Urgent and emergency care
Despite some systems experiencing reductions in attendances to hospital emergency departments, Surrey Heartlands has continued to see high attendance levels, with attendances now higher than pre-COVID-19 levels.
We must manage this demand, helping make patients aware of other available services, which they could use to take pressure off emergency departments (A&E).
Identifying priorities to ease pressures
To help ease pressures on emergency departments, we have identified the following priority areas:
Reduce 12-hour waits in emergency departments to zero and no more than 2%
Reduce waiting times in departments, especially those waiting over 12 hours from arrival. We aim to manage demand through developing other community services, such as urgent community response within 2 hours and virtual wards supporting patients in their own homes. The goal of transforming urgent and emergency care pathways is to enable timely intervention in the most appropriate service to avoid emergency department attendance. We aim to improve access by using alternative community and GP services and optimising our digital capabilities. We are focusing on improving the movement of patients through our acute hospitals to reduce high bed occupancy rates, mitigate discharge delays and improve care quality and outcomes.
Minimise handover delays between ambulance and hospital
Demand for the ambulance service remains high across Surrey Heartlands. The ambulance service and hospitals are working to ensure we minimise any handover waits, as these result in delays. These delays affect patient care and hold up ambulance crews responding to their next 999 call. As a system, we are working on alternative pathways to reduce the need for people to attend emergency departments.
Improve Ambulance Response Standards
Nationally, ambulance services are struggling to meet the response standards, the time it takes to reach a patient after a 999 call, based on their clinical priority. To improve performance, the South East Coast Ambulance Service Transformation Programme called 'Better by Design.' Actions for include:
- Offering alternative treatment options
- Improving efficiency
- Staff wellbeing, workforce capacity and career options
Transform and build community services – As a system, our key priority in support of our acute hospitals is the transformation of community services. Our ambition is to provide as many services as possible close to the patient's home, to improve patient experience and outcomes.
Our five focus areas for recovery, reset and transformation are:
- Urgent community response
- Core community services
- Integrated community-based pathways
- Care homes and domiciliary care
- Prevention and independent living
Community service waiting lists
Waiting list sizes have increased during and since the pandemic. Reduction in the number of citizens waiting for treatment is a key objective. The system is working collaboratively to improve the data quality, transparency, and reporting consistency to reduce the impact on patients' health and wellbeing during treatment waits. Waiting lists are reviewed for clinical risk, with individuals supported by personalised care and shared care decision-making to 'wait well' before their appointment.
We are ambitious in our plan to expand the 'virtual ward' programme, first developed as part of the Covid response. By providing care through a virtual ward, as opposed to traditional admission into the hospital, we plan to deliver community-based acute health and care or early supported discharge to reduce demand on precious bed resources and provide care closer to the patient's home.
2-hour urgent community response
The urgent community response service development is one of several measures to increase the capacity and responsiveness of community care services. The aim is to support people in managing changes in their health and social care needs within their home environment without needing to go to hospital. This partnership urgent response and recovery support is being delivered by collaborating with all community services, GPs and our District and Borough Council. The urgent community response plan sets out how Surrey Heartlands will increase referrals to the service from all key sources. Referrals from 111, 999/ambulance services and first contact care provision will be accepted.
Surrey Heartlands plans to deliver health and care discharge services seven days a week for people ready to leave an acute hospital bed. Surrey Heartlands will continue to build on personalised health and care initiatives that focus on people leaving the hospital, including interim care support packages coordinated across health, social care and voluntary sector partners. Getting discharge planning right is a crucial component of our process for managing surges in demand.