The Health Secretary, Jeremy Hunt, has announced proposals to tackle increasing pressures on NHS A&E services – starting with care for vulnerable older patients with complex health problems.
Overall, the number of people going to A&E departments in England has risen by 32% in the past decade, and by one million each year since 2010. The over-65s represent 17% of the population, but 68% of NHS emergency bed use. They also represent some of the NHS’s most vulnerable patients, and those most at risk from failures to provide seamless care. Therefore, a key aim will be to provide joined-up care – spanning GPs, social care, and A&E departments – overseen by a named GP. To support the NHS in the short term, the Government has made an extra £500 million funding available over the next two years. The Health Secretary outlined plans on how £250 million should be used by 53 NHS Trusts this winter. This funding will include:
• Around £62 m for additional capacity in hospitals – for example extra consultant A&E cover over the weekend so patients with complex needs will continue to get high-quality care. • Around £57 m for community services – such as better community end of life care and hospices.
• Around £51 m for improving the urgent care services – for example for patients with longterm conditions.
• Around £25 m for primary care services – for instance district nursing, to provide care for patients in their home, preventing them from being admitted to A&E.
• Around £16 m for social care – such as integrating health and social care teams to help discharge elderly patients earlier and prevent readmission.
• Around £9 m for other measures – for example to help the ambulance service and hospitals work better together.
£15 million of this money will also be spent on NHS 111 to increase the number of clinicians and call handlers so that non-emergency visits to A&E can be avoided. Flu also has a big impact on the NHS, with on average around 750,000 patients going to their GP with flu symptoms and 27,000 people admitted to hospital as a result of the disease each year. For this reason, Jeremy Hunt also announced specific measures to minimise the effects of flu, and flu-related A&E visits in the coming winter months:
• For the first time, any NHS Trust eligible for a share of the £250 m A&E funding for next year will need to ensure that at least 75% of its own staff have been vaccinated against flu this year.
• A national flu campaign to protect the most vulnerable from the disease, and avoid flurelated A&E visits.
• A flu vaccination programme for children between two and three years old, to reduce potential spread of the disease.
Proposals being put together, in order to be rolled out next year include:
• Patients should have a named clinician responsible for the coordination of their care right across the NHS – between hospital, in care homes, and in their own homes. This is subject to on-going engagement, but current views are that a GP should fill this role.
• Care for older people must be joined up between social care services and the NHS, starting with the £3.8 bn integrated care fund recently announced by the Chancellor.
• Information and patient records must be shared across the NHS and social care services so that accurate clinical information is available at all times to everyone involved in a patient’s care. By the end of 2014 at least one-third of A&Es should be able to see the GP records of their patients; and at least onethird of NHS 111 services to be able to see the GP records of their callers.
