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NHS England announces A&E revamp

NHS England announces A&E revamp
9 May 2013

Plans to strengthen performance in urgent and emergency care are being put in place across the country to help hospital A&E departments meet demand and tackle waiting time pressures. 

Plans to strengthen performance in urgent and emergency care are being put in place across the country to help hospital A&E departments meet demand and tackle waiting time pressures. 

NHS England has joined with the NHS Trust Development Authority (NTDA) and Monitor, which are responsible for provider regulation, to ensure coordinated action to ease the immediate pressures. 
At the same time, a review will take place to understand the causes of problems, which differ around the country.
A&E departments have seen a rise in the number of patients they are seeing in recent years, with an extra 4 million people a year using emergency services compared with 2004 according to government figures. 
Professor Keith Willett, NHS England's National Director for Acute Episodes of Care and a trauma surgeon, said: "When pressure builds across the health and social care system, the symptoms are usually found in the A&E Department. 
"What we all want is great service for patients that meets and often exceeds the minimum standards.  
"To get there, we need the whole NHS system, in the community and hospitals, to recognise the problems and help to relieve the pressure on their colleagues in A&E."
Although the government claims 90% of A&E patients are seen within four hours, concern has been growing about the underlying trend of more patients waiting longer.
An NHS England spokesperson said: "The maximum four-hour wait in A&E remains a key NHS commitment to the public, set out in the NHS Constitution."
The support plan, published today (9 May 2013), says: "Long waiting times in A&E – often experienced by those awaiting admission and hence ill patients – not only deliver poor quality in terms of patient experience, they also compromise patient safety and reduce clinical effectiveness".  
NHS England has pledged to ensure healthcare leaders from different parts of the local NHS will come together to form 'urgent care boards', covering all A&E departments. 
By the end of May, NHS England claims they will ensure local recovery and improvement plans are in place for each A&E on their patch. 
Monitor and the NTDA will expect hospitals and other providers, for example community services, to participate. This follows on from the monitoring and support programmes both regulators have been carrying out with the trusts for which they are responsible in recent weeks.
  The three organisations will ensure a coordinated national approach and monitor progress. They will also ask NHS organisations to bring forward planning for next winter so hospitals are well prepared.
Urgent care review
NHS England has already announced a review of the model of urgent and emergency services, led by Sir Bruce Keogh. 
The review will consider and develop a new national framework for urgent and emergency care that can help the NHS deliver improvements to patient care in the future.  
A&E attendances have risen steadily over the past decade, although they have been relatively flat in recent months.
NHS England has also pledged to ensure money is freed up and available to improve A&E services.  
Above certain limits, hospitals are currently paid 30 per cent of the fee for emergency admissions on the nationally-set NHS tariff. The aim of this policy is to help reduce unnecessary hospital admissions and improve services in the community.
The support plan says urgent care boards should oversee use of the remaining 70 per cent of the fee.  Expenditure, which will be closely monitored, should be linked to specific improvements, including in A&E.
While the recovery plan is underway, a review will bring together data and evidence on the factors which may cause problems in A&E departments as it is clear that problems vary across the NHS. 
These factors include:
• increased numbers of patients visiting A&E – although some performance problems have arisen when numbers have been lower than usual;
• seasonal illnesses such as flu and norovirus;
• patients attending A&E who are more ill than usual leading to more acute admissions;
• hospital processes around efficient admittance and discharge leading to a delay in beds being available;
• delays in discharge as local primary, community or social care services are not in place.

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