NHS Plan To Cut Avoidable Admissions To Further Boost Efforts To Reduce Waiting Times
The NHS is set to increase virtual ward use as new analysis shows that 9,000 hospital admissions have been avoided in the South East in the past year thanks to the world-leading initiative.
NHS hospitals are being encouraged to refer more patients directly to virtual wards where they can receive treatment from the comfort of their own home, while freeing up hospital beds for the sickest patients.
More people suffering from respiratory conditions or heart failure are set be treated through an intravenous drip or a nebuliser – a machine that turns liquid medicine into a mist that can be easily inhaled – from home, instead of needing to be cared for in hospital. While more people living with frailty are also set to benefit from the virtual ward programme.
It comes as the largest evaluation of the effectiveness and benefits of virtual wards found one non-elective hospital admission could be avoided for every 2.5 virtual ward admissions.
It found that if the South East virtual ward model is scaled up across England, 178,000 admissions could be avoided over the next two years according to NHS analysis.
The enhancement of the virtual ward programme forms part of an NHS England letter to every local hospital and health system in the country, setting out evidence-based actions to continue to boost urgent and emergency care performance in the year ahead.
For the first time ever, funding incentives will include 12-hour A&E waits, with hospitals asked to focus on ensuring that patients don’t wait beyond this timeframe.
National guidance, backed by £150 million, will focus on helping patients to avoid an A&E admission in the first place, with patients admitted to virtual wards straight from home and measures to support regular A&E attenders who don’t need urgent care to get the help they need.
The updated framework also sets out how local areas can allow direct referrals by GPs and 999 to same day emergency care, which sees patients receive timely diagnosis, care and treatment while avoiding an overnight stay.
The plan builds on last year’s improvements in performance thanks to the Urgent and Emergency Care Recovery Plan, which saw the first improvement in the proportion of patients seen within four hours in A&E since 2009, outside of the pandemic.
NHS national director for urgent and emergency care, Sarah-Jane Marsh, said:
“Thanks to the hard work of NHS staff, last year saw considerable progress in the recovery of urgent and emergency care services with the first improvement in A&E performance outside of the pandemic in nine years, and Category 2 ambulance response times 17 minutes faster than the year before, all despite a record year of demand for A&E and ambulance call-outs.”
“However, it is clear there is still much further to go and with the rollout of ambitious new measures like more direct referrals to same day emergency care, more ‘step-up’ virtual wards, and targeted support for patients who regularly attend A&E, we are confident this plan can deliver further improvements for patients and continue to bring down the longest waits for care.”
Minister for Urgent and Emergency Care Helen Whately said:
“Last year, we started planning for winter earlier than ever before and that plan worked.”
“We got A&E waits down and ambulances to people quicker – and over 200,000 more people received NHS same day emergency care. That was thanks to the hard work of our NHS and social care staff, and by doing things differently to improve care.”
“We’re learning from what worked to do better again this year, like helping people get home sooner when they are well enough to leave hospital and preventing people needing to go to hospital in the first place.”
“We’re making our health service faster, fairer and simpler, and urgent and emergency care is at the forefront of that.”
Other actions from the UEC letter include:
– Clinical assessment of 111 and 999 calls to direct patients to the best service for them
– Frailty assessments at the A&E front door to identify patients over 65 who may need access to specialist clinicians
– More flexibility for urgent and emergency care staff to boost retention and increase capacity
Last year, NHS staff worked hard to recover urgent and emergency care services with the first improvement in the proportion of patients seen within four hours in A&E since 2009, outside of the pandemic, and an average category 2 ambulance response time 17 minutes faster than the year before. An improvement in ambulance handovers outside hospital meant a 40% reduction in ‘lost’ hours on the road.
This year, two new targets have been set to improve waiting times further, with the aim of ensuring 78% of patients are treated, admitted, or sent home from A&E within four hours by March 2025, and ambulances get to Category 2 calls within an average of 30 minutes this year.
As well as those targets, this year, working with colleagues in social care and local authorities, hospitals will focus on reducing the number of 12 hour waits in A&E, particularly for mental health patients, alongside going further on reducing ambulance waits outside hospitals, sending people home sooner, and keeping the high levels of bed capacity delivered this winter with an average of 99,500 beds to be open each day across the year.
President of the British Geriatrics Society, Professor Adam Gordon, said:
“We are particularly pleased to see the focus on frailty assessments at the front door, which brings the expertise into Emergency Departments and Admission Units which is needed to support people with the most complex care needs.”
“This approach is feasible through careful redeployment of existing teams. It helps more vulnerable patients start treatment sooner and can, in many instances, help people get out of hospital with appropriate care days earlier.”
