Ian Blunt: urgent care in the English NHS
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Transcript of Ian Blunt: urgent care in the English NHS
© Nuffield Trust and Health Foundation © Nuffield Trust
3/12/14
Where will the cracks show?
Ian Blunt
© 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
© 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
© Nuffield Trust and Health Foundation
Indicators of Quality
Access Safety Effectiveness Person
centred careCapacity 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
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Focus on: a series of in-depth reports
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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
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…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
© Nuffield Trust and Health Foundation
Urgent care wobbles
4063440695
4075640817
4087840940
4100041061
4112241183
4124441306
4136541426
4148741548
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
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The big one – four hour waits
© Nuffield Trust and Health Foundation
Increase in attendance?
0
1000000
2000000
3000000
4000000
5000000
6000000
7000000
8000000
Total attendances
Att
end
ance
s
© 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
Att
end
ance
s
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Occupancy
4027140298
4032540352
4037940406
4043340460
4048740514
4054140568
4059540622
4064940676
4070340730
4075740784
4081140838
4086540892
4091940946
4097341000
4102741054
4108141108
4113541162
4118941216
4124341270
4129741324
41351
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
Minimum Minimum to maximum Average
Nu
mb
er o
f p
eop
le s
imu
ltan
eou
sly
occ
up
yin
g A
&E
dep
artm
ent s
in
En
gla
nd
© Nuffield Trust and Health Foundation
Expression of long term growth in demand for urgent care?
3552135704
3588636069
3625136434
3661736800
3698237165
3734737530
3771237895
3807838261
3844338626
3880838991
3917339356
3953939722
3990440087
4026940452
4063440817
4100041183
4136541548
0
100000
200000
300000
400000
500000
600000
Em
erg
ency
in
pat
ien
t ad
mis
sio
ns
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Some of the solutions in A&E units… …and some in other services
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Potentially preventable admissions…
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Some progress on prevention, but…
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-60%
-40%
-20%
0%
20%
40%
60%
Local authority Average
Local authority
Per
cen
tag
e c h
ang
e in
ne t
cu
rren
t sp
e nd
ing
(re
al t
erm
s),
2009
/10-
2012
/13
Reductions in adult social care funding
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Falls in the number of people receiving lower intensity services
2009/10 2010/11 2011/12 2012/1350
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
Ch
ang
e re
lat i
ve t
o i
nd
ex y
ear
(200
9/10
= 1
00)
© 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
© 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
© 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
© Nuffield Trust and Health Foundation
www.qualitywatch.org.uk
Sign-up for our newsletterwww.qualitywatch.org.uk/newsletter
Follow us on Twitter:Twitter.com/qualitywatch
© Nuffield Trust and Health Foundation
3/12/14