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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...?. 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

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  1. 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

  2. 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

  3. The current system – why things really must change

  4. 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

  5. Confusing (and piecemeal?) system

  6. 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

  7. 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

  8. 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

  9. Shifting care closer to home

  10. Building a new system

  11. Care at home

  12. Care close to home

  13. Care in hospital

  14. 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

  15. How we will get there

  16. Users Delivery Group – invited members…Local Commissioners and Providers NHS England System Partners Tools & Levers Professionals and Workforce Challenge

  17. 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

  18. The 8 Workstreams • Whole system • Data, IT and care planning • Community pharmacy • 111 • Primary care • Ambulance services • ED and networks • Workforce

  19. 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

  20. Opportunities for Independent Services • Supporting new models of care • Urgent transport • Access to diagnostics • Workforce flexibility • Transfer and retrieval services

  21. 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

  22. Questions and DiscussionProfessor Jonathan BengerNational Clinical Director for Urgent CareJBenger@nhs.net

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