Urgent Emergency Care (UEC)

Background

Hospital occupancy rates in the NHS are consistently high. An aging population with complex health needs and seasonal increases in COVID and flu make this worse. This places significant strain on bed capacity and affects how quickly care can be given in urgent and emergency care (UEC). Long wait times are common for those for those in accident and emergency (A&E) departments, including for those arriving by ambulance.

Complex dependencies between hospital systems mean that challenges in UEC departments and ambulance services are often linked to broader issues. An example of this is where there are capacity constraints in wards. Timely discharge of patients who no longer need in-patient care is a significant bottleneck.

The NHS delivery plan for recovering UEC services is a substantial two-year initiative. It aims to enhance care delivery for both service users and staff.

Its primary goals include achieving at least 76% of patients coming to UEC being admitted, transferred, or discharged within four hours by March 2024. With further improvements anticipated in 2024/25.

Additionally, it aims to improve ambulance response times for Category 2 incidents. This involves targeting an average of 30 minutes over 2023/24 and aiming for pre-pandemic levels by 2024/25.

The recovery programme encompasses various focuses, including:

• Streamlining discharge processes;
• Expanding community-based care options;
• Enhancing communication and coordination across the health and care system to optimize patient flow and resource utilisation.

Support from NHS England is integral to guiding and facilitating improvements in UEC. The UEC recovery plan involves implementing a range of high-impact initiatives (HII) aimed at alleviating pressures on hospital occupancy.

The protocol for this evaluation can be found here.

What we have done

Our aim was to rapidly investigate the implementation and impact of innovations adopted in NHS health and care systems as part of the urgent and emergency care recovery programme.

Over ten weeks we investigated the implementation and perceived impact of ten ‘high impact’ initiatives prioritised in NHS health and care systems as part of the UEC Recovery Plan.

We conducted:

• An online survey of systems and providers.
• Follow up interviews with systems and providers.

What we found

1. Implementation & Reception: The plan was well received, prompting NHS regions and providers to prioritise focus areas and begin implementation by summer 2023. Many initiatives were already underway before the July 2023 ‘high-impact’ announcement. 
2. Impact of initiatives: Improvements were reported in 4-hour A&E waiting times. Some of the initiatives which may have supported this include: Same Day Emergency Care, Acute Frailty Services, Urgent Community Response and Inpatient Flow and reduced length of stay. Improvements in Category 2 ambulance response times were also perceived to be linked to Urgent Community Response and Single Point of Access initiatives. Virtual wards were seen as valuable for select patient groups but having limited impact on overall flow/discharge. 
3. Challenges: Staff felt that the right initiatives were chosen but long-term consistency was crucial. There was also a desire for peer-to-peer learning across systems and the sharing of successful practices. NHS England’s universal support offer faced criticism for disjointed delivery and relevance, and it was reported that gaps remain in care for complex needs, ambulance strategy and national programme alignment.  

Further evaluation is required to assess the implementation and impact of these high impact initiatives to inform decision-making and future delivery. This will be investigated in phase 2 of the evaluation.