Ian Blunt: urgent care in the English NHS

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Ian Blunt gives a snapshot of the quality of urgent care in the English health service. He was speaking at the Nuffield Trust's Health Policy Summit in March 2014.

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Ian Blunt: urgent care in the English NHS

  1. 1. © Nuffield Trust and Health Foundation © Nuffield Trust 3/12/14 Where will the cracks show? Ian Blunt
  2. 2. © Nuffield Trust and Health Foundation Background • Dominated by scandals and reports - Morecombe Bay, Colchester, Francis I&II, Keogh Reviews etc • Real fears on costs - prospect of continuing years of constrained finances • Major organisational change within NHS - low morale and pervasive pessimism • Critical period for quality
  3. 3. © Nuffield Trust and Health Foundation Parallel Realities? • An NHS that has failed patients and public trust alongside an NHS that is still improving • An NHS that needs to change whilst not losing the gains that have been realised • QualityWatch - providing independent scrutiny into how the quality of health and social care is changing over time
  4. 4. © Nuffield Trust and Health Foundation Indicators of Quality Access Safety Effectiveness Person centred care Capacity Equity Social care 13 11 13 18 30 0 Primary & community 46 66 147 27 35 7 Secondary / tertiary 75 160 274 159 47 10 Mental health 41 82 26 77 24 10 Population 9 7 82 5 1 1
  5. 5. © Nuffield Trust and Health Foundation Focus on: a series of in-depth reports
  6. 6. © Nuffield Trust and Health Foundation General Observations … Many access indicators ‘holding up’. Activity continues to increase – nurse staffing steady, beds reduced Patient experience -paradox of surveys continuing to be positive despite failings in care within individual organisations Effectiveness – typically very specific markers and positive findings Inequalities – stubbornly persistent
  7. 7. © Nuffield Trust and Health Foundation …but… Urgent care is a critical area – and though there have been wobbles we are still ahead of where we were five years ago. Progress on prevention limited
  8. 8. © Nuffield Trust and Health Foundation Urgent care wobbles 40634 40695 40756 40817 40878 40940 41000 41061 41122 41183 41244 41306 41365 41426 41487 41548 41609 66.0% 68.0% 70.0% 72.0% 74.0% 76.0% 78.0% 80.0% Category A calls attended within target time National standard
  9. 9. © Nuffield Trust and Health Foundation The big one – four hour waits
  10. 10. © Nuffield Trust and Health Foundation Increase in attendance? 0 1000000 2000000 3000000 4000000 5000000 6000000 7000000 8000000 Total attendances Attendances
  11. 11. © Nuffield Trust and Health Foundation Increase in attendance? 0 1000000 2000000 3000000 4000000 5000000 6000000 7000000 8000000 Total attendances Type 1 Departments - Major A&E Attendances
  12. 12. © Nuffield Trust and Health Foundation Occupancy 40271 40298 40325 40352 40379 40406 40433 40460 40487 40514 40541 40568 40595 40622 40649 40676 40703 40730 40757 40784 40811 40838 40865 40892 40919 40946 40973 41000 41027 41054 41081 41108 41135 41162 41189 41216 41243 41270 41297 41324 41351 0 1000 2000 3000 4000 5000 6000 7000 8000 9000 10000 Minimum Minimum to maximum Average NumberofpeoplesimultaneouslyoccupyingA&EdepartmentsinEngland
  13. 13. © Nuffield Trust and Health Foundation Expression of long term growth in demand for urgent care? 35521 35704 35886 36069 36251 36434 36617 36800 36982 37165 37347 37530 37712 37895 38078 38261 38443 38626 38808 38991 39173 39356 39539 39722 39904 40087 40269 40452 40634 40817 41000 41183 41365 41548 0 100000 200000 300000 400000 500000 600000 Emergencyinpatientadmissions
  14. 14. © Nuffield Trust and Health Foundation Some of the solutions in A&E units… …and some in other services
  15. 15. © Nuffield Trust and Health Foundation Potentially preventable admissions…
  16. 16. © Nuffield Trust and Health Foundation Some progress on prevention, but…
  17. 17. © Nuffield Trust and Health Foundation -60% -40% -20% 0% 20% 40% 60% Local authority Average Local authority Percentagechangeinnetcurrentspending(realterms),2009/10-2012/13 Reductions in adult social care funding
  18. 18. © Nuffield Trust and Health Foundation Falls in the number of people receiving lower intensity services 2009/10 2010/11 2011/12 2012/13 50 60 70 80 90 100 110 Less than or equal to 2 hours Number of Service Users More than 2 hours and less than or equal to 5 hours Number of Service Users More than 5 hours and less than or equal to 10 hours Number of Service Users More than 10 hours inc overnight/live in/24 hour Number of Service Users Financial Year Changerelativetoindexyear(2009/10=100)
  19. 19. © Nuffield Trust and Health Foundation When is a crack not a crack? Median distance travelled to A&E is 2.6 miles, to emergency inpatient admission is 3.4 miles (2011/12) 8% net reduction in the number of major A&E units since 2001/02 Slight, but not statistically significant, increase in the average distance for an emergency admission from 2001/02 to 2011/12, rising from 5.2 miles 5.4 miles The biggest increase in the distances travelled was observed for emergency admissions following stroke, which rose from 4.9 miles to 5.5 miles. The average distance following trauma did not change substantially
  20. 20. © Nuffield Trust and Health Foundation Where else might cracks appear? • Some topics poorly served by data • Cracks hiding in the averages Access Safety Effectiveness Person centred care Capacity Equity Social care 13 11 13 18 30 0 Primary & community 46 66 147 27 35 7 Secondary / tertiary 75 160 274 159 47 10 Mental health 41 82 26 77 24 10 Population 9 7 82 5 1 1
  21. 21. © Nuffield Trust and Health Foundation Summary Most measures holding up (for now) Protect gains made over the last decade Urgent care – wobble or trend? Keep watching
  22. 22. © Nuffield Trust and Health Foundation www.qualitywatch.org.uk Sign-up for our newsletter www.qualitywatch.org.uk/newsletter Follow us on Twitter: Twitter.com/qualitywatch © Nuffield Trust and Health Foundation 3/12/14 ian.blunt@nuffieldtrust.org.uk

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