Leaders at Northumbria Healthcare NHS Foundation Trust and North East Ambulance Service NHS Foundation Trust have welcomed feedback from the national ‘emergency care improvement programme’ (ECIP) following a visit last November to help support improvements in patient flow.
Part of NHS Improvement, the national body responsible for supporting NHS providers and sharing good practice, the ECIP team were invited to see work taking place, across the whole system, to address the challenges experienced with delayed ambulance handovers at The Northumbria hospital.
The ECIP team spent a week with a variety of staff at The Northumbria hospital and in the Emergency Operations Centre (EOC) at the ambulance service. During the visit they had the opportunity to discuss work taking place to improve and support proactive patient flow throughout the whole system.
In a report presented to the local A&E delivery board in February and shared publicly today, the ECIP team praised the ‘commitment of staff to provide first class patient care’ which it described as ‘exceptional’ and ‘epitomised all that is right about care in the NHS’.
Some of the key findings, acknowledged by the ECIP team, include:
• clear evidence that the new model of emergency care introduced by Northumbria has directly benefitted patient care with good ‘front-end senior decision making and clinical pathways’ – principles which should now be shared across the wider NHS
• the fact that long ambulance handover delays are not a permanent feature at The Northumbria hospital, but do follow a predictable pattern from early afternoon to evening when a high number of GP referrals arrive
• the shared view that these ambulance handover issues are a symptom of wider challenges to efficient patient flow across the whole health and care system
• a high ambulance conveyance rate to hospital in the North East which is over 10 per cent higher than the national average due to complex issues
• an unprecedented rise in demand for urgent and emergency care services across the NHS nationally which has continued since The Northumbria hospital opened in summer 2015
• challenges that are to be expected with large-scale change and a culture focussed on improvement and a clear commitment from clinical and leadership teams to provide safer, faster and better patient care.
The ECIP team also highlighted evidence of best practice and made a number of further recommendations to build on work already underway to improve flow of patients both into and out of hospital. Further improvement work underway includes:
• reducing the number of less serious attendances at The Northumbria hospital by streaming patients into more appropriate care settings – this includes implementation of ‘front-door’ streaming announced by the Secretary of State for Health following the recent budget
• ensuring appropriate ‘clinical challenge’ before patients arrive at hospital and on arrival to increase knowledge of alternative pathways amongst ambulance crews and thereby ensure patients are conveyed to hospital only when this is clinically necessary
• ensuring consistency between local providers of the NHS 111 service and increase the number of calls receiving clinical assessment so that only patients who genuinely need to attend the emergency department are advised to do this
• ensuring better use of ambulances for patient transport to ensure GP referred patients are brought into hospital earlier in the day in order to prevent current predictable peaks in demand in the emergency department
• expanding the ‘rapid assessment and treatment’ (RAT) with the emergency department with more staffing now in place and increased designated triage space
• improving bed management across the system which a new digital care solution already being implemented across Northumbria Healthcare which will show live bed data at any point in time
• expanding the opening hours of the current seven day service already offered by the multidisciplinary ‘Hospital2Home team’ to support discharge processes into the early evening
• expanding the ‘full hospital protocol’ which is already in place to help ‘decongest’ the emergency department at two points of the day in order to encourage better patient flow from hospital into the community
• developing a clearer criteria around the use of beds at general hospitals and community sites to ensure consistency of use and improve processes so that discharges happen earlier in the day
• improving patient flow between The Northumbria hospital, where there is a very short length of stay thanks to the speed of treatment, and general hospitals / community sites where length of stay is much longer
• constantly asking the question “what are we doing for this patient which cannot be done elsewhere” and ensuring patients are not kept in hospital for any longer than necessary.
A spokesperson for NHS Improvement said: “We have welcomed the opportunity to look in detail at such a high performing part of the NHS where pioneering work has already taken place, ahead of the rest of the country, to transform emergency care.
“The positive impact on patient care is already very clear but with any transformational change of this scale, there will always be challenges to overcome. Our visit last year enabled us to learn about the improvement work taking place locally and we are now able to share this learning more widely for the benefit of patient care in other more challenged parts of the NHS across the country.
“We would like to thank all staff for their time and commitment during our visit to the region and were very impressed with the collaborative and committed approach across all parts of the system.”
Mr David Evans, chief executive of Northumbria Healthcare NHS Foundation Trust, said: “We wholeheartedly welcome the feedback from the ECIP team and continue to work closely with all partners to collectively plan for the increasing and unprecedented demand placed on all parts of our health and care system from people living longer and with more complex health problems.
“It is always reassuring to read such encouraging independent feedback about the changes we have made to our emergency care model and the positive impact on patient care which all staff and everyone living in Northumberland and North Tyneside should feel proud of.
“The ECIP team rightly recognise that delivering large scale change in the NHS is not easy. It is really important, however, that we continue to innovate and change the way we do things, together with our partners, in the very best interests of safe and high quality patient care.”
Paul Liversidge, chief operating officer at North East Ambulance Service NHS Foundation Trust, said: “Hospital handover delays are a system-wide issue and we continue to work closely with Northumbria Healthcare, the clinical commissioning group and community health services to tackle the range of factors that contribute to ambulance handover delays.”
Dr Stewart Findlay, Chair of the North East and North Cumbria Urgent and Emergency Care Network, said: “The Northumbria hospital has brought a major stride forward in quality of care, and NHS organisations across the region are working closely together to address some highly complex issues around the way patients flow through the system.
“Our network has supported The Northumbria hospital and other North East hospitals with a number of steps to improve patient flow and reduce pressures. That has included bringing in specialist advisors to carry out a detailed analysis of the problem and its underlying causes, and helping to introduce the Full Capacity Protocol, which helps to ease the pressure within A&E at the busiest times of day.
“We have invested in additional clinical advice and support for 999 and 111 call handlers, to ensure patients are referred to the right place first time and emergency departments can concentrate on the people who need them most.
“Everyone can do their bit to help, by taking a moment to consider the best service for their needs, as many patients with common problems can get the help they need from a pharmacist, GP or local urgent care centre.”
Siobhan Brown, director of transformation at NHS Northumberland Clinical Commissioning Group (CCG), said: “This is our chance to address the complex issues in urgent and emergency care as a whole system and NHS Northumberland Clinical Commissioning Group recognises that no one organisation can do this alone.
“Primary, community, social care and mental health services are fundamental parts of the solution alongside Northumbria Healthcare NHS Foundation Trust and North East Ambulance Service NHS Foundation Trust. To deliver a whole system solution, an independent chair from the ECIP team will challenge and support all partners to reset the Northumberland and North Tyneside system for the benefit of local people.”
To view a copy of the ECIP report, click here