Public back NHS plans for new rapid care measures

1 Nov 2019 10:52 AM

England’s top doctor has welcomed new polling showing that patients and the public support NHS proposals focussing on fast treatment for those who need it in A&E.

national survey commissioned by Healthwatch England found that an overwhelming majority of people placed a high priority on early initial assessment on arrival at A&E for everyone, allowing staff to prioritise those patients with the greatest need, and ensuring that patients with critical conditions get the right standard of care quickly.

These priorities are mirrored in new standards now being trialled across the NHS, as part of a review led by NHS National Medical Director, Professor Stephen Powis, supported by leading staff and patient groups.

They include a rapid assessment measure for all patients arriving at A&E, coupled with measuring how quickly life-saving treatment – or Critical Time Standards – is delivered for those with the most serious conditions, such as heart attacks, sepsis, stroke and severe asthma attacks.

Experts believe updating the 15-year old target regime for emergency department teams with these new measures, combined with an average waiting time target to bring down long waits for all patients, may help NHS teams save more lives and prevent long term disability for thousands more people.

Release of the new research comes as the NHS publishes an update on the progress made in the six months since these proposals were set out alongside updates to targets on cancer and routine care, and new targets for access to mental health services.

Field testing of the full range of proposals for pre-planned, urgent and emergency, mental health and cancer services is now underway in more than 70 local hospitals and health groups, bringing together relevant NHS teams to ensure the proposals are practical, support staff to deliver the most up to date and effective care, and measure what matters most to patients.

NHS National Medical Director, and chair of the review, Professor Stephen Powis, said: “Medicine has constantly improved and evolved over the last seven decades, and it’s important that NHS standards keep up with the evidence of what works best, and what people expect from their local services.

“While it’s still too early for us to draw conclusions, this new research, combined with early feedback from local trials, provides real encouragement that our proposals will both command the confidence of patients and the public, and support staff to provide the high quality care we all want to see.”

Populus surveyed 1,773 people in England between 21 to 22 October, and found that just one in seven actually know what the current target in A&E is, despite it being used for 15 years – and less than half thought that meeting the current target should be a high priority for emergency department teams.

Instead, the public expressed a clear preference for an average waiting time measure, with more people thinking it was easy to understand and would give a clear expectation of how long they could expect to wait than said the same of the current standard.

A group of 14 hospital trusts with major A&Es have been trialling the use of this measure since the end of May, with an initial six-week phase finding that it could be implemented safely and successfully.

Yesterday’s update from Professor Powis finds that early signs suggest that this measure may be having the expected positive impact for patients, with the number of people being admitted to hospital and the number of people spending 12 hours or more in A&E falling faster in trial sites than in a control group.

Further testing over the traditionally busier winter period will help medics and other experts determine whether this continues.

Professor Carrie MacEwen, Chair of the Academy of Medical Royal Colleges, said: “These early results are encouraging and the fact that it is getting support from patients at this stage is also welcome news. With the additional work that’s planned we look forward to exploring ways which ensure those requiring urgent care are seen first and that no patient waits longer than they should to be treated.”

The findings of the polling on A&E echo similar research into public attitudes to waiting times for routine operations and other treatment.

The survey, also released by Healthwatch yesterday, found that less than one in five people were able to accurately identify the current 18-week standard, and almost three in four said an average measure would be easy to understand and helpful in comparing performance across organisations.

Field testing of this measure launched in 12 hospitals at the beginning of August. In common with emergency care, the first phase of testing established that the measure can be implemented safely and effectively.

Further testing will now take place over the coming months to establish whether it can achieve the ambition of reducing long waits for care.

Imelda Redmond, Chief Executive of Healthwatch England, said: “It’s important that patient and public views guide how we measure success in the NHS, and we’re pleased that our research is helping to make sure this is the case. It’s crucial that the elements of care that are most important to people are prioritised and that people receive quick and effective triage, ensuring those who need it most get help the fastest.

“People told us that average time measures are easier to understand and more useful, but also that time spent waiting for care is less important to them than other aspects of their experience, like clear communication and staff support. As the clinical standards review progresses, we need to make sure a wide set of indicators is considered to make sure trusts and staff are empowered to do things differently, not just count differently.”

Testing of using the ‘Faster Diagnosis Standard’ for cancer also begun in August across 11 hospitals.

The measure was recommended by the Independent Cancer Taskforce in 2015, and would mean that people referred for an urgent cancer check can expect to receive a diagnosis or all-clear within 28 days. This would replace the current standard, which covers seeing a specialist within 14 days but has no limit on how long someone should wait to be told whether or not they have cancer.

Brand new mental health standards – covering both urgent and emergency care in hospitals and the community – are being trialled in more than 30 parts of the country.

The proposals, which attracted widespread support from mental health experts, staff and patient groups, are designed to support local teams to ensure that significant extra investment going in to specialist services – an extra £2.3bn a year by 2023/24 – results in real improvements in quality and access for those who need them.

Testing across all sites will continue ahead of final recommendations being made by the end of March 2020.

The information they generate will be considered by health experts, alongside research on what staff and patients think of them, to inform updated proposals which will be opened up to the public for consultation next year.