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Urgent Emergency Care (UEC)<\/h1>\nBackground<\/h2>\n
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.<\/p>\n
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.<\/p>\n
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.<\/p>\n
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.<\/p>\n
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.<\/p>\n
The recovery programme encompasses various focuses, including:<\/p>\n
- \n
- Streamlining discharge processes;<\/li>\n
- Expanding community-based care options;<\/li>\n
- Enhancing communication and coordination across the health and care system to optimize patient flow and resource utilisation.<\/li>\n<\/ul>\n
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.<\/p>\n
The protocol for this evaluation can be found on the bottom of this page<\/a>\u00a0<\/a>under ‘Jan 2026 Protocol’.\u00a0<\/p>\n
What we have done<\/h2>\n
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.<\/p>\n
Over ten weeks we investigated the implementation and perceived impact of ten \u2018high impact\u2019 initiatives prioritised in NHS health and care systems as part of the UEC Recovery Plan.<\/p>\n
We conducted:<\/p>\n
- \n
- An online survey of systems and providers.<\/li>\n
- Follow up interviews with systems and providers.<\/li>\n<\/ul>\n
What we found<\/h2>\n
- \n
- Implementation & Reception: <\/b>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 \u2018high-impact\u2019 announcement.\u00a0<\/li>\n
- Impact of initiatives: <\/b>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.\u00a0<\/li>\n
- Challenges: <\/b>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\u2019s 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.\u00a0\u00a0<\/li>\n<\/ol>\n
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.\u00a0\u00a0<\/p>\n
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Contact Us<\/h4>\n
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Find Us<\/h4>\n
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The University of Manchester
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Connect With Us<\/h4>\n
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Policy insights reports<\/h2>\n
Recovery Support Programme (RSP)<\/strong><\/p>\n
- \n
- Kletter, M., Gillibrand, S., Dumville, J., & Wilson, P. (2023). Rapid Evaluation of the Implementation of the Recovery Support Programme<\/a><\/li>\n<\/ul>\n
Enhanced Midwifery Continuity of Carer model (EMCoC)<\/strong><\/p>\n
- \n
- Gillibrand, S (2025). <\/a><\/a><\/a>Evaluation of the Enhanced Model of Midwifery Continuity\u00a0of Carer\u00a0– infographic of the findings<\/a><\/li>\n
- Gillibrand, S (2025).\u00a0<\/a><\/a>Evaluation of the Enhanced Model of Midwifery Continuity of Carer\u00a0– summary of the findings\u00a0\u00a0<\/a><\/li>\n
- Gillibrand, S., Dumville, J., Wilson, P., Kletter, M., Harkness, E. (2024).\u00a0<\/span>Evaluation of the Enhanced Model of Midwifery Continuity of Carer Insights report\u00a0<\/a>\n
<\/a><\/p>\n<\/li>\n<\/ul>\n
Evaluation of the integrated diabetes and mental health services to support patients with Type 1 diabetes related disordered eating (T1DE)<\/strong><\/p>\n
- \n
- Harkness, E., Bashir S., Kletter, M., Gillibrand, S., Dumville J., Wilson P., & Bower, P.\u00a0 (2026).\u00a0Evaluation of Type 1 Diabetes Eating Disorder (T1DE) Services Insights report\u00a0<\/a><\/span><\/li>\n<\/ul>\n
<\/h1>\n
Published papers<\/h2>\n
Recovery Support Programme (RSP)<\/strong><\/p>\n
- \n
- Kletter, M., Gillibrand, S., Harkness, E., Dumville, J., & Wilson, P. (2025).\u00a0Rapid evaluation of the NHS Recovery Support Programme (RSP) in England: Implementing intensive national improvement support for challenged healthcare providers and systems<\/a><\/li>\n<\/ul>\n
Enhanced Midwifery Continuity of Carer Model (EMCoC)<\/strong><\/p>\n
- \n
- Gillibrand, S., Parkyn, K., Hall, C., Kletter, M., & Harkness, E., Munford L, A., Wilson, P., Dumville, J. (2025).\u00a0\u00a0<\/span>Releasing time to deliver care: a mixed methods evaluation of the implementation of enhanced midwifery continuity of carer<\/a><\/li>\n<\/ul>\n
Evaluation of the integrated diabetes and mental health services to support patients with Type 1 diabetes related disordered eating (T1DE)<\/strong><\/p>\n
- \n
- Harkness, E, F., Bashir, S., Kletter, M., Gillibrand, S., Wilson, P., Dumville, J., Bower, P. (2026).\u00a0Delivering integrated diabetes and mental healthcare for people with type 1 diabetes disordered eating (T1DE): a mixed methods evaluation<\/a><\/span><\/li>\n<\/ul>\n
[\/et_pb_text][et_pb_code admin_label=”Social Media” global_parent=”380″ _builder_version=”3.17.6″]<\/p>\n
- Harkness, E, F., Bashir, S., Kletter, M., Gillibrand, S., Wilson, P., Dumville, J., Bower, P. (2026).\u00a0Delivering integrated diabetes and mental healthcare for people with type 1 diabetes disordered eating (T1DE): a mixed methods evaluation<\/a><\/span><\/li>\n<\/ul>\n
- Gillibrand, S., Parkyn, K., Hall, C., Kletter, M., & Harkness, E., Munford L, A., Wilson, P., Dumville, J. (2025).\u00a0\u00a0<\/span>Releasing time to deliver care: a mixed methods evaluation of the implementation of enhanced midwifery continuity of carer<\/a><\/li>\n<\/ul>\n
- Kletter, M., Gillibrand, S., Harkness, E., Dumville, J., & Wilson, P. (2025).\u00a0Rapid evaluation of the NHS Recovery Support Programme (RSP) in England: Implementing intensive national improvement support for challenged healthcare providers and systems<\/a><\/li>\n<\/ul>\n
- Gillibrand, S (2025).\u00a0<\/a><\/a>Evaluation of the Enhanced Model of Midwifery Continuity of Carer\u00a0– summary of the findings\u00a0\u00a0<\/a><\/li>\n
- Gillibrand, S (2025). <\/a><\/a><\/a>Evaluation of the Enhanced Model of Midwifery Continuity\u00a0of Carer\u00a0– infographic of the findings<\/a><\/li>\n
- Impact of initiatives: <\/b>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.\u00a0<\/li>\n
- Implementation & Reception: <\/b>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 \u2018high-impact\u2019 announcement.\u00a0<\/li>\n
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