Department of Health and Social Care
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Hunt - NHS must fundamentally change to solve A&E problems

Today, Health Secretary Jeremy Hunt outlined radical changes to improve care for vulnerable older people and alleviate pressure on A&E.

Alongside specific plans to support NHS A&E departments in the short-term this winter, the Health Secretary set out proposals to fundamentally tackle increasing pressures on NHS A&E services in the long-term – starting with care for vulnerable older patients with complex health problems.

Fundamental changes mean joined-up care - spanning GPs, social care, and A&E departments - overseen by a named GP. Many vulnerable older people end up in A&E simply because they cannot get the care and support they need anywhere else.

These changes will reduce the need for repeated trips to A&E, and speed up diagnosis, treatment and discharge home again, when patients do need to go to hospital.

The facts are clear one in four of us already have a long term condition and half of all GP appointments and two-thirds of outpatients and A&E visits are now made by patients with multiple long term health problems.

Overall, the number of people going to A&E departments in England has also risen by 32 per cent in the past decade, and by one million each year since 2010. The over-65s represent 17 per cent of the population, but 68 per cent of NHS emergency bed use. They also represent some of the NHS’s most vulnerable patients, and those most at risk from failures to provide seamless care.

This is why, to support the NHS in the short term, the Government has made an extra £500 million funding available over the next two years. Today, the Health Secretary set out how £250 million would be used by 53 NHS Trusts this winter.

Of the £250 million:

  • Around £62 million for additional capacity in hospitals – for example extra consultant A&E cover over the weekend so patients with complex needs will continue to get high-quality care;
  • Around £57 million for community services – for example better community end of life care and hospices;
  • Around £51 million for improving the urgent care services - for example for patients with long-term conditions;
  • Around £25 million for primary care services – for example district nursing, to provide care for patients in their home, preventing them from being admitted to A&E;
  • Around £16 million for social care – for example integrating health and social care teams to help discharge elderly patients earlier and prevent readmission and;
  • Around £9 million for other measures – for example to help the ambulance service and hospitals work better together.

£15 million of this money will also be spent on NHS 111 - to increase the number of clinicians and call handlers so that non-emergency visits to A&E can be avoided.

Flu also has a big impact on the NHS, with on average around 750,000 patients going to their GP with ‘flu symptoms and 27,000 people admitted to hospital as a result of the disease each year.

That is why with Chief Medical Officer Dame Sally Davies, Mr Hunt also today announced specific measures to minimise the effects of ‘flu, and flu-related A&E visits in the coming winter months:

  • For the first time, any NHS Trust eligible for a share of the £250 million A&E funding for next year will need to ensure that at least 75 per cent of its own staff have been vaccinated against ‘flu this year;
  • A national flu campaign to protect the most vulnerable from the disease, and avoid flu-related A&E visits; and
  • A flu vaccination programme for children between two and three years old, to reduce potential spread of the disease.

Setting out more fundamental long-term changes, Mr Hunt highlighted three key elements emerging as a result of the on-going engagement on improving care for vulnerable older people with complex health problems. Proposals being put together, in order to be rolled out next year include:

  • Patients should have a named clinician responsible for the coordination of their care right across the NHS – between hospital, in care homes, and in their own homes. This is subject to on-going engagement, but current views are that a GP should fill this role.
  • Care for older people must be joined up between social care services and the NHS, starting with the £3.8 billion integrated care fund recently announced by the Chancellor.
  • Information and patient records must be shared across the NHS and social care services so that accurate clinical information is available at all times to everyone involved in a patient’s care, and staff can spend more time providing care, not form-filling. So by the end of 2014 at least one-third of A&Es should be able to see the GP records of their patients; and at least one-third of NHS111 services to be able to see the GP records of their callers.

The Health Secretary said:

This winter is going to be tough– that’s why the Government is acting now to make sure patients receive a great, safe service, even with the added pressures the cold weather brings. But this is a serious, long-term problem, which needs fundamental changes to equip our A&Es for the future.

In the long term, I want a 24/7 service which recognises patients as individuals and looks out for them proactively. Starting with our most vulnerable, this Government is going to support the NHS in doing exactly that.

The Health Secretary was supported today by senior NHS leaders, and by health minister Norman Lamb, who is specifically overseeing how the £3.8 billion integrated care funding will be used across social services and the NHS.

Care and Support Minister Norman Lamb said:

We want to build a stronger economy and a fairer society. That’s why we recognise the need to join up services around people’s lives so that vulnerable people get better care, closer to home, and the NHS is sustainable for the long term. People shouldn’t fall between the cracks in services, being pushed from pillar to post and not getting the care they need simply because these systems do not work together.

We have been talking about integrated care between the NHS and social care for years – and now the Government has put its money where its mouth is. We have created a £3.8 billion Integration Transformation Fund to make sure everyone gets a properly joined up service in order to get the care they need from whoever is best placed to deliver – the NHS or the local authority.

This can no longer be just an aspiration – by joining up service, we will help keep people out of hospital and provide better care.

NHS Confederation Chief Executive Mike Farrar said:

Health and social care leaders will welcome receiving notification of where and how this money is to be spent, and that it will be available for services which can prevent patients needing to visit A&E in the first place.

Our members have told us one of the most frustrating aspects of trying to plan for A&E pressures is not knowing how they will fund them until the bulk of winter has been and gone. Getting this detailed breakdown in September means the NHS can put the right plans in place and get ahead of some of the pressures we know are lurking round the corner.

A&E is often seen as the NHS safety net, but that net is now stretched so tight it can’t cope much longer. The warning signs are clear; the time for stop-gap solutions has passed. As a society, we need to drastically change how we regard hospital-based A&Es, so a public campaign reminding people of the full range of healthcare options available to them would be a good place to start.

Chief Medical Officer Dame Sally Davies said:

Frontline staff, by the very nature of their jobs, deal with people who are unwell every day. Simply by having the flu vaccine, as recommended by the GMC, NHS staff can play an important role in not picking up the flu virus and passing it on to other patients – often people who are already poorly and vulnerable to infection.

Currently less than half of frontline NHS staff get vaccinated against flu – and in some hospitals, this figure drops to fewer than 1 in 5. I urge all frontline staff to get vaccinated and encourage their colleagues to do so too.

Full press release and Notes to Editors

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