Ready to take action? Emergency care in the NHS Long Term Plan

The NHS Long Term Plan sets out an ambition to make profound changes to the emergency care system and reduce pressures on emergency service staff. With a focus on increasing the share of community emergency care, how can hospital emergency services take matters into hand to turn the ambition of the Long Term Plan into action?
Ready to take action? Emergency care in the NHS Long Term Plan
Jan 25th 2019

“We have an emergency care system under real pressure, but also one in the midst of profound change.” Overview and Summary, NHS Long Term Plan (LTP).

This statement goes a long way to explaining the rationale behind the actions the LTP outlines for emergency care.

That “we have an emergency system under real pressure” does not come as a shock: such pressures regularly flood our headlines due to the tireless monitoring of A&E 4-hour performance in Trusts across the country. The emergency care system faces ongoing strain from disproportionate increases in demand against capacity for quantity and quality of urgent care.

The statement that the emergency system is also “in the midst of profound change” is just as important. It provides astute insight into the underlying impact of the LTP on emergency care – namely, the commitment to ongoing change since the publication of Next Steps on the Forward View two years ago. This shifted the focus of emergency care improvement work towards increasing emergency care provided outside the hospital, to reduce pressure on emergency service staff.

Ultimately, the LTP emergency care strategy aims to relieve pressures on emergency services by reducing demand on hospital emergency care. To achieve this, the LTP commits to:

  1. Integrating and expanding pre-hospital urgent care by embedding a multidisciplinary Clinical Assessment Service and fully implementing the Urgent Treatment Centre model by 2020
  2. Reforming hospital emergency care to reduce stays in hospital and encourage same-day discharge. To do this by expanding a comprehensive model of Same Day Emergency Care (SDEC) to every acute hospital with a type 1 A&E department, and developing new ways to care for patients with most serious illness and injury
  3. Cutting delays in patients going home through maintaining an average Delayed Transfer of Care figure of 4,000 days or fewer.


The benefits of SDEC: our view

The 4-hour A&E target established in 2004 is one of the many legacies of the healthcare strategy laid out in the NHS 10-year plan released in July 2000. Given the high media profile that Trust 4-hour performance has since acquired, it’s surprising that the LTP makes little reference to maintaining this standard.

Nonetheless, if it’s successful, the strategy laid out in the LTP to reduce demand on hospital emergency care services should directly reduce pressure on emergency services and improve 4-hour performance across the country.

The commitment to expand SDEC in both medical and surgical specialties is particularly exciting, as we believe that large-scale implementation of the intervention can be quickly achieved and will have a positive effect in numerous ways.

SDEC requires very little estate space, works to improve flow throughout the hospital, and improves patient experience.

By discharging patients who would normally be admitted within the same day, SDEC creates a fast lane for appropriate patients through emergency care, increasing the department’s capacity to deal with other patients. This means improved quality of care and reduced waiting times.

Meeting SDEC challenges: our experience

The current state of SDEC services varies greatly between different Trusts. The plan to embed the SDEC model in every hospital during 2019/2020 is extremely ambitious. It has great potential to improve hospital flow, but there are some big challenges to overcome. This means we will need to create new and effective solutions and communicate them well.

Rolling out comprehensive SDEC services will require improvement in workforce skills, recruitment and retention of acute medics. It means designing clinical pathways transfer between emergency departments, SDEC and wards. It demands that hospital estate is set aside for SDEC.

At 2020 Delivery we have experience supporting large acute Trusts across the country to master these challenges. We helped one Trust to adapt space from their acute medical unit for use in ambulatory emergency care. We supported them to implement appropriate interventions both upstream and downstream to resolve issues associated with this transformation. This included:

  • Supporting the design of a process and clinical pathway to transfer patients to SDEC
  • Establishing appropriate communication routes between emergency care and SDEC, to monitor the flow of patients regularly
  • Working with frontline staff to influence an ‘SDEC unless proven otherwise’ philosophy among staff, to maximise the use of SDEC

Proven support

We also have proven urgent care expertise in transformation change management: we have rolled out support to Trusts in a range of starting positions. We have helped deliver sustained improvements in 4-hour performance, with results so significant they have improved regional measures.

Get in touch if you’d like to know more about how we can help you effectively manage transformation in your Trust, in response to the emergency care changes identified in the LTP.

Authors: Louis Jamart and Chris Bradley