Urgent and emergency care

About the urgent and emergency care programme

The West Yorkshire urgent and emergency care system (UEC) includes hospitals, primary care, mental health, social care, urgent care, dentistry, community pharmacy and voluntary organisations. Our aim is to further develop our health and care system, so it delivers a highly responsive service for people. This involves working with other West Yorkshire priority programmes such as mental health, primary care and improving population health who share common themes. It means ensuring that people’s needs are met in the right place, at the right time, with the right support.

Ensuring our approach is collaborative and remains focused on place is important to both transformation and operational work. As a Partnership, with Harrogate remaining as a strategic partner we are working at a West Yorkshire region level that includes Bradford & Craven, Calderdale, Kirklees, Leeds and Wakefield. In doing so we remain focused on the primacy of our places (work continues to be led at place) and local population need and local variances in the urgent care offer means we work collectively when it is the right thing to do for local people.

The key partners and attendees at our monthly programme board meetings include:

The West Yorkshire Association of Acute Trusts (WYAAT) are part of the Health and Care Partnership. WYAAT is an innovative collaboration which brings together the NHS trusts who deliver acute hospital services across West Yorkshire and Harrogate. It is about local hospitals working in partnership with one another to give patients access to the very best facilities and staff.
Yorkshire Ambulance Service (YAS)
Local Care Direct (a social enterprise that provides both urgent medical and dental services and support the delivery of Primary Care services at scale to Health and Social Care partners across Yorkshire and the Humber)
Community pharmacy (were known in the past as chemists. Like GPs, community pharmacists are part of the NHS family)
NHS England and NHS Improvement (they lead the National Health Service (NHS) in England)
Third sector representative (for example charities, voluntary and community organisations and social enterprises).

The programme board is chaired by Dr Adam Sheppard, Clinical Chair of Wakefield Clinical Commissioning Group. Dr David Tatham, Strategic Clinical Director, Bradford Districts & Craven CCG is also a clinical lead for the programme board.

The Senior Responsible Officers is Pat Keane, Programme Director Strategic Projects, Wakefield CCG.

Connectivity, Flow chart illustration of the urgent and emergency care system.jpg there are many partners, programmes, organisations and representatives that come together as part of the urgent care agenda as illustrated in the diagram opposite. We work together to form an urgent care response to shared priorities.

At the bottom of the page is a key to all the terms used in the flow chart illustration (right).

Patient experience and outcomes, across our area we want to ensure that more people receive care and support out of hospital and ensure patients and communities experience fully joined-up; are responsive to their needs and with excellent outcomes. Collaborative working is pivotal to ensuring this happens in a consistent way. The pandemic has brought many issues to the forefront but what remains is that people want urgent and emergency care that is close to home and easier to navigate.

Our vision, across West Yorkshire we aim to recognise the work happening in each of our places. By working together at scale, we have the opportunity to highlight the good practice already happening at a local level and share and apply this learning at scale.

Our priorities, the urgent and emergency care programme has recently defined priorities for 2021/22 These priorities align to our strategic vision as set out in the Long-Term Plan.

Health inequalities, improving health and wellbeing is at the very heart of the partnership and we work alongside other programmes and organisations to seize new opportunities for improving health and to reduce health inequalities and the unjust differences in life expectancy which exist across our area. This can be due to social, geographical or other barriers and some of the other preventable differences that contribute to inequality. We have carried out HEIA as part of our programme of work to help us to identify such issues. Read more about the population health agenda here. View animation expplaining more about health inequalities.

Shared priorities and ambitions across the ICS programmes, there are a number of key interdependencies and shared priorities and ambitions across the ICS programmes. The UEC Programme Management Office (PMO) has assigned portfolio owners to ensure there is an accountable interface for each workstream where there are crosscutting priorities. There are also a number of interdependencies across the three UEC workstreams, Pre-hospital, In-hospital and Safer Transfer of Care (SToC). The workstream leads meet regularly to review progress and ensure that interdependencies between the programmes of work are managed.

The UEC Programme workstreams have a focus on addressing health inequalities and ensuring equity of access across West Yorkshire for all patients. The programme is data and intelligence driven, positive patient outcomes are at the heart of our work and to do this we must understand our populations and their barriers, to be able to address and meet their differing needs.

The diagram below notes how the programme links to other programmes and priority areas.

Pre-Hospital

As part of our commitment to deliver a model of urgent and emergency care that meets the health needs of the population and uses resources in a way that has the greatest impact in terms of patient outcomes and value, the pre-hospital workstream aims to consolidate the work initiated as part of the NHS 111 First initiative with a focus on UEC service provision in the community.

This includes the promotion of the NHS 111 service to be available as a point of contact for patients when seeking urgent care

The objectives of the pre-hospital workstream are to:

Support 100% of the public to be able to access NHS 111 for advice (including clinical advice if needed) for unplanned health and care problems and where appropriate, onward referral.
Ensure we improve the patient journey, experience and outcomes thus reducing the number of points of contact within the system; getting the patient to the right care at the right place and right time.
To ensure a channel shift of patients who would have previously used our emergency departments by triaging them to appropriate alternatives.
Support the development of 24/7 urgent primary care across West Yorkshire and providing an alternative capability to support the left shift.

In Hospital

The remit of this workstream includes reviewing the in-hospital elements of urgent and emergency care services. The flow of patients to the right service that meets their need directly is an improved patient experience and ultimately will provide better outcomes for patients too. In addition, it reduces over-crowding in Emergency Departments, and will free up resource for the sickest people. Improved flow also allows for timely ambulance handover releasing those resources back onto the road for the sickest patients. This work is therefore crucial in ensuring that as a system we use our resource most appropriately to benefit all our patients.

The objectives of the in-hospital workstream are to:

Ensure flow and timely access to same day emergency care services
Minimise ambulance handover delays by providing appropriate access to paramedics to same day emergency care pathways reducing ED acting as a bottleneck for ambulance crews to hand over,
Support effective ambulance handover management
Embed same day emergency care and alternative in house pathways for primary care and other appropriate clinician led services
Enable alignment of frailty services into same day emergency care services
Support COVID and delivery of social distancing to maximise patient safety

Safer Transfer of Care

The Safer Transfer of Care workstream is dedicated to bringing systems together to improve how people move across services when their care needs change with a focus on the national ‘Home First’ agenda.

The workstream will support the improvement of hospital discharge and work to reduce hospital length of stay.

In 2020 the national Discharge Policy was introduced and priorities for the workstream include:

Effective collaboration and partnership working across systems to facilitate timely discharge
Implementation of Discharge to Access (D2A) models
Criteria to reside implementation in acute trusts - maintaining good decision making in acute settings

Current campaigns and engagement for 2021/22

‘Together We Can’ a collaborative winter campaign is currently running across West Yorkshire. Together We Can (TWC) is a joined-up communications approach to help to alleviate the impact of additional demand being placed on services over the winter period. Find out more by clicking here. You can also visit the signposting website by clicking here.
Pressures across the health and care system health and care services across West Yorkshire, which includes hospitals, GPs, the ambulance service, councils, mental health, community services and social care providers have come together to ask for your support as we head into what is likely to be the busiest and most challenging winter the sector has faced. At the current time we are seeing pressures across the entire system and this is only likely to increase as we move further into the winter period. Read more here
The Partnership’s weekly blog recently featured Pat Keane, Senior Responsible Officer for the Urgent and Emergency Care Programme and Keith Wilson, Programme Director. They shared an update about how the partnership are preparing for winter and the work happening to help support. The full piece is available to read here.
The West Yorkshire Non-Emergency Patient Transport Services Review is to be conducted during the current financial year of 2021-22 formally launched at the end of August. West Yorkshire has been confirmed as a national pathfinder area as part of the National NHS Non-Emergency Patient Transport Services (NEPTS) review. We are aligning the West Yorkshire review to this work and have set out key areas for action.
Why are GP practices still working differently? The pandemic is not over. GP practices worked hard to provide a service throughout lockdown and continue to do so. To protect everyone, we must maintain safe infection control and minimise unnecessary physical contact. We’ve created a helpful infographic to explain more.
Looking out for our neighbours is a social marketing campaign that aims to prevent loneliness and its associated health issues by encouraging communities to look after people who are isolated for various reasons thus reducing demand on health and care services through simple acts of kindness and by ‘looking out for each other’. The campaign aims to inspire communities to engage in activities and micro-wellbeing interventions that will positively impact on their neighbours. Read more about the campaign here.
Zero tolerance to staff abuse campaign for primary care and community pharmacy is currently in development.

Young adults attending Emergency Departments Healthwatch Leeds have been commissioned to produce an insight report into the behaviours of young adults (aged circa 20-29) who are attending ED, for non-emergency needs.

Connectivity

There are many p Flow chart illustration of the urgent and emergency care system.jpg artners, programmes, organisations and representatives that come together as part of the urgent care agenda as illustrated in the diagram below. We work together to form an urgent care response to shared priorities.

A key to the terms used in the illustration (right)

UTC: Urgent Treatment Centres are GP-led, open at least 12 hours a day, every day, offer appointments that can be booked through 111 or through a GP referral, and are equipped to diagnose and deal with many of the most common ailments people attend A&E for.
ED: Emergency Departments are most commonly known as Accident and Emergency or A&E.
GP in-hours: Primary care during surgery hours
DOS: The Directory of Services (DoS) is a central directory that is integrated with NHS Pathways and is automatically accessed if the patient does not require an ambulance or by any attending clinician in the urgent and emergency care services.
GP OOH/Extended access: GP out-of-hours services. Outside normal surgery hours you can still phone your GP surgery, but you'll usually be directed to an out-of-hours service.
CAS: A clinical assessment service (CAS) is an intermediate service that allows for a greater level of clinical expertise in assessing a patient than would normally be expected of a referring clinician (such as a GP). This expertise should be used to ensure that patients are directed efficiently and effectively into the most appropriate onward care pathway.
NHS 111: NHS 111 is available 24 hours a day, 7 days a week. You answer questions about your symptoms on the website, or by speaking to a fully trained adviser on the phone.
SDEC: the provision of same day care for emergency patients who would otherwise be admitted to hospital.
Community crisis response teams: provide urgent care to people in their homes which helps to avoid hospital admissions and enable people to live independently for longer.

Our programme board

The programme board meets on a monthly basis. The programme board is made up of representatives from a wide range of organisations and providers and reflects the diversity of the West Yorkshire urgent and emergency care system.

The programme board is chaired by Dr Adam Sheppard (pictured below), Clinical Chair of Wakefield Clinical Commissioning Group. Dr David Tatham, Strategic Clinical Director, Bradford Districts & Craven CCG is also a clinical lead for the programme board.

Photograph of Dr Adam Sheppard

The Senior Responsible Officer is Pat Keane pictured below.

Pat Keane, Programme Director Strategic Projects, Wakefield CCG.

Photograph of Pat Keane.jpg

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