Ian Blunt: urgent care in the English NHS

© Nuffield Trust and Health Foundation © Nuffield Trust

3/12/14

Where will the cracks show?

Ian Blunt

© Nuffield Trust and Health Foundation

Background

• Dominated by scandals and reports - Morecombe Bay, Colchester, Francis I&II, Keogh Reviews etc

• Real fears on costs - prospect of continuing years of constrained finances

• Major organisational change within NHS - low morale and pervasive pessimism

• Critical period for quality


Parallel Realities?

• An NHS that has failed patients and public trust alongside an

NHS that is still improving

• An NHS that needs to change whilst not losing the gains that

have been realised

• QualityWatch - providing independent scrutiny into how the

quality of health and social care is changing over time


Indicators of Quality

Access Safety Effectiveness Person

centred careCapacity Equity

Social care 13 11 13 18 30 0

Primary & community

46 66 147 27 35 7

Secondary / tertiary

75 160 274 159 47 10

Mental health 41 82 26 77 24 10

Population 9 7 82 5 1 1


Focus on: a series of in-depth reports


General Observations …

Many access indicators ‘holding up’. Activity continues to increase – nurse staffing steady, beds reduced

Patient experience -paradox of surveys continuing to be positive despite failings in care within individual organisations

Effectiveness – typically very specific markers and positive findings

Inequalities – stubbornly persistent


…but…

Urgent care is a critical area – and though there have been wobbles we are still ahead of where we were five years ago. Progress on prevention limited


Urgent care wobbles

4063440695

4075640817

4087840940

4100041061

4112241183

4124441306

4136541426

4148741548

41609

66.0%

68.0%

70.0%

72.0%

74.0%

76.0%

78.0%

80.0%

Category A calls attended within target time

National standard


The big one – four hour waits


Increase in attendance?

0

1000000

2000000

3000000

4000000

5000000

6000000

7000000

8000000

Total attendances

Att

end

ance

s


Increase in attendance?

0

1000000

2000000

3000000

4000000

5000000

6000000

7000000

8000000

Total attendances Type 1 Departments - Major A&E

Att

end

ance

s


Occupancy

4027140298

4032540352

4037940406

4043340460

4048740514

4054140568

4059540622

4064940676

4070340730

4075740784

4081140838

4086540892

4091940946

4097341000

4102741054

4108141108

4113541162

4118941216

4124341270

4129741324

41351

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Minimum Minimum to maximum Average

Nu

mb

er o

f p

eop

le s

imu

ltan

eou

sly

occ

up

yin

g A

&E

dep

artm

ent s

in

En

gla

nd


Expression of long term growth in demand for urgent care?

3552135704

3588636069

3625136434

3661736800

3698237165

3734737530

3771237895

3807838261

3844338626

3880838991

3917339356

3953939722

3990440087

4026940452

4063440817

4100041183

4136541548

0

100000

200000

300000

400000

500000

600000

Em

erg

ency

in

pat

ien

t ad

mis

sio

ns


Some of the solutions in A&E units… …and some in other services


Potentially preventable admissions…


Some progress on prevention, but…


-60%

-40%

-20%

0%

20%

40%

60%

Local authority Average

Local authority

Per

cen

tag

e c h

ang

e in

ne t

cu

rren

t sp

e nd

ing

(re

al t

erm

s),

2009

/10-

2012

/13

Reductions in adult social care funding


Falls in the number of people receiving lower intensity services

2009/10 2010/11 2011/12 2012/1350

60

70

80

90

100

110

Less than or equal to 2 hours Number of Service Users

More than 2 hours and less than or equal to 5 hours Number of Service Users

More than 5 hours and less than or equal to 10 hours Number of Service Users

More than 10 hours inc overnight/live in/24 hour Number of Service Users

Financial Year

Ch

ang

e re

lat i

ve t

o i

nd

ex y

ear

(200

9/10

= 1

00)


When is a crack not a crack?

Median distance travelled to A&E is 2.6 miles, to emergency inpatient admission is 3.4 miles (2011/12)

8% net reduction in the number of major A&E units since 2001/02

Slight, but not statistically significant, increase in the average distance for an emergency admission from 2001/02 to 2011/12, rising from 5.2 miles 5.4 miles

The biggest increase in the distances travelled was observed for emergency admissions following stroke, which rose from 4.9 miles to 5.5 miles. The average distance following trauma did not change substantially


Where else might cracks appear?

• Some topics poorly served by data

• Cracks hiding in the averages

Access Safety Effectiveness

Person centred care

Capacity Equity

Social care 13 11 13 18 30 0

Primary & community

46 66 147 27 35 7

Secondary / tertiary

75 160 274 159 47 10

Mental health 41 82 26 77 24 10

Population 9 7 82 5 1 1


Summary

Most measures holding up (for now)

Protect gains made over the last decade

Urgent care – wobble or trend?

Keep watching


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3/12/14

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Ian Blunt: urgent care in the English NHS

Health & Medicine

Transcript of Ian Blunt: urgent care in the English NHS