Transcript Presentation heading - Independent Ambulance Association

The Urgent and Emergency Care Review: What
Does it Mean for Independent Ambulance Services
Prof Jonathan Benger
NCD for Urgent Care
NHS England
April 2014
Where are we now...?
Phase 1 – Evidence gathering and principles development
18 Jan 2013
Review launched
Mar-May 2013
Evidence base and emerging
principles developed
Jun 11 2013
Engagement begins
Engagement
Jun – Jul 2013
Workstream design
& setup
Phase 2 - Delivery
Aug – Oct 2013
Close of Engagement
(11 Aug) & Analysis.
Develop Clinical Models.
Nov 2013
Publish Engagement Outcomes
& Mobilise Delivery Group
NOW
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Feb – May 2014
Delivery Group
outputs
May – Nov 2014
Tariff Amendments &
Commissioning Guidance
2015 / 2016
Implementation for
Contracting Round
The current system – why things really
must change
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Big volumes….
Every year the NHS deals with:
• 438 million visits to a pharmacy in England for health
related reasons
• 340 million GP consultations
• 24 million calls to NHS urgent and emergency care
telephone services;
• 7 million emergency ambulance journeys
• 21.7 million attendances at A&E departments, minor injury
units and urgent care centres
• 5.2 million emergency admissions to England’s hospitals
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Confusing (and piecemeal?) system
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Changing patients, changing country
• More frail, elderly with increasing complexity and
multi-morbidities
• More treatable illnesses
• Expectations of the service the NHS should
provide, and when it should provide it, are shifting:
• 7 day society
• Information and communication
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Keeping pace with advances in care
• Timely access to specialist services, and
concentration of expertise, improves outcomes
• But there are still some wide disparities in the
system:
• Self-care works, but awareness and support is sub-optimal
• Primary care access variable across England
• A&E departments: same name, very different services
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The Ambulance Evidence Base
• 999 calls have increased from 4.7 million in 2001/02 to over
8 million in 2010/11
• Costs are rising by 4% per annum
• Only 4% of 999 calls are closed using “hear and treat”,
though variation from <1% to >7% (35% in France)
• Most 999 calls don’t need an ambulance, but most are
transported
• 21% of patients are managed at scene
• 64% are transported to A&E (range 47% to 77%)
• Workforce development safely reduces transportation rates
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Shifting care closer to home
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Building a new system
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Care at home
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Care close to home
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Care in hospital
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A Network approach
Creating a “whole system” –
more than the sum of its parts:
• Develop emergency care networks
• Support the introduction of an efficient
critical care transfer and retrieval
system
• Ensure that the networks extend to
community services, with free flow of
information and expertise between
the hospital and community
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How we will get there
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Delivery Group – invited members
…Local
Users
Commissioners and
Providers
LGA
FTN
Patients
Comm
Assemb
NHS
England
NHS IQ
AACE
HEE
Delivery
Group
Tools & Levers
System
Partners
AMRCs
Professionals and
Workforce
PHE
CEM
NTDA
RCGP
Monitor
Kings
Fund
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Challenge
What we’re working on
1. Better support for self-care
2. Right advice, right place, first time
3. Highly responsive out-of-hospital services
4. Specialist centres to maximise recovery
5. Connecting services, so the system is more
than the sum of its parts
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The 8 Workstreams
1. Whole system
2. Data, IT and care planning
3. Community pharmacy
4. 111
5. Primary care
6. Ambulance services
7. ED and networks
8. Workforce
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What Does This Mean For Ambulances?
• Real change, right across the system
• Fundamental changes to commissioning, payment and
standards
• Increased “hear and treat”, and “see and treat” options
• Urgent care alternatives to A&E
• Reduced hospital transport and admission
• Increased community provision
• Free flow of information and patients
• Joined up working with social care
• Clinical support and workforce development
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Opportunities for Independent Services
• Supporting new models of care
• Urgent transport
• Access to diagnostics
• Workforce flexibility
• Transfer and retrieval services
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Summary
• The future system of urgent and emergency care requires a
radically different ambulance service
• Emphasis on treatment at scene and in community settings
• Ambulance services must be fully integrated within one or
more Urgent Care Networks
• Closer integration with 111 and the support of an
interdisciplinary clinical hub
• Development of the ambulance workforce, coupled with
changes to organisational culture, will be essential to longterm success
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Questions and Discussion
Professor Jonathan Benger
National Clinical Director for Urgent Care
[email protected]
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