Alamy
Analysis anywhere for patients to go, they will end up in corridors and waiting rooms.’ NHS England medical director Sir Bruce Keogh agrees this winter could be especially ‘challenging’. He says: ‘The four‑hour target is a barometer for the whole system. Not only is A&E under pressure; the whole system is. That is why, in the long term, we need to change the way the NHS works. ‘The NHS Forward View and the Urgent and Emergency Care Review are important in relieving the pressures on EDs. In the short term, though, this money can help put some extra support in place.’
Winter emergency care funding more than doubles in two years Additional £700 million over coming months may not reduce pressure on departments, writes Nick Triggle ONE LOOK at the size of the winter funding pot for emergency care is enough to realise the NHS is facing a crucial few months. Ministers announced in early November that the pot would be increased to £700 million, which means it will be 75% higher than it was last year and more than double the amount in the year before that. Increases in winter funding in England over the past three years are shown in the panel below right. It is easy to understand why more and more money must be ploughed into the system. While the NHS coped pretty well last year, in part because of the mild weather, the pressure on services did not ease in the spring and summer. Weekly waiting-time performance during May was especially bad. The proportion of patients seen within four hours dipped below 95% several times and, between the end of August and early November, rose above this figure only once. In the middle of November, performance dropped to less than 93%, lower than for any single week during the whole of last 8
December 2014 | Volume 22 | Number 8
winter. As a result of this deterioration, the average weekly total from April to the start of November was under 95%. Royal College of Nursing Emergency Care Association chair Janet Youd says that these figures are unlikely to improve in the near future. ‘Much will depend on the cold weather and viral load in the community,’ she says. ‘It is clear that, with services being so stretched at this time of year, it will not be an easy winter.’ She says that demand has become so high, with 3,000 more attendances each day than in 2010, there is a limit to what the extra money can achieve. ‘We do not have space for all these patients. A&E buildings were designed with 1970s demand in mind. You can put in extra money but, if we do not have
Extra funds by year ■■ 2012 ■■ 2013 ■■ 2014
£300 million £400 million £700 million
Estimated spend Based on what has been achieved since the first £400 million of this winter’s money was announced during the summer, the Department of Health estimates that this winter there will be: ■■ Up to the equivalent of 2,000 extra nurses and 1,000 extra doctors, achieved by encouraging staff to work overtime and making temporary appointments. ■■ Up to 2,000 more other care staff, including physiotherapists, social workers and occupational therapists, from the same sources. ■■ About 2,500 extra beds in the acute and community sectors due to the introduction of quicker discharge arrangements. ■■ More GPs working in emergency departments (EDs) and longer pharmacy opening hours. More than £25 million has been earmarked for these improvements. ■■ Improved support for ambulance crews and faster handover times. About £50 million has been earmarked for this. There will also be a public information campaign encouraging people with non‑urgent clinical problems to use NHS services other than EDs. The ‘Feeling Under The Weather’ campaign, which is intended particularly for older patients and those with respiratory conditions, will encourage people to seek early advice from their local pharmacists. King’s Fund director of policy Richard Murray has doubts about the effectiveness of the winter plans, however. He says: ‘I am not sure there are lots of nurses out there EMERGENCY NURSE
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Analysis for hospitals to take on. They will have to rely on overtime and you can only do that so much. The other option is agency staff, but we have been trying to get away from that. ‘There comes a point where you have to question whether the NHS has enough funding. Winter is not an unusual event, it happens every year. But each year we are in a position where the government is giving the NHS more and more just to get through. This is unsustainable.’ ED pressures are not unique to England, moreover. In Scotland, for example, the target set for hospitals that 98% of patients are seen in four hours is being missed. According to latest figures, an average of 94% of patients have been seen in this time since June. In October, ministers announced they were releasing an extra £8.2 million for the NHS to increase capacity and improve how patients are discharged during winter. Health secretary Alex Neil says the money will allow hospitals to ensure they have ‘robust and comprehensive’ plans in place to cope with surges in demand. Like England, Wales and Northern Ireland have set the targets at 95%, but both are missing it by some way. In Wales, for example, only 86% of patients were seen within four hours duringSeptember. Welsh ministers have given the NHS an extra £425 million to be spread over this year and next. The money is for the whole system, not only to help with winter, but ministers say it will help relieve some of the pressures in the coming months. ‘All NHS organisations have detailed arrangements and contingency plans to help maintain services in the event of severe weather,’ a Welsh Government spokesperson adds. Meanwhile, in Northern Ireland, just under 80% of patients were managed properly within four hours, according to figures for the July-to-September quarter. An additional £5 million of funding has been set aside to deal with winter pressures there, for example through investment in out-of-hours community services and hospital-ambulance liaison officers to speed up handover with ED staff. Nick Triggle is a freelance journalist EMERGENCY NURSE
Pregnant women call on Labour Line
A local telephone service for expectant mothers takes pressure off urgent care providers, writes Stephanie Jones-Berry WOMEN EXPERIENCING unplanned births are receiving better care due to a unique telephone service run by midwives based in an emergency call centre. The ‘Labour Line’ project began as a short pilot by Hampshire Hospitals NHS Foundation Trust (HHFT) and South Central Ambulance Service NHS Foundation Trust (SCAS). One year on, after women’s satisfaction with the service increased and its clinical effectiveness was improved, it has become a permanent feature. A team of 11 midwives work in shifts on a 24-hour dedicated phone line at the ambulance operations centre in Otterbourne, Hampshire. Women going into labour can call the HHFT number and speak to an experienced midwife, who provides a triage service by telephone.The midwives deal with between 35 and 40 calls a day, on average, and can easily request emergency support for women experiencing difficulties. Senior midwife and HHFT maternity pathways manager Janice Mackenzie says that Labour Line midwives can assess a caller’s situation quickly and triage appropriately. As a result, she says, the 200 women who have unplanned emergency births a year in the UK are better supported now than before the initiative began.
‘We have not reduced the number of women going into unplanned labour, but we have reduced the number of unattended births because we can get midwives to them quicker,’ Ms Mackenzie says. The Labour Line project was devised because HHFT and SCAS had wanted to improve the advice given to women in labour. She says: ‘There was a huge inconsistency in the advice and support women received.’ Ms Mackenzie adds that there were also too many points of contact, including the maternity centre, delivery suite, day assessment unit and labour ward, for the 6,000 women who passed through HHFT. Now they can ring just one phone number and the advantages in this are said to be manifold. For example, midwives working at HHFT’s three labour sites, in Andover, Basingstoke or Winchester, are no longer expected to answer calls from women in early labour and so have more time to spend with those giving birth. In addition, more women in the early stages of labour can stay at home, which reduces the number of unnecessary admissions. Home assessments Ms Mackenzie says: ‘We found that home assessments have reduced the number of women in early labour staying in hospital.’ SCAS head of emergency operations Tony Peters says that 999 and NHS 111 calls that relate to pregnancy or women in labour can be passed directly to Labour Line midwives. ‘This gives our emergency operations centre staff and front line paramedics more time to respond to other emergency calls,’ he says. Similar collaborative models for children and patients with mental health problems are being discussed. ‘It seems so simple, but it has made such a massive difference to women in our service,’ says Ms Mackenzie. ‘The midwives love it. It is a real feel-good job.’ ■■ The Labour Line project has been shortlisted for a Royal College of Midwives Excellence In Maternity award. The winner will be announced in March. Stephanie Jones-Berry is a freelance journalist December 2014 | Volume 22 | Number 8
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9
Analysis anywhere for patients to go, they will end up in corridors and waiting rooms.’ NHS England medical director Sir Bruce Keogh agrees this winter could be especially ‘challenging’. He says: ‘The four‑hour target is a barometer for the whole system. Not only is A&E under pressure; the whole system is. That is why, in the long term, we need to change the way the NHS works. ‘The NHS Forward View and the Urgent and Emergency Care Review are important in relieving the pressures on EDs. In the short term, though, this money can help put some extra support in place.’
Winter emergency care funding more than doubles in two years Additional £700 million over coming months may not reduce pressure on departments, writes Nick Triggle ONE LOOK at the size of the winter funding pot for emergency care is enough to realise the NHS is facing a crucial few months. Ministers announced in early November that the pot would be increased to £700 million, which means it will be 75% higher than it was last year and more than double the amount in the year before that. Increases in winter funding in England over the past three years are shown in the panel below right. It is easy to understand why more and more money must be ploughed into the system. While the NHS coped pretty well last year, in part because of the mild weather, the pressure on services did not ease in the spring and summer. Weekly waiting-time performance during May was especially bad. The proportion of patients seen within four hours dipped below 95% several times and, between the end of August and early November, rose above this figure only once. In the middle of November, performance dropped to less than 93%, lower than for any single week during the whole of last 8
December 2014 | Volume 22 | Number 8
winter. As a result of this deterioration, the average weekly total from April to the start of November was under 95%. Royal College of Nursing Emergency Care Association chair Janet Youd says that these figures are unlikely to improve in the near future. ‘Much will depend on the cold weather and viral load in the community,’ she says. ‘It is clear that, with services being so stretched at this time of year, it will not be an easy winter.’ She says that demand has become so high, with 3,000 more attendances each day than in 2010, there is a limit to what the extra money can achieve. ‘We do not have space for all these patients. A&E buildings were designed with 1970s demand in mind. You can put in extra money but, if we do not have
Extra funds by year ■■ 2012 ■■ 2013 ■■ 2014
£300 million £400 million £700 million
Estimated spend Based on what has been achieved since the first £400 million of this winter’s money was announced during the summer, the Department of Health estimates that this winter there will be: ■■ Up to the equivalent of 2,000 extra nurses and 1,000 extra doctors, achieved by encouraging staff to work overtime and making temporary appointments. ■■ Up to 2,000 more other care staff, including physiotherapists, social workers and occupational therapists, from the same sources. ■■ About 2,500 extra beds in the acute and community sectors due to the introduction of quicker discharge arrangements. ■■ More GPs working in emergency departments (EDs) and longer pharmacy opening hours. More than £25 million has been earmarked for these improvements. ■■ Improved support for ambulance crews and faster handover times. About £50 million has been earmarked for this. There will also be a public information campaign encouraging people with non‑urgent clinical problems to use NHS services other than EDs. The ‘Feeling Under The Weather’ campaign, which is intended particularly for older patients and those with respiratory conditions, will encourage people to seek early advice from their local pharmacists. King’s Fund director of policy Richard Murray has doubts about the effectiveness of the winter plans, however. He says: ‘I am not sure there are lots of nurses out there EMERGENCY NURSE
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Analysis for hospitals to take on. They will have to rely on overtime and you can only do that so much. The other option is agency staff, but we have been trying to get away from that. ‘There comes a point where you have to question whether the NHS has enough funding. Winter is not an unusual event, it happens every year. But each year we are in a position where the government is giving the NHS more and more just to get through. This is unsustainable.’ ED pressures are not unique to England, moreover. In Scotland, for example, the target set for hospitals that 98% of patients are seen in four hours is being missed. According to latest figures, an average of 94% of patients have been seen in this time since June. In October, ministers announced they were releasing an extra £8.2 million for the NHS to increase capacity and improve how patients are discharged during winter. Health secretary Alex Neil says the money will allow hospitals to ensure they have ‘robust and comprehensive’ plans in place to cope with surges in demand. Like England, Wales and Northern Ireland have set the targets at 95%, but both are missing it by some way. In Wales, for example, only 86% of patients were seen within four hours duringSeptember. Welsh ministers have given the NHS an extra £425 million to be spread over this year and next. The money is for the whole system, not only to help with winter, but ministers say it will help relieve some of the pressures in the coming months. ‘All NHS organisations have detailed arrangements and contingency plans to help maintain services in the event of severe weather,’ a Welsh Government spokesperson adds. Meanwhile, in Northern Ireland, just under 80% of patients were managed properly within four hours, according to figures for the July-to-September quarter. An additional £5 million of funding has been set aside to deal with winter pressures there, for example through investment in out-of-hours community services and hospital-ambulance liaison officers to speed up handover with ED staff. Nick Triggle is a freelance journalist EMERGENCY NURSE
Pregnant women call on Labour Line
A local telephone service for expectant mothers takes pressure off urgent care providers, writes Stephanie Jones-Berry WOMEN EXPERIENCING unplanned births are receiving better care due to a unique telephone service run by midwives based in an emergency call centre. The ‘Labour Line’ project began as a short pilot by Hampshire Hospitals NHS Foundation Trust (HHFT) and South Central Ambulance Service NHS Foundation Trust (SCAS). One year on, after women’s satisfaction with the service increased and its clinical effectiveness was improved, it has become a permanent feature. A team of 11 midwives work in shifts on a 24-hour dedicated phone line at the ambulance operations centre in Otterbourne, Hampshire. Women going into labour can call the HHFT number and speak to an experienced midwife, who provides a triage service by telephone.The midwives deal with between 35 and 40 calls a day, on average, and can easily request emergency support for women experiencing difficulties. Senior midwife and HHFT maternity pathways manager Janice Mackenzie says that Labour Line midwives can assess a caller’s situation quickly and triage appropriately. As a result, she says, the 200 women who have unplanned emergency births a year in the UK are better supported now than before the initiative began.
‘We have not reduced the number of women going into unplanned labour, but we have reduced the number of unattended births because we can get midwives to them quicker,’ Ms Mackenzie says. The Labour Line project was devised because HHFT and SCAS had wanted to improve the advice given to women in labour. She says: ‘There was a huge inconsistency in the advice and support women received.’ Ms Mackenzie adds that there were also too many points of contact, including the maternity centre, delivery suite, day assessment unit and labour ward, for the 6,000 women who passed through HHFT. Now they can ring just one phone number and the advantages in this are said to be manifold. For example, midwives working at HHFT’s three labour sites, in Andover, Basingstoke or Winchester, are no longer expected to answer calls from women in early labour and so have more time to spend with those giving birth. In addition, more women in the early stages of labour can stay at home, which reduces the number of unnecessary admissions. Home assessments Ms Mackenzie says: ‘We found that home assessments have reduced the number of women in early labour staying in hospital.’ SCAS head of emergency operations Tony Peters says that 999 and NHS 111 calls that relate to pregnancy or women in labour can be passed directly to Labour Line midwives. ‘This gives our emergency operations centre staff and front line paramedics more time to respond to other emergency calls,’ he says. Similar collaborative models for children and patients with mental health problems are being discussed. ‘It seems so simple, but it has made such a massive difference to women in our service,’ says Ms Mackenzie. ‘The midwives love it. It is a real feel-good job.’ ■■ The Labour Line project has been shortlisted for a Royal College of Midwives Excellence In Maternity award. The winner will be announced in March. Stephanie Jones-Berry is a freelance journalist December 2014 | Volume 22 | Number 8
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