The plan for urgent and emergency care services for 2025/26, unveiled in early June by the Department of Health and Social Care and the soon-to-be-abolished NHS England, is a very strange document.
Despite the attempts to strike a positive note in many of the official press releases, and the assurances of NHS England CEO Sir Jim Mackey that there have been months of prior discussions on the draft plan before it was published, it could well confuse and demoralise some senior managers, especially after the succession of rapid changes in direction this year from government and NHS England.
The Plan proposes increases in capacity to address dangerously long delays in emergency admissions and, importantly mental health, which are dealt with separately. But there are some concerns that run right through the Plan.
Even its timing is bizarre: it was published just after all of the trusts and Integrated Care Boards had drawn up their financial plans and projections for the current financial year, with many trusts having had to resort to substantial cuts in staffing in their efforts to balance the books.
UNISON’s Head of Health Helga Pile said:
“It feels unrealistic to ask trusts to develop winter plans amid the chaos, uncertainty and plummeting morale provoked by demands to balance budgets and shed employees.” And while “Hard-pressed ambulance crews will appreciate the new 45-minute standard for handing over patients to A&E so they can get back on the road,” she warned: “this isn’t necessarily good news for patients if all it means is a long wait in a hospital corridor instead of the back of an ambulance.”
The late publication of the Plan is doubly disorienting because not only are the extra resources it announces inadequate to deliver the required results, but it also requires a series of changes to be rushed through, to take effect this coming winter – in less than 6 months time.
Indeed while the Plan may be vague on detail, it also sets some ambitious – possibly even impossible – targets:
- “eradicate” last winter’s lengthy ambulance handover delays;
- reduce ambulance waiting times for Category 2 patients (stroke, heart attack, sepsis or major trauma) by 14%;
- tackling (or according to Association of Ambulance Chief Executives Managing Director, Anna Parry in the government’s press release “eliminating”) corridor care;
- and “tackle” delays in discharging patients – “starting with the nearly 30,000 patients a year staying 21 days over their discharge-ready-date,” beginning with steps to,
- “eliminate” internal discharge delays of more than 48 hours in all settings.
Delayed discharge of patients who are medically fit but need support at home has been a chronic issue that has stubbornly defied repeated efforts by NHS England and trust bosses to deal with it. Exactly how trusts are supposed to deliver the results now after years of failure, and without any expansion of community health or social care services, is of course not explained.
The BMA and the Doctors Association have both expressed concern that despite the Plan’s call for more care to be shifted out of hospitals and into “alternative settings” and “the community,” and Wes Streeting’s claims that A&E caseloads are driven by the lack of sufficient access to GP appointments, the Plan offers no additional resources to expand and improve primary care, and “completely overlooks general practice”.
The BMA’s GP Committee Chair Dr Katie Bramall goes further and warns that paramedics following the Plan may make matters worse by calling GPs and asking Duty doctors on-call to take decisions outside their remit to avoid hospital admissions.
Her BMA press comment went further, stating: “There is a huge missed opportunity where this announcement mentions patients’ challenges in accessing GP services, but offers no proposals and zero funding to increase GP capacity at all.”
Dr Bramall added: “Anyone calling 111 for GP care will appreciate how dangerously stretched GP out of hours services are, with poor computer algorithms and cut-cost alternative staff replacing GPs, where patients may be sent to the wrong setting – at best this can be a waste of time, at worst it carries tragic consequences. …
“With no apparent extra funding for pressures outside hospitals this winter, we fear we will see further predictable NHS crises dominating the headlines yet again in the months ahead unless we stop making the same mistakes.”
The same BMA response also warns that “This long-promised plan will likely leave doctors working in Emergency Departments and other acute specialties severely underwhelmed.
“The emphasis on preventing the need for patients to visit the ED is of course right, but there seems little to nothing on improving the experience for those who do find themselves there. There is a clear need to increase capacity within acute hospitals to improve patient flow and shorten waits – but the plan does not set out how acute trusts will improve this.”
The statement adds: “As we – and many of our peers – have consistently said, you cannot fix the front door of the hospital without fixing the back. A lack of social care provision means patients who are ready to be discharged are unable to leave, despite the ambition to reduce length of stay.”
Royal College of Nursing general secretary and chief executive Professor Nicola Ranger, welcoming what she called the “admission” from the government that corridor care was “unacceptable”, warned “This is a plan high in ambition, but low on detail of how the nursing staff needed to make this work will be supported to deliver these changes.”
Her statement insisted “Those in government must recognise that their plans will also require investment in the nursing staff to deliver them.” Failure to invest in nursing would add “even greater pressures” to the profession, which she said is “on the brink”.
Even the NHS Confederation, concluding its quite lengthy summary of the Plan, which seems determined to accentuate the positive but cannot completely eliminate the negative, warns:
“Nonetheless, the scale of the challenge for the NHS remains vast. With limited extra investment and faced by ever-worsening demographics, the underlying model of UEC itself is coming under more and more stress every year. Breaking the cycle of winter crises and patient harm may require more than incremental improvements to the status quo in years to come.”
Other commitments and targets tend to be even more vague:
- “reduce” 24-hour plus A&E waits for mental health patients;
- “increase” the number of children seen within 4 hours;
- “improve” vaccination rates for frontline staff;
- “increase” numbers of patients receiving urgent care in primary community and mental health settings;
- “improve” flow through hospitals …
There is no doubt that the commitment to build new purpose-built capacity to relieve pressure on Emergency Departments should be welcomed, and can make an important difference – if the investment is in the right places.
However the plan as a whole lacks details that might make it convincing. It makes no mention of funding of revenue costs, not least to pay the medical, professional nursing and support staff needed to run services in:
- “around 40” new Same Day Emergency Care units (SDECs) or Urgent Treatment Centres (UTCs),
- 15 new mental health crisis assessment centres (which must be built and opened in time for the coming winter period),
- and an undefined number of additional mental health inpatient beds.
The UEC Plan states that capital spending of £370m has been allocated (from existing funds rather than new money) to set up all the new units and capacity. £250m is to cover the 40 new acute units; £26m to cover the mental health centres; £75m to cover expansion of mental health inpatient capacity, and another £20m is allocated to finance “expansion of the Connected Care Records for ambulance services”, giving paramedics access to the patient summary (including recent treatment history) from different NHS services.
However there is no mention of where any of the new units are to be located, or explain how the numbers of units have been decided, or by whom.
Location is important: in Reading health bosses have just decided to close the urgent care centre in Broad Street Mall which opened two-and-a-half years ago in hopes of easing the pressure on Reading’s A&E. Instead the UCC seems to have led to an overall increase in use of Urgent Care, both in the town centre and at the Royal Berkshire Hospital. A replacement urgent care unit will now be located in the hospital itself.
The UEC Plan proposes “around 40 new same day emergency care centres and urgent treatment centres”. But these two types of unit are both quite different in their design and the way they work: so how many would be UTCs (nurse-led clinics dealing with minor injuries), and how many would be consultant-led SDECs?
Are the UTCs to run 24/7 in parallel with the full Emergency Departments (as happens at St Thomas’s Hospital), or more limited hours like many existing UTCs, closing their doors in the early evening? How, where and by whom are all these decisions being made? Has there been any local consultation, any attempt to ensure the new units deliver easy local access where they are most needed?
Without these details, and a proper decision on where best to locate the new units to minimise inequalities of access, this is not a plan at all.
Dear Reader,
If you like our content please support our campaigning journalism to protect health care for all.
Our goal is to inform people, hold our politicians to account and help to build change through evidence based ideas.
Everyone should have access to comprehensive healthcare, but our NHS needs support. You can help us to continue to counter bad policy, battle neglect of the NHS and correct dangerous mis-infomation.
Supporters of the NHS are crucial in sustaining our health service and with your help we will be able to engage more people in securing its future.
Please donate to help support our campaigning NHS research and journalism.
The plan for urgent and emergency care services for 2025/26, unveiled in early June by the Department of Health and Social Care and the soon-to-be-abolished NHS England, is a very strange document.
Despite the attempts to strike a positive note in many of the official press releases, and the assurances of NHS England CEO Sir Jim Mackey that there have been months of prior discussions on the draft plan before it was published, it could well confuse and demoralise some senior managers, especially after the succession of rapid changes in direction this year from government and NHS England.
The Plan proposes increases in capacity to address dangerously long delays in emergency admissions and, importantly mental health, which are dealt with separately. But there are some concerns that run right through the Plan.
Even its timing is bizarre: it was published just after all of the trusts and Integrated Care Boards had drawn up their financial plans and projections for the current financial year, with many trusts having had to resort to substantial cuts in staffing in their efforts to balance the books.
UNISON’s Head of Health Helga Pile said:
The late publication of the Plan is doubly disorienting because not only are the extra resources it announces inadequate to deliver the required results, but it also requires a series of changes to be rushed through, to take effect this coming winter – in less than 6 months time.
Indeed while the Plan may be vague on detail, it also sets some ambitious – possibly even impossible – targets:
Delayed discharge of patients who are medically fit but need support at home has been a chronic issue that has stubbornly defied repeated efforts by NHS England and trust bosses to deal with it. Exactly how trusts are supposed to deliver the results now after years of failure, and without any expansion of community health or social care services, is of course not explained.
The BMA and the Doctors Association have both expressed concern that despite the Plan’s call for more care to be shifted out of hospitals and into “alternative settings” and “the community,” and Wes Streeting’s claims that A&E caseloads are driven by the lack of sufficient access to GP appointments, the Plan offers no additional resources to expand and improve primary care, and “completely overlooks general practice”.
The BMA’s GP Committee Chair Dr Katie Bramall goes further and warns that paramedics following the Plan may make matters worse by calling GPs and asking Duty doctors on-call to take decisions outside their remit to avoid hospital admissions.
Her BMA press comment went further, stating: “There is a huge missed opportunity where this announcement mentions patients’ challenges in accessing GP services, but offers no proposals and zero funding to increase GP capacity at all.”
Dr Bramall added: “Anyone calling 111 for GP care will appreciate how dangerously stretched GP out of hours services are, with poor computer algorithms and cut-cost alternative staff replacing GPs, where patients may be sent to the wrong setting – at best this can be a waste of time, at worst it carries tragic consequences. …
“With no apparent extra funding for pressures outside hospitals this winter, we fear we will see further predictable NHS crises dominating the headlines yet again in the months ahead unless we stop making the same mistakes.”
The same BMA response also warns that “This long-promised plan will likely leave doctors working in Emergency Departments and other acute specialties severely underwhelmed.
“The emphasis on preventing the need for patients to visit the ED is of course right, but there seems little to nothing on improving the experience for those who do find themselves there. There is a clear need to increase capacity within acute hospitals to improve patient flow and shorten waits – but the plan does not set out how acute trusts will improve this.”
The statement adds: “As we – and many of our peers – have consistently said, you cannot fix the front door of the hospital without fixing the back. A lack of social care provision means patients who are ready to be discharged are unable to leave, despite the ambition to reduce length of stay.”
Royal College of Nursing general secretary and chief executive Professor Nicola Ranger, welcoming what she called the “admission” from the government that corridor care was “unacceptable”, warned “This is a plan high in ambition, but low on detail of how the nursing staff needed to make this work will be supported to deliver these changes.”
Her statement insisted “Those in government must recognise that their plans will also require investment in the nursing staff to deliver them.” Failure to invest in nursing would add “even greater pressures” to the profession, which she said is “on the brink”.
Even the NHS Confederation, concluding its quite lengthy summary of the Plan, which seems determined to accentuate the positive but cannot completely eliminate the negative, warns:
“Nonetheless, the scale of the challenge for the NHS remains vast. With limited extra investment and faced by ever-worsening demographics, the underlying model of UEC itself is coming under more and more stress every year. Breaking the cycle of winter crises and patient harm may require more than incremental improvements to the status quo in years to come.”
Other commitments and targets tend to be even more vague:
There is no doubt that the commitment to build new purpose-built capacity to relieve pressure on Emergency Departments should be welcomed, and can make an important difference – if the investment is in the right places.
However the plan as a whole lacks details that might make it convincing. It makes no mention of funding of revenue costs, not least to pay the medical, professional nursing and support staff needed to run services in:
The UEC Plan states that capital spending of £370m has been allocated (from existing funds rather than new money) to set up all the new units and capacity. £250m is to cover the 40 new acute units; £26m to cover the mental health centres; £75m to cover expansion of mental health inpatient capacity, and another £20m is allocated to finance “expansion of the Connected Care Records for ambulance services”, giving paramedics access to the patient summary (including recent treatment history) from different NHS services.
However there is no mention of where any of the new units are to be located, or explain how the numbers of units have been decided, or by whom.
Location is important: in Reading health bosses have just decided to close the urgent care centre in Broad Street Mall which opened two-and-a-half years ago in hopes of easing the pressure on Reading’s A&E. Instead the UCC seems to have led to an overall increase in use of Urgent Care, both in the town centre and at the Royal Berkshire Hospital. A replacement urgent care unit will now be located in the hospital itself.
The UEC Plan proposes “around 40 new same day emergency care centres and urgent treatment centres”. But these two types of unit are both quite different in their design and the way they work: so how many would be UTCs (nurse-led clinics dealing with minor injuries), and how many would be consultant-led SDECs?
Are the UTCs to run 24/7 in parallel with the full Emergency Departments (as happens at St Thomas’s Hospital), or more limited hours like many existing UTCs, closing their doors in the early evening? How, where and by whom are all these decisions being made? Has there been any local consultation, any attempt to ensure the new units deliver easy local access where they are most needed?
Without these details, and a proper decision on where best to locate the new units to minimise inequalities of access, this is not a plan at all.
Dear Reader,
If you like our content please support our campaigning journalism to protect health care for all.
Our goal is to inform people, hold our politicians to account and help to build change through evidence based ideas.
Everyone should have access to comprehensive healthcare, but our NHS needs support. You can help us to continue to counter bad policy, battle neglect of the NHS and correct dangerous mis-infomation.
Supporters of the NHS are crucial in sustaining our health service and with your help we will be able to engage more people in securing its future.
Please donate to help support our campaigning NHS research and journalism.
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