COMMISSIONING FOR THE RATIONALISATION OF EMERGENCY DEPARTMENTS

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COMMISSIONING FOR THE RATIONALISATION OF
EMERGENCY DEPARTMENTS

• KGMM Alberti

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THE STARTING POINT
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THE PAST

• Overcrowded, understaffed, under-resourced
  casualty departments
• Trolleys
• Sickest patients seen by most junior doctors
• Scoop and run ambulances
• Patchy primary care
• FRAGMENTATION

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All types
Type 198.4 (4wma 98.3)
National Performance is now at 98.4 with a
4-week moving average of 98.2
98.4 (4wma98.2)
97.9 (4wma 97.6)
SHA and Trust Performance139 trusts achieved 98
or more this week, an increase of 12 on the
previous week. 27 SHAs achieved this level this
week. 146 trusts and all 28 SHAs have achieved
98 for the current quarter to date.All type
PerformanceWeekly performance is at 98.8
compared to 98.6 last week. The quarter to date
performance is at 98.8. The 4wma is at
98.8.Type 1Weekly type 1 performance is at
98.4, up from 98.1 last week. The quarter to
date performance is at 98.4. The 4wma is at
98.3.BreachesTotal breaches are 4,221 of
which 4,147 are type 1.Please address any
comments or queries to emergencycare_at_dh.gsi.gov.uk

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BUT
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CURRENT PROBLEMS

• Too much focus on AE
• Rising demand
• Resource constraints
• Inappropriate staffing
• Unsafe services

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THE SOLUTIONS (1)

• The White Paper
• Right place, right time, first time as close to
  home as safely possible
• IT
• Mobile workforce

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THE SOLUTIONS (2)

• Integrated geographical approach
• Pathways
• Simple access
• Staff to fit needs

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KEY FACTOR

• Urgent Care Board
• Empowered
• Funded/Commissioned
• Total system planning
• Performance managed
• NB ALL partners involved

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ACCESS
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THE URGENT CARE PATHWAY 2008
PATIENT
AE
GP
NHSD
Acute Trusts
SINGLE PHONE NUMBER
RRTs
Pharmacy
GP Appt
Acute Alcohol Team
Mental Health Services
Emergency Social Services
Voluntary Sector
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CARE PATHWAYS

• Whole patient journey
• Consistent response
• Monitored
• Clinical outcomes

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LEVELS OF URGENT AND EMERGENCY CARE

• Self care
• Primary Care/Community
• Urgent Care Centres
• Acute hospitals selective AE
• Acute hospitals
• Acute hospitals highly specialised services

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HOME SERVICES 2008

• Self care IT assisted?
• Proactive prevention
• Case management high risk LTCs
• 1st contact practitioners
• NB EPRs the end of veterinary medicine

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URGENT CARE CENTRES (WiCs/MIUs)

• Free standing and hospital-based
• Nurse-led
• Open at least 18/7
• Diagnostic capabilities
• Co-located OOH
• Pharmacist presence or easy access
• Close links with other services

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THE ACUTE HOSPITAL
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THE ACUTE HOSPITAL

• Only for those who require the expertise and/or
  facilities
• Front door UCCs
• One per 500,000

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EMERGENCY DEPARTMENT KEY COMPONENTS

• Skillmix, e.g. ENPs, GPSIs
• Primary Care input
• See and Treat/Senior led
• Direct admissions
• Rapid diagnostics
• Observation Units /AUs

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THE ACUTE HOSPITAL

• MAU/SAU
• More senior involvement
• Rapid throughput
• Direct admissions
• NB Reclassify zero day admissions
• NB How many acute hospitals?

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ACUTE HOSPITALS THE FUTURE

• Less doing everything
• Networks
• Super A Es
• Better transport

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COMMISSIONING THE CHALLENGE

• Social Services
• Ambulance
• Home care

• OOH
• UCCs
• AE
• Acute Specialties
• Acute mental health, etc

• or pathways ?

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URGENT CARE STRATEGY
Watch this space !!