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Reforming and Improving Emergency Care

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Reforming & Improving Emergency Care

In October 2001, the Department of Health (DoH) document ‘Reforming Emergency Care’ took on the challenges of the emergency care system within Britain, stating that “too many people have to wait too long for the care and treatment they need” (DoH, 2001b, p. 1). The document outlined the key areas it felt represented the need for reform. Each stage of the emergency care system went under review, from access to GP services and ambulance response times, to the experience of the patient upon arrival in hospital through to the provision of treatment and care packages allowing them to be discharged home again.

The reports objectives were to cut ambulance response times to life-threatening emergencies, end widespread bed-blocking in the NHS, improve access to GP and other primary care professionals, minimise cancellations of on-day surgery and cut accident and emergency (A&E) waiting times to under 4 hours. This would, in the reports opinion, “bring the response to everyday events up to this first class standard” (DoH, 2001b, p. 1).

A number of challenges faced this reform and were highlighted by the report. Workforce issues, for example staff capacity in A&E departments, were overstretched due to the significant increase in the demand for emergency services. To combat this, the increase in funding for the recruitment of A&E Nurses and consultants outlined in ‘The NHS Plan, A plan for investment, a plan for reform’, (DoH, 2000, p. 77), meant that at busier periods, senior presence would still be available and the demand met without causing delays to patients.

The resources used by emergency care services are often fully stretched. The report highlighted how capacity in hospitals is not sufficient and this, along with delays in discharging patients from hospital impacts these resources leading to high risk of long waits for admission and cancellation of planned operations. Too often, patients are medically ready to leave hospital but a lack of social services, NHS or other support in the community means they cannot, resulting in added pressure on acute beds. Using new investment in both NHS and private hospitals and Local Authorities for investment in social care, the plan hopes to reduce occupancy levels in hospital, freeing up beds and therefore reducing risks of delays and cancellations. Improvements are also recommended in delivering the standards outlined in the ‘National Service Framework for Older People’ (DoH, 2001a, p. i), which will help improve care to older people and “avoid an unnecessary hospital admission”.

Emergency patients regularly compete with routine (elective) needs, certain diagnostic and other services are unavailable outside of traditional office hours and little distinction is made between major and minor injuries patients. The report aims to provide distinction between elective and emergency workloads and further to dividing major and minor injury patients in A&E. The plan for extra consultants and nurses are designed to help achieve this, along with extending the working day and making use of the private sector and new technology.

“Traditional working practices can result in barriers to team working, duplication of services and repeated requests for the same information from patients” (DoH, 2001b, p. 4). Demarcation of these barriers, along with ensuring patients don’t go to the ‘wrong’ service by making it easier for patients to identify the most appropriate part of the emergency care system for their needs, will improve assessment of each patient and remove the disjointed working that causes delays in each stage of their care. Important input from NICE (National Institute for Clinical Excellence) and CHI (Commission for Health Improvement) will ensure that care pathways are introduced for emergency care, so that standards are more consistent and do not vary in different parts of the system.

Reforming emergency care set targets of increased capacity, reduced fragmentation, wider access and consistency of services, as well as new professional roles and ways of working. The National Audit Office (NAO) audited these reforms in 2004, producing the document ‘Improving Emergency Care in England’.

The audit tracked the progress of these reforms and noted that improvements had been made in certain areas but went on to make further recommendations for continued improvement. The improvements since 2000 were mainly in the A&E departments with waiting times and environments improved for both staff and patients. However, some groups of patients, namely the elderly, were still at risk of longer waiting times.

The inception of Emergency Care Practitioner’s and the introduction of NHS Direct, along with better provision of out-of-hours GP services “provides an opportunity for primary care trusts to integrate emergency services better” (DoH, 2004, p. 4).

Integration of services had improved and they were “becoming more patient-centered” (DoH, 2004, p.1), but it advised that full integration was yet to be achieved. The report stated that development of local emergency care networks had assisted the integration process but many of these networks were still in their infancy and had not achieved true cross-organisational success, therefore they “lacked a well-defined role in influencing decision-making” (DoH, 2004, p. 5).

The NAO report concludes with recommendations to achieve and sustain further improvements in time spent and patients’ experiences in A&E, improve the integration of emergency care services around patients’ needs and improve joint working in emergency care. Effectively, the entire emergency care system is still under review, and “achieving the Department's vision for whole-system modernisation of emergency care will require greater integration and more effective joint working” (DoH, 2004, p. 6).

Both the 2001 and 2004 investigations analysed and critiqued the current systems and made recommendations for change. These recommendations would vary depending on which government was in power at the time of the report and would rely heavily on a commitment to the financial investment required to make these changes happen. Inevitably, each individual area of the healthcare system will be subjected to an investigation into its short-comings, and with any possible change in government will come the promise of action through an investigation, and investment of funds in order to right the wrongs. But while one area is in the spot light, another will fall by the wayside, in an ever-turning circle of fortune. Something our emergency care system will continue to suffer with, as long as the demand continues to increase on it.

“Problems in the emergency services do not exist in isolation” (DoH, 2001b, p. 2), in fact, any issues affecting the emergency care services have a direct impact on the general health care system and vice versa. Further improving the way the whole hospital system and other health and social care provider’s work to manage the flow of their patients will enable the beneficial changes to continue.
Word Count: 1097

References

Great Britain. Department of Health. (2000). The NHS Plan: A Plan for Investment A Plan for Reform. London: HMSO.

Great Britain. Department of Health. (2001a). National Service Framework for Older People. London: HMSO.

Great Britain. Department of Health. (2001b). Reforming Emergency Care. London: HMSO.

Great Britain. National Audit Office. (2004). Improving Emergency Care in England. London: HMSO.

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