Urgent and emergency and hospital care services
WHY this is important for people in Suffolk and North East Essex
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.
As an Integrated Care System we will ensure that:
- People needing urgent and emergency care receive skilled treatment and support in the best setting for their needs
- People who have completed their acute treatment stay in hospital no longer than necessary
- Urgent and emergency services’ design and organisation reflects local people’s needs
Recent Healthwatch England research (2019) identified what people want from A&E:
- Ensuring that the treatment patients receive is of the highest quality.
- Assessing patients quickly on arrival and reassuring them they will be seen in a medically appropriate timeframe.
- Seeing patients in priority order – most urgent cases first – even if this means some people may have to wait longer.
- Highlighting that systems are in place to monitor people while they wait in case their condition gets worse.
- Ensuring there are staff on hand to provide support while people wait, such as offering pain relief or providing drinks.
- Giving people an estimated waiting time on arrival and keeping them informed if things change, such as a major incident.
- Making information about current waiting times easily available to people before they turn up at A&E and providing information about alternative services.
- Treating or admitting all patients within a guaranteed timeframe (currently four hours) regardless of what attention is required.
- Reassuring patients that if they end up waiting longer than expected it won’t result in a parking fine in the hospital car park.
- Clearly communicating that a safe number of staff are working on the ward, particularly during busy periods.
What do we know about people’s local experiences?
People generally report high levels of satisfaction, confidence and trust in A&E and the ambulance service.
- Publicise what defines emergency and urgent care, and when to use A&E or call for an ambulance; increase awareness of alternative services such as NHS111 and walk in centres.
- Resolve conflict between performance and patient expectations by improving communication about when the ambulance or first responder is likely to arrive.
- Telephone operators and paramedics should be able to access patients’ medical records.
- Changes to the way urgent care services are delivered could burden GPs, A&Es and other services. Enhance the roles of Advanced Health Practitioners, pharmacists and nurses.
- Some people are concerned about the quality and effectiveness of alternative services like NHS choices and 111; and are frustrated by the time call handlers take to ask questions.
For further information see www.healthwatchessex.org.uk and www.healthwatchsuffolk.org.uk
HOW we plan to make a difference
1.1 People know where to seek urgent help.
- Awareness raising will enable people to understand the range of urgent and emergency care available. Knowledge of the range of services helps people to understand their emergency needs better and to seek care in the right setting first time. We will do this through targeted communications and ongoing social media promotion of alternatives to ED attendance including services available via extended hours GP, self - help, pharmacists and through 111 Online and primary care screening.
1.2 People seeking urgent care will have access to specialist advice to ensure they obtain support in the right setting at the right time to support their needs.
- We will further develop our single multi-disciplinary Clinical Assessment Service (CAS) within our Integrated Urgent Care Service which provides integrated NHS111, ambulance dispatch and GP out of hours services, providing specialist advice, treatment and referral. The CAS encompasses both mental and physical health and will be supported by collaboration plans with all secondary care providers. It will have access to medical records and can support community-based clinicians including ambulance staff on scene, and staff in care homes to make best decisions on care and potentially avoid unnecessary trips to Emergency Departments.
- People will have equal access to care regardless of their circumstances or their community. Equality of access is essential for marginalised groups and more isolated communities will be supported via our Urgent Treatment Service satellite units at Clacton, Harwich and Ipswich Urgent Treatment Centres in Suffolk.
1.3 People seeking urgent care who do not need to attend hospital have access to treatment at a local centre.
- The Urgent Treatment Centre (UTC) model will ensure all localities provide consistent out of-hospital urgent care, with the option of appointments booked through a call to NHS111. The ICS has successfully opened UTCs in Harwich and Clacton as well as co-located with A&E at Colchester Hospital during 2019/20 and intends to open a co-located facility at Ipswich Hospital by autumn 2021. Our UTCs will offer assessment to urgent and emergency ambulatory patients, and co-location with ED enables direct access to the ED and specialty advice when needed. UTCs will work alongside other parts of the urgent care network including primary care, community pharmacists, ambulance and other community-based services to provide a locally accessible and convenient alternative to ED for patients who do not need this emergency service. Integrated systems should help ensure people obtain alternative care promptly and are coordinated by our Alliances working across partner agencies in well-developed mature forums. We also aim to introduce rotational posts across UTC sites within the next 12 months.
1.4 People receive an efficient and timely emergency response from their ambulance service.
- We will implement Lord Carter’s report recommendations on ambulance service performance. These recommendations will ensure ambulance services offer the most clinically and operationally effective response.
- Skilled paramedics will treat people at home or in a more appropriate setting outside of hospital, treating people at the scene or in an alternative setting can avoid unnecessary journeys to ED. Paramedic services and primary care paramedics will work in an integrated way. We are leading the way in this in North East Essex and West Suffolk, with early intervention ambulance vehicles supporting care in patients’ homes and reducing journeys to hospital where falls and urgent care conditions can be safely managed at home.
- We will increase specialist ambulance capability to respond to terrorism. Emergency responses to terrorism on the scene will be provided by staff with dedicated expertise to provide the best quality of care in traumatic circumstances and is an ongoing focus with the ambulance trust leading this work.
1.5 People with the most serious illness and injury will have improved assessment and prompt treatment.
- We will improve pathways for people who have experienced serious illness/injury such as major trauma, stroke, heart attack, severe asthma attack or sepsis. Improving care pathways will reduce their risk of death or disability, and achieve better care outcomes. The introduction of Urgent Treatment Centres, first in North East Essex in October 2019 and then in Ipswich and East Suffolk in 2021, co located within EDs, will help enable this, with ED specialist clinicians focusing predominantly on those most seriously ill/injured. Adults and children with acute mental health needs receive prompt assessment and care. Enhanced mental health care in emergency settings 24/7 will ensure people receive the right support at the right time in an integrated way. This will be in place across all three of our acute hospital sites by April 2021.
2.1 Emergency hospital services understand and assess people’s needs promptly.
- Primary and community-based services will refer people into emergency care and will share information with the hospital both on the urgent presenting issues and on any underlying difficulties. Understanding the whole person’s needs helps to target treatment and care effectively, supports discharge planning from the outset, and ensures people are referred on to the appropriate support when they leave hospital. We will use technology to support this communication as well as empowering direct communication between clinicians using Consultant Connect and dedicated advice lines for clinicians to support decision making in the community.
- People and their carers will be fully involved in planning to leave hospital-based care. Involvement in care planning increases choice and control and helps the smooth transition between hospital and home.
2.2 People receiving emergency care do not have to stay longer than necessary. We will enable this by
- Moving our A&E departments to a comprehensive model of Same Day Emergency Care (SDEC) at least 12 hours a day 7 days a week, by March 2020. Delivering emergency care on the day, avoiding the need for an overnight stay, relieves pressure elsewhere in the hospital and frees up beds. This system will continue to work to align to domiciliary care provision to ensure people have existing services reinstated in a planned way.
- Continuing to develop and enhance our multidisciplinary acute frailty services carrying out geriatric assessments, treatment and support people in ED and acute receiving units, operating at least 70 hours a week and assessing within 30 minutes of arrival. Acute frailty services located in emergency care will provide prompt specialist support and rehabilitation, and prevent avoidable admissions and shorten length of stay. We are already delivering this in Ipswich and East Suffolk and will deliver this in West Suffolk from December 2019 and in North East Essex from March 2020.
- Placing therapy and social work teams at the beginning of the acute hospital pathway so that people have an agreed care plan within 14 hours of admission, with expected date of discharge, by March 2024. This will build on the existing therapy and social work teams in place on all three hospital sites.
- Implementing the SAFER patient flow bundle to ensure that patients’ progress in treatment and planning is monitored. Multi-disciplinary teams will review people on all hospital wards every morning. These measures will support people to recover and rehabilitate. They will help achieve an ongoing reduction in ‘stranded and super-stranded’ patients (those staying longer than 7 and 21 days respectively) and maintain a lower level of Delayed Transfers of Care (less than 4,000 nationally). Suffolk and North East Essex had 47 days of delayed discharges per 1,000 bed days in quarter 4 2018-19.
- Building on the existing Discharge to Assess models implemented in Ipswich and East Suffolk and West Suffolk into North East Essex to ensure assessment and reablement opportunities are available at home and in the community to ensure people do not stay any longer than needed in a hospital bed.
- No decisions about long term care needs will be made in acute care with assessment happening outside of the hospital
3.1 People access emergency services that have been designed with an understanding of their needs and experience.
- The Emergency Care Data Set will be embedded into our UTCs and SDEC, and an ambulance data set will be developed, by March 2020. These datasets will help understand the patient journey from ambulance to emergency care settings. We are utilising business intelligence in collaboration with all providers involved.
- People in rural areas have access to hospital services to meet their needs, through a standard model of delivery in smaller acute hospitals, including how they work more effectively with other parts of the local healthcare system. The new model of care will help overcome the challenges smaller hospitals face in workforce and in meeting national standards and policies. This includes ‘passporting’ for staff working across sites and in joined up working models, with acute and primary care clinicians leading the way in the delivery of our UTC models of care in Colchester and Ipswich as they come on line.
- People with sub arachnoid haemorrhage will receive high quality emergency care.
We will know we are making a difference because we will see:
- Fewer emergency admissions aged 0-19
- A reduction in emergency inpatient hospital admissions for people with dementia aged 65 and over
- Reduction in the rate of emergency incidents where at least one patient was transported to an emergency department, from 58.5% in 2018/19 to 57% in 2023/24
- Preventing increases in the average number of patients with delayed transfers of care per day, currently at 69 per day in 2018/19
- Reduction in the average number of patients staying a hospital bed for 21 days or more, from 232 in 2018/19 to 173 in 2023/24
Volunteers make a unique and valuable contribution to patients, visitors and staff at West Suffolk NHS Foundation Trust (WSFT). Voluntary Services have been established at the hospital since 1974 and have been developing within the trust up until the present day. We have over 40 volunteering roles within the West Suffolk Hospital (WSH), Newmarket Community Hospital and Glastonbury Court. Volunteers help out in varied clinical areas, for example, outpatients, wards and clinics such as the Macmillan Information Centre. They are integral members of the trust and help our support our staff and patients in many valuable ways and do not replace substantive roles.
Bleep volunteers support staff at West Suffolk Hospital by delivering TTO medication and other pieces of information. By supporting staff with this non-clinical task, they are able to free up valuable time for staff that can then focus on direct patient care or other more clinical tasks. Speedier TTO deliveries may in turn allow for speedier patient discharges and help free up beds sooner. They also are now on an electronic messaging system, which improves their efficiency as they are getting the message straight away rather than waiting for staff to pick up calls
There are also volunteers based in our Discharge Waiting Area – and their aim is to reduce the anxiety of patients before they go home and also as sometimes they are waiting awhile – reduce loneliness. Staff would love to do this but now do not have the time within their roles