Keogh proposes new A&E blueprint

The Medical Director of NHS England, Sir Bruce Keogh, has published his first review of urgent and emergency care in England, which proposes a fundamental shift in the provision of care delivery.1 The report proposes that patients requiring urgent care should have access to more extensive services outside hospital, while those with more serious or life threatening conditions should receive treatment in centres with the best clinical teams, expertise and equipment. Sir Bruce Keogh commented that the current system is under “intense, growing and unsustainable pressure”, driven by rising demand from a population that is getting older, a confusing and inconsistent array of services outside hospital, and high public trust in the A&E ‘brand’. In his report, he advocates a systemwide transformation over the next three to five years, saying this is “the only way to create a sustainable solution and ensure future generations can have peace of mind that, when the unexpected happens, the NHS will still provide a rapid, high quality and responsive service free at the point of need.” In a letter to Health Secretary, Jeremy Hunt, and NHS England Chair, Sir Malcolm Grant, Sir Bruce Keogh said: “Our vision is simple. Firstly, for those people with urgent but non-life threatening needs we must provide highly responsive, effective and personalised services outside of hospital. These services should deliver care in or as close to people’s homes as possible, minimising disruption and inconvenience for patients and their families. “Secondly, for those people with more serious or life threatening emergency needs we should ensure they are treated in centres with the very best expertise and facilities in order to maximise their chances of survival and a good recovery.” Highlighting opportunities to shift care closer to home, he pointed out that 40% of A&E patients are discharged requiring no treatment; up to one million emergency admissions were avoidable last year; and up to 50% of 999 calls could be managed at the scene. Citing modern treatment of the nation’s two biggest killers – heart attacks and strokes – he also pointed out that survival rates have improved significantly by taking patients to specialist centres that provide the best available hospital treatment. “Advancing science has directed the way we deliver services to achieve the best results, but it also exposes the illusion that all A&Es are equally able to deal with anything that comes through their doors,” said Sir Bruce Keogh, adding: “We now find ourselves in a place where, unwittingly, patients have gained false assurance that all A&Es are equally effective. This is simply not the case. A&E departments up and down the country offer very different types and levels of service, yet they all carry the same name. We need to ensure that there is absolute clarity and transparency about what services different facilities offer and direct or convey patients to the service that can best treat their problem.”

The report makes proposals in five key areas:

Providing better support for people to self-care: The NHS should provide better and more easily accessible information about self-treatment options so that people can avoid the need to see a healthcare professional where possible.