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The Urgent and Emergency Care Review: What Does it Mean for Independent Ambulance Services. Prof Jonathan Benger NCD for Urgent Care NHS England April 2014. Where are we now...?. Phase 1 – Evidence gathering and principles development. Mar-May 2013. 18 Jan 2013. Jun 11 2013.

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the urgent and emergency care review what does it mean for independent ambulance services

The Urgent and Emergency Care Review: What Does it Mean for Independent Ambulance Services

Prof Jonathan Benger

NCD for Urgent Care

NHS England

April 2014

where are we now
Where are we now...?

Phase 1 – Evidence gathering and principles development

Mar-May 2013

18 Jan 2013

Jun 11 2013

Evidence base and emerging principles developed

Review launched

Engagement begins

Engagement

Aug – Oct 2013

Jun – Jul 2013

Nov 2013

Workstream design & setup

Publish Engagement Outcomes & Mobilise Delivery Group

Close of Engagement (11 Aug) & Analysis.

Develop Clinical Models.

Phase 2 - Delivery

NOW

2015 / 2016

Feb – May 2014

May – Nov 2014

Implementation for Contracting Round

Tariff Amendments & Commissioning Guidance

Delivery Group outputs

big volumes
Big volumes….

Every year the NHS deals with:

  • 438 million visits to a pharmacy in England for health related reasons
  • 340 million GP consultations
  • 24 million calls to NHS urgent and emergency care telephone services;
  • 7 million emergency ambulance journeys
  • 21.7 million attendances at A&E departments, minor injury units and urgent care centres
  • 5.2 million emergency admissions to England’s hospitals
changing patients changing country
Changing patients, changing country
  • More frail, elderly with increasing complexity and multi-morbidities
  • More treatable illnesses
  • Expectations of the service the NHS should provide, and when it should provide it, are shifting:
    • 7 day society
    • Information and communication
keeping pace with advances in care
Keeping pace with advances in care
  • Timely access to specialist services, and concentration of expertise, improves outcomes
  • But there are still some wide disparities in the system:
    • Self-care works, but awareness and support is sub-optimal
    • Primary care access variable across England
    • A&E departments: same name, very different services
the ambulance evidence base
The Ambulance Evidence Base
  • 999 calls have increased from 4.7 million in 2001/02 to over 8 million in 2010/11
  • Costs are rising by 4% per annum
  • Only 4% of 999 calls are closed using “hear and treat”, though variation from <1% to >7% (35% in France)
  • Most 999 calls don’t need an ambulance, but most are transported
  • 21% of patients are managed at scene
  • 64% are transported to A&E (range 47% to 77%)
  • Workforce development safely reduces transportation rates
a network approach
A Network approach
  • Creating a “whole system” – more than the sum of its parts:
  • Develop emergency care networks
  • Support the introduction of an efficient critical care transfer and retrieval system
  • Ensure that the networks extend to community services, with free flow of information and expertise between the hospital and community
delivery group invited members local

Users

Delivery Group – invited members…Local

Commissioners and Providers

NHS England

System

Partners

Tools & Levers

Professionals and Workforce

Challenge

what we re working on
What we’re working on

Better support for self-care

Right advice, right place, first time

Highly responsive out-of-hospital services

Specialist centres to maximise recovery

Connecting services, so the system is more than the sum of its parts

the 8 workstreams
The 8 Workstreams
  • Whole system
  • Data, IT and care planning
  • Community pharmacy
  • 111
  • Primary care
  • Ambulance services
  • ED and networks
  • Workforce
what does this mean for ambulances
What Does This Mean For Ambulances?
  • Real change, right across the system
  • Fundamental changes to commissioning, payment and standards
  • Increased “hear and treat”, and “see and treat” options
  • Urgent care alternatives to A&E
  • Reduced hospital transport and admission
  • Increased community provision
  • Free flow of information and patients
  • Joined up working with social care
  • Clinical support and workforce development
opportunities for independent services
Opportunities for Independent Services
  • Supporting new models of care
  • Urgent transport
  • Access to diagnostics
  • Workforce flexibility
  • Transfer and retrieval services
summary
Summary
  • The future system of urgent and emergency care requires a radically different ambulance service
  • Emphasis on treatment at scene and in community settings
  • Ambulance services must be fully integrated within one or more Urgent Care Networks
  • Closer integration with 111 and the support of an interdisciplinary clinical hub
  • Development of the ambulance workforce, coupled with changes to organisational culture, will be essential to long-term success
slide22
Questions and DiscussionProfessor Jonathan BengerNational Clinical Director for Urgent CareJBenger@nhs.net