to avoid injury or harms means I can stay safe.
|I can access high quality healthcare in an emergency||Prompt assessment and treatment is vital regardless of how or where I arrive at the emergency department.|
Avoidable waits for the right treatment mean my condition deteriorates and I suffer for longer.
Sensitive and compassionate crisis mental health assessment in a calm and private space helps me to talk openly, and obtain the right help for my needs.
|I know how and where to obtain urgent care||Knowing the best sources of support to access urgent care when I need it means I can access the right care first time.|
|I am treated as an individual||Treating me, my carer and my family with dignity and respect, recognising my culture, characteristics and life circumstances, means my care and support is inclusive, sensitive and responsive to my needs.|
|I am seen and heard||Communicating with me about waiting for care and how I am enables me to manage the stresses of waits and to highlight if my needs are changing.|
Giving me choice and control about how my urgent care needs are met, particularly at end of life, means I can be treated in the environment and in the way of my choice.
How will things be different in Suffolk and North East Essex
|We will co-produce advice and support for people with long term conditions and disabilities to prevent falls, deteriorations in their conditions and events such as stroke.||We will enable healthcare services to have access to care plans for people at end of life, and consult them to ensure they are given care in the environment of their choice.|
|We will promote the full range of early support including pharmacies and primary care to prevent crisis.||We will enable more access to urgent care and support in communities such as hubs for people at risk of falls.|
|We will co-produce advice and support to report safeguarding concerns for children and vulnerable adults at risk of harms or abuse.||We will support people to maintain their health and wellbeing before, while waiting for, during and after treatment to help them stay well and recover well.|
|We will ensure waits for care are minimised, and that people waiting for emergency care are kept informed and asked about any change in their condition.|