Urgent and Emergency Care - NHS Redbridge Clinical ...€¦ · Urgent and Emergency Care Providing...

Urgent and Emergency Care

Providing patients with better access to

services – a Vanguard programme

Health and social care organisations across Barking and Dagenham, Havering and Redbridge working together to improve the quality

of care, with better outcomes for our patients and public

Content

1. Purpose of this phase of the programme

2. Our local context

3. Our story so far

4. Approach taken

5. Telephone survey

6. Face to face engagement

7. Feedback from Stakeholder Event

8. Next Steps

Page number

1

2

4

11

12

18

27

36

Purpose of this phase of the programme

To ensure high quality engagement and consultation with local patients,

carers and the public on Urgent and Emergency Care to help us to

identify the following:

- The understanding of the urgent and emergency services available

locally

- How patients and the public currently use our services and what

drives behaviours

1

Our local context

Barking and Dagenham, Havering and Redbridge residents live in one

of the most challenged health and social care economies in the country.

2

Our local context

This variation and challenge

makes Barking and

Dagenham, Havering and

Redbridge an ideal test bed

for transforming urgent and

emergency care (UEC)

services.

Strong partnership in place

and a track record of

effective collaborative

working.

3

Our story so far

• Locally, as nationally, people are confused by the various urgent

and emergency care (UEC) options available to them

• We talked to local people, health and social care professionals,

and local organisations who represent patients and service users

(July 2015 conference)

• We wanted to know what people thought of services, how they

used them and what they found good – or bad – and what they felt

we could do to make it all work better

4

Our story so far

This is what you told us

Patients and staff told us they

are ‘confused’ by the number of

local services and settings

available to them and that care

is ‘fragmented’ and ‘inefficient’

That confusion and

fragmentation is one reason

why our local hospitals see

around 500 people per day in

A&E at busy times, with 40% or

more not needing to be there –

because they don’t have

emergency needs

5

Our story so far

The financial challenges

• The NHS and local authorities all face funding challenges

• If we continue as we are, we forecast a system wide budget gap of over £400million by 2020

• Spending on urgent and emergency care forecast to increase significantly over the next few years if nothing is done to change services.

We need to do things differently for our patients and for our staff

6

Our story so far

A ‘Vanguard’ programme

• Department of Health asked the NHS to look at new ways of doing things

• BHR partnership has a excellent reputation for working together to find new ways of delivering better care for local people

• BHR invited to describe our big idea for UEC care and bid for support

• Using your feedback, we made a bid and were successful. We are the only UEC Vanguard in London

• We now need to refine our idea – using your help and expertise

• “Vanguard” is just a word – describes a funding programme. This transformation of urgent and emergency care is already a priority for local health and social care partners

7

Our story so far

Our ambition

As a partnership of health and social care organisations, we want to:

• create a simple and streamlined urgent care system which delivers excellent care and patient experience – while achieving financial stability.

• provide services that gives patients better and personalised care through shared care records

• build on already successful schemes e.g. Community Treatment Team (CTT)

• deliver better care closer to your home when you need it

• break down the barriers between health and social care, and between different organisations

8

Our story so far

What does it mean for patients, carers and staff

We want to

• end confusion for our patients

• improve the co-ordination of urgent and emergency care services

• allow GPs to focus on patients who need their care e.g. long term conditions

• signpost patients and carers to other urgent care services, and allow A&E to focus on emergency care

• Patients and staff will co-design the new urgent and emergency care pathway, giving them a real say in what services look like and how they work for them

9

Our story so far

What our vision is – and isn’t

• We need to develop a new model of care that provides them with a

simple way of getting the right care, first time in the right place

• Focus is on providing better care, closer to your home

• Better signposting, advice and access for patient in need of urgent

care or advice

• We know there are local people who go to A&E when they could

choose to go to an alternative service.

• This is not about closing services or healthcare settings

• Vision for a smart digital platform that will recognise patients and

personalise the help they get as soon as they get in contact

• Helping people to self-care is a future priority

• Patients, carers and staff will be at the heart of what we do and will

help co-design the model of care, services, pathways and

information materials – whatever we all agree is important

10

Our approach to this phase of the programme

We want to build upon the work we have already carried out to co-design the new model

of care in Barking and Dagenham, Havering and Redbridge by carrying out extensive

research with our local populations through the following independently delivered

engagement activity:

1. Quantitative - telephone research (BMG Research)

2. Qualitative - face to face surveys and focus groups (Healthwatch partnership)

The purpose of the research was to explore the awareness of urgent and emergency

care services, provide information on how residents are currently navigating these

services and to get feedback that will help to start the co-design of urgent care services

across the three boroughs.

Both BMG Research and the Healthwatch partnership worked with us to co-design the

questions used for both the telephone and face to face surveys.

A stakeholder event was held on the 17th March 2016 to help us to understand the

findings, continue the co-design of the care model and start to shape the next steps of

the programme.11

Telephone survey

• BMG Research was commissioned in early February to deliver 3000 telephone interviews – 1000 per borough

• 3002 telephone interviews were conducted between the 2nd and 21st March, 2016

• The data has been weighted by age, gender, ethnicity and ward within borough and then by borough population. The objective of the weighting is to make the data representative by borough and overall.

• Weights are based on 2011 census data.

• The final report is attached at Appendix A

12

Telephone Survey

Key Findings – Service Awareness

• Only half (51%) of residents overall are

aware of NHS Choices as a source of

advice about urgent and emergency

care. Even among those who state that

they have internet access, this

proportion only rises to 55%. On this

basis it appears that there is potential to

increase awareness of this signposting

resource.

• While awareness of Walk In Centres is

high at 94% awareness of Urgent Care

Centres at 37% is 59-percentage points

lower than the awareness of A&E

departments (96%) despite these two

resources being co-located.

• Any focus on raising awareness of GP Hubs

and GP Out of Hour’s services should focus

on Barking and Dagenham and Redbridge.

Havering residents are more likely to be

aware of Out of Hours GP services (81%)

than residents of both Barking and Dagenham

(77%) and Redbridge (76%). Havering

residents are also more likely to be aware of

GP Hubs (51%).

• A&E users in the last 6 months do not have

significantly lower awareness of other urgent

and emergency care services than non-users.

Indeed, where significant variations do exist,

these show that A&E visitors have a higher

awareness of some of the other providers of

urgent and emergency care than non-users.

• On this basis, it would appear that it is not

simply the case of ignorance of other services

driving A&E attendance. The reality is likely to

be a more complex mix of awareness and

understanding of what each service can offer

and when these services can be accessed. 13

Telephone Survey

Key Findings – Service Usage

• In the last 6 months A&E is the third

most commonly used source of urgent

and emergency care after GPs and

chemists. Residents are most likely to

have used their Doctor/GP in the last six

months (72%), followed by a

chemist/pharmacy (69%). Accident and

Emergency was the third most

commonly used by respondents or their

households at 31%.

• Within this, 18% of A&E users within the

last 6 months only went on one

occasion, the highest proportion across

all of the listed services. The proportion

who visited A&E in the last 6 months is 8

times larger than the proportion that went

to an Urgent Care Centre (4%).

• The proportion of those who state that either

they, a household member, or someone they

care for has been to A&E in the last 6 months is

significantly higher among the 18-34 age group

(38%) and among those aged 35 to 54 (33%).

• Parents with children aged 0-5 (41%), those

with a long term illness or disability (35%) and

those with caring responsibilities (41%) are all

significantly more likely to have visited A&E than

those who do not have these roles/conditions.

14

Telephone Survey

Key Findings – Advice and Signposting

• Where NHS advice/signposting is sought

for health issues the advice received is

followed in the majority of cases. Among

those who visited A&E in the last 6

months and sought prior advice either

from an NHS information source such as

111 or NHS Choices or from a healthcare

professional 87% said that the advice

they received was to go to A&E. Similar

proportions are seen among Urgent Care

Centre visitors (91% of those who

sought NHS advice were advised to go

here), those who went to a Walk In

Centre (87%) and those who went to a

GP Hub (86%).

• When considering scenarios where advice and treatment would be required there is evidence of

younger residents being more likely to seek

information prior to treatment. For example, in a

scenario where someone with ongoing health

issues is experiencing breathlessness more

than twice as many 18-34 year olds (37%)

would suggest phoning NHS 111 than those

aged 65 and over (16%). This younger age

group are also most likely to suggest searching

for advice online (4%). Among older residents

(aged 65+) the most common suggestion is

calling a GP.

• Furthermore, among A&E visitors in the last 6

months, analysis by age shows that those aged

18-34 and 35-54 are most likely to have sought

advice from an NHS information source prior to

their attendance at A&E (26% and 24%

respectively).

15

Telephone Survey

Key Findings – Interest in personalised IT systems

• Looking to the future residents were

asked to state whether they would be

interested in a personalised IT solution to

help them access healthcare locally. All

were asked:

“If the local NHS had a website or app

which held all your health information,

where you could get advice, chat with a

doctor or nurse if necessary or book

yourself into appointments with your GP

or a clinic, do you think you would you

use it? “

• A clear majority of 79% express an interest in

such a solution, suggesting they would use it,

while 21% said they would not use it.

• Breaking these responses down further shows

that among those with access to the internet

84% would be interested in such a website or

app compared to 47% of those who do not have

internet access

16

Telephone Survey

Key Findings – Views on over-use of Accident and

Emergency

• When asked why they think that people

tend to go to A&E when they have non-

emergency issues the key themes that

emerge are:

• o Awareness of the alternatives;

o Resource/capacity issues with other

services; o Speed/convenience;

o Reassurance/trust issues;

o Personal circumstances or

characteristics;

o Uncertainty;

o Habit; and,

o Referrals.

• Within these comments there are two responses

that are particularly prevalent. The first is that

individuals cannot get an appointment with a GP

or other care services (33%). This includes

comments on GP appointments taking too long

to get, GP practice hours and GPs being

overworked. The second major suggestion is

that the public don't know of other services or

are not well informed (31%).

• The dominance of these two comments

suggests that future strategies will need to

assess both capacity issues in care provision

and information provision/signposting in relation

to urgent and emergency care.

• The other comments suggest that awareness

raising will need to develop trust in the

alternatives in terms of both the quality of care

and its availability.

17

Face to face engagement

A Healthwatch partnership from Barking and Dagenham, Redbridge

and Havering were commissioned to deliver face to face discussions

and focus groups across the three boroughs which included:

Redbridge Barking and Dagenham Havering

361 1:1 face to face discussions



3 Focus Groups 3 Focus Groups 4 Focus Groups/Workshops

Healthwatch from Barking & Dagenham, Havering & Redbridge

Urgent and Emergency Care Consultation Responses Barking and Dagenham, Havering and Redbridge CCGs Response Data from Healthwatch’s in Barking & Dagenham, Havering & Redbridge

The final report is attached at Appendix B

18

0

200

400

600

800

1000

Yes No


Key Findings – Service Awareness Have you heard of the following services where you can get help with treatment, or advice for urgent and emergency care?

19

Of the 774 people who have heard of walk-in Centres, 502 people knew the location.

Of the 301 people who have heard of Urgent Care Centres, 154 people knew the location.

0

100

200

300

400

500

600

Yes No

Do you know the location ofnearest WIC?

Do you know the location ofnearest UCC?



20

0 20 40 60 80 100 120 140 160 180 200

NHS Choices website

Non-NHS health advice websites

NHS 111 telephone helpline

Chemist/Pharmacy

Your GP

Out of Hours GP Services

Mental Health Direct telephone helpline

GP Hubs

Walk in Centre

Urgent Care Centres (UCCs)

Accident and Emergency (A&E)

999 (London Ambulance Service)

Community Treatment Team

Emergency dentists

5 or more 4 3 2 1

How often have you or your household used the following health services for urgent or emergency care the last 6 months?

Number of visits


Key Findings – Service Usage

21

Of those who had made one or more visits to: A&E, and Urgent Care Centre, a

Walk-in Centre or a GP Hub 298 people sought advice on where to go before they

went from the following…

• 110 Yes - from an NHS information source such as 111/ NHS choices

• 134 Yes – from a healthcare professional such as a doctor, chemist

• 54 Yes - from a non-NHS source e.g. other website/friends family

• 297 No – I did not seek advice

• 60 I was taken to A&E by ambulance

Did the NHS advice suggest you go to this service?

Yes 171

No 147



22

If the local NHS had a website or app which held all your health information, where you could get advice, chat with a doctor or nurse if necessary or book yourself into appointments with your GP or a clinic, do you think you would you use it?

0

100

200

300

400

500

600

700

Yes No


Key Findings – Interest in Personal IT systems

23

What do you think would be the main advantages of such a site or app?

0 50 100 150 200 250 300 350 400

Don’t know

Other (please state)

Single source of information

Personalised/responses based on myhealth records

Can be accessed anywhere

Available all the time/ outside of workinghours



24

Can you explain why you would be unlikely to use such a website or mobile phone app?

0 20 40 60 80 100 120

Don’t have internet access/computer/ smartphone

Don’t feel confident with technology/ would not know how to use

Data charges/cost to access

Concern about security of personal data/ health records

Would prefer to speak to someone in person

Use existing online GP booking systems

Other (please state)

Don’t know



25

NHS Accident and Emergency Departments commonly treat people whose injuries or

illnesses could be treated just as well elsewhere. Why do you think that people tend

to go to A&E when they have non-emergency issues?

• They do not have an understanding about other options

• Guaranteed that they will definitely be seen in A&E and have the problem

dealt with (Even if there is a long wait!)

• People thought it was the safest option

• Takes too long to see the GP. E.G No appointments for up to three weeks+

• No confidence in other services

• NHS 111 are not as competent as ambulance staff


Key Findings – Views on over-use of Accident and Emergency

26

Urgent and emergency careVanguard

Feedback from Stakeholder Event

17th March, 2016

27

Purpose of the event

To come together as a mixed group to help shape the next phase of

developing our urgent and emergency care services within Barking and

Dagenham, Havering and Redbridge by:

• Bringing everybody up to date on the story so far

• Provide feedback on the face to face and telephone engagement,

understand what it is telling us and agree whether there are any

gaps

• Start to shape the engagement activity for the next phase – co-

designing services

28

Attendees

• A mix of 40 people attended

including patients, carers,

clinicians and representatives

from Social Care, Healthwatch,

Voluntary Organisations and

NHS organisations operating

within the three boroughs

• A mix of people and

organisations from across the

three boroughs were present

and participated in three

workshops

29

Workshop 1 – What is the feedback telling us?

• What is interesting about the feedback?

• What is surprising?

• What questions does this raise?

These questions were discussed at six separate tables by a mixed group of attendees with a facilitator present

30

Summary of the feedback from Workshop 1 –what is the feedback telling us?

• Very complex system and therefore confusion for both patients and staff

• The language used for the different services is not easy to understand

• There is a need for simplicity ‘Clunk, click every trip’

• Rebadge services to reduce confusion

• There is a lack of awareness of some of the services available particularly the hubs and Mental Health Direct

• Should keep mental health on the radar and be clear on the services being provided

• Most of the awareness is where the services have been established the longest

• Need to explore the benefit of increasing awareness if the capacity doesn’t exist?

• Support clinicians to redirect to risk levels

• There are cultural nuances within the feedback and need to understand these

• We only advertise in English – should be advertising services in the main community languages and making best use of our community assets

• Need to understand the efficiency of community services

• More willingness to use online services than expected

• Maybe should consider Skype contact so patients can talk to someone

• Health Education, self care and prevention are important

• Ensure A&E message does not stop people accessing services

• We should be asking people what should we do?

31

Workshop 2 – Working together to shape the

services to meet the needs of local people

• What is missing from the research so far

• What else do we need to find out?

• How do we take this forward in the next phase?

These questions were discussed at six separate tables by a mixed group of attendees with a facilitator present

32

Summary of the feedback from Workshop 2 –

working together to shape the services to meet the

needs of local people• The engagement needs to be consistent

across the three boroughs

• Face to face versus non – experience of Learning/physical disabilities

• Missing questions from research which included:

– what does good look like?

– What would make it better?

– Why do people end up going to A&E when advised not to?

– What was the reason for the visit?

– Did the patient mean to go to A&E or just want a GP

• Data not collecting all equality groups and other groups within the community and therefore need to be much wider in engagement approach should be used to understand experiences “we are not hard to reach we are easy to ignore”

• Still focus on physical health need more focus on mental health

• Need to capture the experience of people using 999 services

• Understand reputation of services, good standards/quality

• Require different ways to cut the data to better understand the issues

• Look at data from 111 – are referrals appropriate?

• Education very important – need behaviour change – target schools and information and advice at surgery level

• Assumption about records being shared as an issue – how much would the community know about record sharing?

• Non English speakers – improve information and signposting to services

• Target the audiences likely to use the service – Physical disabilities/Learning Disabilities/Mental Health

– How do they access services

– What are the services doing to avoid A&E

admission?

• Access to GP/Primary Care is an issue

• Symbol recognition could be used to simplify the system

• Apps – growing use – potential – range of solutions (don’t assume age!)

• Need to explore how to support risk taking

• People need more confidence in services

33

Workshop 3

• Who do we need to talk to?

• How should we talk to people about it?

• What should we focus the discussions on?

• Can you help?

All individuals were given the opportunity to respond to these questions through the completion of post it notes placed on the relevant flip chart – facilitators were present to be able to help if required

34

Workshop 3

A huge response was received to each of the four questions and is

shown in detail at Appendix C.

35

Next steps

• The report of the engagement activity carried out in this phase will be made

publicly available

• The feedback from both the telephone research and face to face will be

analysed further and will help shape the next stage of activity to co-design

the urgent care services for Barking and Dagenham, Havering and

Redbridge.

36

Urgent and Emergency Care - NHS Redbridge Clinical ...€¦ · Urgent and Emergency Care Providing...

Documents

Transcript of Urgent and Emergency Care - NHS Redbridge Clinical ...€¦ · Urgent and Emergency Care Providing...