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.

1. © Nuffield Trust and Health Foundation © Nuffield Trust
3/12/14
Where will the cracks show?
Ian Blunt

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. © 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. © 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. © Nuffield Trust and Health Foundation
Focus on: a series of in-depth reports

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. © 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. © 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. © Nuffield Trust and Health Foundation
The big one – four hour waits

10. © Nuffield Trust and Health Foundation
Increase in attendance?
0
1000000
2000000
3000000
4000000
5000000
6000000
7000000
8000000
Total attendances
Attendances

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. © 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. © 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. © Nuffield Trust and Health Foundation
Some of the solutions in
A&E units… …and some in other services

15. © Nuffield Trust and Health Foundation
Potentially preventable admissions…

16. © Nuffield Trust and Health Foundation
Some progress on prevention, but…

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. © 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. © 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. © 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. © 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. © Nuffield Trust and Health Foundation
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© Nuffield Trust and Health Foundation
3/12/14
ian.blunt@nuffieldtrust.org.uk