A major review of urgent and emergency services has been launched by the NHS Commissioning Board to establish proposals for the best way to organise care in England.
The review, led by Medical Director Sir Bruce Keogh, will work with clinical commissioning groups (CCGs) to develop a national framework offer to help them ensure high-quality, consistent standards of care across the country.
Sir Bruce said: “The NHS is there for all of us and should offer appropriate, effective and rapid care whenever and wherever it is needed.
“Treatments for many common conditions such as heart attacks and strokes have evolved considerably over the last decade and are now best treated in specialist centres. Yet we know people want their A&E nearby.
“This makes me think we need to review the increasingly complex and fragmented system of urgent and emergency care, so that sick, anxious and often frightened people can get what they need when they need it.”
The review comes as a number of hospital A&E departments are under threat of closure, provoking public outrage.
The NHS Commissioning Board stresses that local commissioning will be at the heart of this review, which follows the Board’s commitment in its recent planning guidance. It aims to enable CCGs to shape services for the future and put in place arrangements that meet the needs of patients.
It plans to publish emerging principles for consultation in the Spring. In its planning guidance, published late last year, the NHS Commissioning Board said it would review urgent and emergency care as part of plans for more seven-day services.
As well as seven-day working, the review aims to help CCGs find the right balance between providing excellent clinical care in serious complex emergencies and maintaining or improving local access to services for less serious problems.
It will set out the different levels and definitions of emergency care. These range from top-level trauma centres at major hospitals to local accident and emergency departments and facilities providing access to expert nurses and GPs for the treatment of more routine but urgent health problems.
As well as looking at how emergency care is provided, the review will also assess transfer processes between these levels of emergency care.
The NHS Commissioning Board also says it wants to improve public understanding of the best place to go for care. By helping the public to go to the right place first, both they - and those who have very serious illnesses and injuries - will be seen more quickly by specialist clinical teams with the right qualifications and facilities.
It stresses that the pattern of urgent and emergency care, including the number and location of services, will continue to be de developed locally to meet the different needs of urban and rural communities. The review aims to provide a national framework so high quality, consistent standards are offered across the country.
In future, planning reconfigurations should take account of the review’s conclusions, the emerging evidence and the national framework.
The Foundation Trust Network recently published a briefing document summarising the results of their A&E 2012 benchmarking study. It found that the majority of trusts are losing money on their A&E services. It called on the Department of Health to re-examine the policy of paying for some emergency admissions at 30% of the standard tariff, and called on the risks and responsibility for avoiding emergency admissions should be more fairly shared between acute trusts and primary and community care.
It also found that trusts with primary care or urgent care centres within their A&E departments have faster average treatment times. And trusts that use senior clinicians as part of a rapid assessment team have faster initial assessments for the most acute A&E patients
Nearly half of all A&E attendances for older patients (75yrs+) end in admission. Multidisciplinary teams in A&E reduce admissions of elderly patients, and trusts have reduced reattendance rates by providing comprehensive information and follow up advice.
Dr Clive Peedell, a clinical oncologist and co-leader of the National Health Action Party, said A&E closure was often the “death knell” for a hospital.
He said: “Once you lose A&E, you lose all your acute admissions. It’s like dominoes. It’s a way to close a hospital. There seems to be a drive to close hospitals on an ad hoc and financially-driven basis. There’s a definite agenda to treat more people in the community - but the capacity isn’t there.
“We welcome the review but it needs to be open to debate. It should not be a central diktat.”