Research and analysis

A&E delays: next steps

Published 3 September 2015

Applies to England

The findings of our analysis of A&E delays are helping to inform improvements in 4 key areas:

1. Improving patient flow in the rest of the hospital

1.1 Upcoming reports and guidance

• the National Institute for Health and Care Excellence (NICE) is currently developing service guidance on ‘Acute medical emergencies in adults and young people’, which will cover service organisation and delivery across the NHS
• Monitor will publish research on ‘Moving healthcare closer to home’, which includes an assessment of the impacts and provides examples of schemes that could improve patient flow
• the Productive Models of Elective Care research team will soon publish a report that identifies opportunities to improve productivity through models of elective care

2. Getting a better understanding of the impact of social and community care

2.1 The impact of delayed transfers of care

• NHS England, with the support of the Department of Health (DH) and Monitor, has reviewed the ‘Delayed Transfers of Care’ (DTOC) guidance to improve the quality and consistency of providers’ reporting in this area
• the National Audit Office is scoping a value-for-money study looking at the discharge of patients from acute hospitals; this is likely to have a focus on how delayed transfers of care are managed and monitored locally, and how DH and its arm’s length bodies are supporting health and social care bodies to minimise delays
• NHS England’s Urgent and Emergency Care (UEC) Review Programme has launched an ‘Out-of-Hospital Urgent Care’ programme which will include roll-out of an integrated NHS 111 service, improved co-ordination between the independent care sector and the NHS, and development of community-based care models

3. Supporting the mid-long term sustainability of A&E departments

3.1 Better planning and reducing emergency care

• NHS England, DH and Public Health England (PHE) are working together on a national Services Information Campaign to reduce emergency care pressures; local NHS organisations will be able to join up with this campaign
• a new Emergency Care Data Set is being developed, which should enable providers and commissioners to better plan and monitor the delivery of emergency care
• NHS England’s UEC Review Programme is developing guidance for commissioners on urgent care centres, emergency centres and emergency centres with specialist services

4. Supporting efforts to tackle local issues

4.1 Patient flow and local health communities

• DH, Monitor, the NHS Trust Development Authority (TDA) and NHS England are setting up an Emergency Care Improvement Programme (ECIP) to help the most challenged urgent care systems, with a focus on patient flow
• the ‘Safer, Faster, Better’ guide for delivering urgent and emergency care services is a practical summary of good-practice design principles for local health communities to adopt