NICE update: offers system view on emergency care

Demand in the NHS is increasing across the whole urgent and emergency care system. Hospitals are finding it increasingly challenging to maintain the flow of patients from admission to discharge, and readmissions to hospital are also increasing.

A number of recommendations are made, though they do not include detail about how they should be implemented (how many staff are needed or the exact content of an intervention). The most cost-effective solution is likely to vary depending on local systems.

One recommendation is to provide specialist and advanced paramedic practitioners who have extended training in assessing and treating people with medical emergencies.

Higher banded advanced paramedic practitioners would result in additional staff costs for ambulance trusts. Staff undergoing additional training may need to be released to attend courses, and extra staff time could be needed to backfill rotas. There may also be increased training and education costs.

However, using advanced paramedics may result in fewer attendances at emergency departments and fewer admissions and avoid more costly call-outs for an ambulance.

A further recommendation is to provide access to physiotherapy and occupational therapy seven days a week for people admitted to hospital with a medical emergency. The costs of expandng therapy services should be offset by savings from reduced length of stay and fewer delays to discharge.

Increased nurse-led support in the community for people at increased risk of hospital admission or readmission could prevent admissions and readmissions and give better outcomes for patients. 

There is considerable overlap between the guideline and other policy initiatives, such a NHS England seven-day services clinical standards. Commissioning for urgent and emergency care needs align with NHS England programmes on the Five-year forward view and urgent and emergency care programme.

Costs and associated savings are likely to arise in different sectors of the health and social care system. Commissioners may need to consider local funding changes to reflect this and support providers.

Nicola Bodey is senior business analyst at NICE