Emergency care delivery plan promises new beds, ambulances and staff

The Delivery plan for recovering urgent and emergency care services will see escalation beds – set up in many trusts over the last few months – made permanent, often in modular buildings to move them out of existing inappropriate spaces, and 3,000 more virtual ward beds in time for next winter, boosting the number of virtual beds to over 10,000.

Prime minister Rishi Sunak (pictured) reiterated that cutting NHS waiting times was one of his five priorities. ‘Urgent and emergency care is facing serious challenges, but we have an ambitious and credible plan to fix it,’ he said. ‘It will take time to get there, but our plan will cut long waiting times by increasing the number of ambulances, staff and beds – stopping the bottlenecks outside A&E and making sure patients are seen and discharged quickly.’

He added that meeting this ambition would ‘represent one of the fastest and longest sustained improvements in emergency waiting times in NHS history’.

The ambition of admitting, transferring or discharging 76% of patients within four hours by March 2024 is restated with no mention of when performance would be expected to return to the target of 95%. But new data on how many patients spend over 12 hours in total in A&E will be published for the first time: currently NHS England only publishes waits over 12 hours once a decision has been taken to admit patients.

Any improvement in A&E performance is expected to be partly due to better flow through hospitals, with the plan calling for all hospitals with a major A&E to establish same-day emergency centres – which diagnose and treat many patients who don’t need to stay in hospital – and investment in discharge.

Over the next two years £1.6bn of the extra funding from last year’s autumn statement will be spent on discharges, with care transfer hubs set up in hospitals to ensure faster discharge to the right setting. Patients will be given a target date to discharge on admission and there will be monitoring of whether these dates are being achieved with data on this being published by next winter. There will also be changes to processes around stepdown care such as patients who are going home no longer having to wait for local authority assessments before they can access physiotherapy.

The government will also set out further details in February of how it plans to increase social care capacity and streamline discharge, assessment, and placement processes.

Improved community services will avoid admission in the first place with scaling up of urgent community response, frailty and falls services. 

 Ambulance trusts – which already have a target of returning category 2 response times to 30 minutes averaged over 2023/24 – get 800 new ambulances. The guidance explains that the new vehicles will be part of ‘ongoing improvement and replacement’ of the fleet, but will include 100 new specialist mental health response vehicles. There is also a promise to increase emergency medical technicians and to fill paramedic workforce gaps – although the numbers are not specified.  More mental health clinicians will work in mental health ambulances.

Clinicians who have already retired, are thinking of retirement or seeking more flexible options will be encouraged to work for NHS 111 and integrated urgent care, with more home working alternatives.  The role of NHS 111 as the first port of call for many patients seeking urgent or emergency care is also restated with plans for more clinical input and a review of 111 First, which encouraged people to come through NHS 111 and be booked into an ‘appointment slot’ at A&E – although there was no guarantee they would be seen at this time.

The plan also outlines an increased focus on accountability with integrated care boards being held accountable for improving A&E and ambulance wait times and setting targets for individual providers.  And providers will be put in one of three tiers depending on how well they are doing with delivering the plan with intensive support for those in tier three.

Funding for these initiatives will come from the money already announced for the NHS and social care in last year’s autumn statement.

But while many groups were broadly supportive of the plan – many elements of which had already been announced – there was scepticism about what could be achieved without additional workforce. NHS England has still to publish its workforce plan which the King’s Fund said was likely to be the ‘defining’ document for the NHS.   

Miriam Deakin, director of policy at NHS Providers, described the plan as a ‘positive first step’ towards sustainable recovery. ‘Trust leaders will welcome its incremental approach to recovering core standards, the acknowledgment that current pressures need system-wide solutions, and the dedicated focus on increasing capacity in ambulance services, growing bed numbers and reducing bed occupancy,’ she said.

She also underlined that ‘sustainable recovery’ would be dependent on ‘funded workforce planning’.

B2034-delivery-plan-for-recovering-urgent-and-emergency-care-services.pdf (england.nhs.uk)