Opinion
New vision for emergency care
Keith Willett asks nurses to become ambassadors for NHS England’s blueprint for change ■■ Helping people with urgent care needs to get the right advice in the right place, first time. ■■ Connecting urgent and emergency care services together so the overall system becomes more than the sum of its parts.
■■ Ensuring that people with more serious or life-threatening emergency needs receive treatment in centres with the right facilities and expertise to maximise their chances of survival and good recovery.
Alamy
YOU MAY have heard Sir Bruce Keogh talk about the publication last month of the first report on NHS England’s urgent and emergency care review. I have led this review for Professor Keogh and the report sets out a new vision for the delivery of urgent and emergency care. This vision is simple: First, we must provide people with urgent but non-life threatening needs with responsive, effective and personalised services outside of hospital, as close to their homes as possible, while ensuring that we minimise disruption and inconvenience for them and their families. Second, we must ensure that people with more serious or life-threatening emergency needs are treated in centres with the best facilities and expertise. We developed this vision by working, not with bureaucrats, but with people who are involved with urgent and emergency care on a daily basis. To put it into practice, we plan to make five changes to the urgent and emergency care system. These involve: ■■ Providing better support for people to self-care.
Nurses will be asked to become advocates for the ‘greatest change to emergency services in 40 years’
Mobilising staff in the interests of patients JP Nolan explains the role of the RCN in the current review of urgent care services IN JANUARY 2013, the NHS Commissioning Board, now NHS England, announced a systematic review of urgent and emergency care (UEC) services in England in response to a widely held view that the existing UEC model is outdated, confusing and inconsistent. A steering group of clinicians was formed to provide clinical input for the review board, which is chaired by national director for acute episodes of care Keith Willett. The composition and terms of reference of the steering group, on which the RCN is represented, as well as evidence supporting the review and the board’s 12 December 2013 | Volume 21 | Number 8
emerging principles, are available on the NHS England website. It was clear from the outset that, to succeed where previous reviews had failed, the board would have to adopt a patient-centred approach. Artificial barriers Such an approach would have to liberate itself from the agendas of different specific professional groups or health-service sectors, and pay no heed to artificial barriers between, for example, acute and primary care providers, paramedics and nurses, or between doctors and pharmacists.
According to the review’s emerging principles, UEC services in England should be sustainable, responsive, interconnected and intuitive to users. Putting this vision into practice will be complicated, however, and will require that the entire healthcare workforce is mobilised in the interests of the public. Innovative models of care involving, for example, streaming in emergency departments, direct-access assessments, urgent and acute mental health care, direct-access specialties, elderly-care outreach and hospitals at home will have to be adopted regionally and nationally.
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Opinion ■■ Providing responsive urgent care services outside of hospital so people no longer choose to queue in emergency departments. Perhaps inevitably, the press coverage of the report focused on the new emergency and major emergency centres, and what they mean for patients, but it is also vital to the plan that we as healthcare professionals adopt a new approach and adapt our thinking. As a consultant trauma surgeon for more than 20 years, I have seen and experienced the contribution that a safe, efficient and strong urgent and emergency care system makes to all our lives, and those of our friends and families. It is this system that we are trying to enhance and sustain by undertaking this review. Spotting opportunities As phase two of the review begins, and the reforms begin to filter through our system, its success will depend on you, our NHS family: the staff in emergency departments, the paramedics on the road, and the nurses and doctors in the community. In the rush of the day job, it is not always easy to embrace change. This is why I ask you all to accept a role, no matter how small, as ambassadors for the review, and make sure that colleagues
In gathering evidence for changing UEC services, the review board found little on models of care that maximise nursing potential. This paucity of evidence is due in part to a lack of detail in data on the nursing workforce, and the RCN is calling for a commissioned and systematic review of workforce planning similar to those undertaken in medicine and surgery. The review’s latest output, published last month, clarifies the scale of change required by all specialties, in all settings, to ensure healthcare staff in different geographic areas share responsibility for their populations. In the next phase of the review the board will examine models of care that can deliver a service characterised by the emerging principles. Meanwhile the consultative process will continue to inform the college’s response to the review.
in clinical areas are receptive to change, spot opportunities and help implement the vision wherever possible. What we propose is the greatest change to emergency services in 40 years. It will change how patients access care and how efficiently they are treated. It will involve giving up time to do the caring that can be squeezed out when pressure is unrelenting. As the review progresses, we will keep you informed about our plans on NHS Choices, so that you can see for yourselves how things are developing. I encourage you to have your say about our plans as they develop; we will listen. Our timescale for the delivery phase of the review is between three and five years. But we know that innovative work is already going on, most of it in keeping with the aims and spirit of this review. We are rightfully proud of our healthcare system and we know how hard NHS staff work to keep a huge, complicated and extremely well respected health service working. I hope you will take up the challenge to be advocates and ambassadors for our new blueprint for the urgent and emergency care system. Keith Willett is NHS England’s director for acute episodes of care
I encourage all nurses to share their views with NHS England. The RCN will inform members of the RCN Emergency Care Association when feedback is next invited. JP Nolan is an RCN adviser on acute, emergency and critical care. He is the nursing representative on the national review of urgent and emergency care steering group
Find out more ■■ Further details about the review are available on the NHS England website, at tinyurl.com/mq2qymy ■■ The RCN’s first response is available at www.rcn.org.uk/support/consultations ■■ Information about the review and the RCN’s response are available from the author, at [email protected]
Board’s eye view Human factors EVERY DAY in the NHS, thousands of patients are treated safely by dedicated healthcare professionals, but some are harmed as a result of the treatment they receive. Such harm can be prevented if staff are aware of the human factors that influence behaviour. At the Queen Elizabeth Hospital, Birmingham, an awareness of human factors and the need for team leaders to control hazardous clinical situations are part of resuscitation training. Team leaders must plan roles, manage teams, provide channels for structured communication and be aware of everything that unfolds during emergencies. While they are ultimately responsible for decision-making processes, they should also encourage team members to ask questions, voice opinions and raise concerns. When reflecting on practice, some staff find voicing their concerns difficult, especially when they concern senior professionals. Nevertheless, all staff must remember their duty as advocates for the patients in their care. Meanwhile, the responsibility for creating an open culture does not lie solely with the team leader; it is up to the organisation as a whole to change its hierarchical structures and support all staff to speak freely without fear of reprimand or conflict. Many patient-safety campaigns refer to Elaine Bromiley, who died in 2005 after being deprived of oxygen during surgery, to highlight the importance of recognising and managing human factors. In Ms Bromiley’s case, what should have been a routine operation got out of control in part because of a lack of situational awareness. Human factors can affect any aspect of care delivery, and should be something all healthcare workers understand. ■■ A short film about Ms Bromiley’s case can be viewed at tinyurl.com/m3jpc5a Hannah Bryant is the resuscitation officer at Queen Elizabeth Hospital, Birmingham, and a member of the Emergency Nurse editorial advisory board
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New vision for emergency care
Keith Willett asks nurses to become ambassadors for NHS England’s blueprint for change ■■ Helping people with urgent care needs to get the right advice in the right place, first time. ■■ Connecting urgent and emergency care services together so the overall system becomes more than the sum of its parts.
■■ Ensuring that people with more serious or life-threatening emergency needs receive treatment in centres with the right facilities and expertise to maximise their chances of survival and good recovery.
Alamy
YOU MAY have heard Sir Bruce Keogh talk about the publication last month of the first report on NHS England’s urgent and emergency care review. I have led this review for Professor Keogh and the report sets out a new vision for the delivery of urgent and emergency care. This vision is simple: First, we must provide people with urgent but non-life threatening needs with responsive, effective and personalised services outside of hospital, as close to their homes as possible, while ensuring that we minimise disruption and inconvenience for them and their families. Second, we must ensure that people with more serious or life-threatening emergency needs are treated in centres with the best facilities and expertise. We developed this vision by working, not with bureaucrats, but with people who are involved with urgent and emergency care on a daily basis. To put it into practice, we plan to make five changes to the urgent and emergency care system. These involve: ■■ Providing better support for people to self-care.
Nurses will be asked to become advocates for the ‘greatest change to emergency services in 40 years’
Mobilising staff in the interests of patients JP Nolan explains the role of the RCN in the current review of urgent care services IN JANUARY 2013, the NHS Commissioning Board, now NHS England, announced a systematic review of urgent and emergency care (UEC) services in England in response to a widely held view that the existing UEC model is outdated, confusing and inconsistent. A steering group of clinicians was formed to provide clinical input for the review board, which is chaired by national director for acute episodes of care Keith Willett. The composition and terms of reference of the steering group, on which the RCN is represented, as well as evidence supporting the review and the board’s 12 December 2013 | Volume 21 | Number 8
emerging principles, are available on the NHS England website. It was clear from the outset that, to succeed where previous reviews had failed, the board would have to adopt a patient-centred approach. Artificial barriers Such an approach would have to liberate itself from the agendas of different specific professional groups or health-service sectors, and pay no heed to artificial barriers between, for example, acute and primary care providers, paramedics and nurses, or between doctors and pharmacists.
According to the review’s emerging principles, UEC services in England should be sustainable, responsive, interconnected and intuitive to users. Putting this vision into practice will be complicated, however, and will require that the entire healthcare workforce is mobilised in the interests of the public. Innovative models of care involving, for example, streaming in emergency departments, direct-access assessments, urgent and acute mental health care, direct-access specialties, elderly-care outreach and hospitals at home will have to be adopted regionally and nationally.
EMERGENCY NURSE Downloaded from RCNi.com by ${individualUser.displayName} on Nov 29, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
Opinion ■■ Providing responsive urgent care services outside of hospital so people no longer choose to queue in emergency departments. Perhaps inevitably, the press coverage of the report focused on the new emergency and major emergency centres, and what they mean for patients, but it is also vital to the plan that we as healthcare professionals adopt a new approach and adapt our thinking. As a consultant trauma surgeon for more than 20 years, I have seen and experienced the contribution that a safe, efficient and strong urgent and emergency care system makes to all our lives, and those of our friends and families. It is this system that we are trying to enhance and sustain by undertaking this review. Spotting opportunities As phase two of the review begins, and the reforms begin to filter through our system, its success will depend on you, our NHS family: the staff in emergency departments, the paramedics on the road, and the nurses and doctors in the community. In the rush of the day job, it is not always easy to embrace change. This is why I ask you all to accept a role, no matter how small, as ambassadors for the review, and make sure that colleagues
In gathering evidence for changing UEC services, the review board found little on models of care that maximise nursing potential. This paucity of evidence is due in part to a lack of detail in data on the nursing workforce, and the RCN is calling for a commissioned and systematic review of workforce planning similar to those undertaken in medicine and surgery. The review’s latest output, published last month, clarifies the scale of change required by all specialties, in all settings, to ensure healthcare staff in different geographic areas share responsibility for their populations. In the next phase of the review the board will examine models of care that can deliver a service characterised by the emerging principles. Meanwhile the consultative process will continue to inform the college’s response to the review.
in clinical areas are receptive to change, spot opportunities and help implement the vision wherever possible. What we propose is the greatest change to emergency services in 40 years. It will change how patients access care and how efficiently they are treated. It will involve giving up time to do the caring that can be squeezed out when pressure is unrelenting. As the review progresses, we will keep you informed about our plans on NHS Choices, so that you can see for yourselves how things are developing. I encourage you to have your say about our plans as they develop; we will listen. Our timescale for the delivery phase of the review is between three and five years. But we know that innovative work is already going on, most of it in keeping with the aims and spirit of this review. We are rightfully proud of our healthcare system and we know how hard NHS staff work to keep a huge, complicated and extremely well respected health service working. I hope you will take up the challenge to be advocates and ambassadors for our new blueprint for the urgent and emergency care system. Keith Willett is NHS England’s director for acute episodes of care
I encourage all nurses to share their views with NHS England. The RCN will inform members of the RCN Emergency Care Association when feedback is next invited. JP Nolan is an RCN adviser on acute, emergency and critical care. He is the nursing representative on the national review of urgent and emergency care steering group
Find out more ■■ Further details about the review are available on the NHS England website, at tinyurl.com/mq2qymy ■■ The RCN’s first response is available at www.rcn.org.uk/support/consultations ■■ Information about the review and the RCN’s response are available from the author, at [email protected]
Board’s eye view Human factors EVERY DAY in the NHS, thousands of patients are treated safely by dedicated healthcare professionals, but some are harmed as a result of the treatment they receive. Such harm can be prevented if staff are aware of the human factors that influence behaviour. At the Queen Elizabeth Hospital, Birmingham, an awareness of human factors and the need for team leaders to control hazardous clinical situations are part of resuscitation training. Team leaders must plan roles, manage teams, provide channels for structured communication and be aware of everything that unfolds during emergencies. While they are ultimately responsible for decision-making processes, they should also encourage team members to ask questions, voice opinions and raise concerns. When reflecting on practice, some staff find voicing their concerns difficult, especially when they concern senior professionals. Nevertheless, all staff must remember their duty as advocates for the patients in their care. Meanwhile, the responsibility for creating an open culture does not lie solely with the team leader; it is up to the organisation as a whole to change its hierarchical structures and support all staff to speak freely without fear of reprimand or conflict. Many patient-safety campaigns refer to Elaine Bromiley, who died in 2005 after being deprived of oxygen during surgery, to highlight the importance of recognising and managing human factors. In Ms Bromiley’s case, what should have been a routine operation got out of control in part because of a lack of situational awareness. Human factors can affect any aspect of care delivery, and should be something all healthcare workers understand. ■■ A short film about Ms Bromiley’s case can be viewed at tinyurl.com/m3jpc5a Hannah Bryant is the resuscitation officer at Queen Elizabeth Hospital, Birmingham, and a member of the Emergency Nurse editorial advisory board
EMERGENCY NURSE December 2013 | Volume 21 | Number 8 13 Downloaded from RCNi.com by ${individualUser.displayName} on Nov 29, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
