The speech sets out the case for changes within Emergency Departments which will complement the Keogh initiatives, making the case for:
- the co-location of out of hours urgent and emergency care services with A&E
- two new performance metrics to go alongside the four hour standard
- better directed funding of emergency departments
The President of the Royal College of Emergency Medicine, Dr Cliff Mann, gave a speech on 22nd Sept at the King’s Fund entitled 'Beyond Keogh', in which he made the case for changes within emergency departments to complement the initiatives in the Keogh review of urgent and emergency care.
Dr Mann said:
"The Keogh Review has worked to create networks of providers to improve access to care, reduce duplication of processes and move care ‘closer to home’. Various network models are currently being evaluated through a series of ‘vanguard’ sites.
"We welcome these changes, but we believe there is now compelling evidence for changes within departments that will complement the Keogh initiatives."
These changes include making A&E the ‘hub’ for all out of hours urgent and emergency care, co-locating other services with the emergency department. This approach reflects the strong A&E ‘brand’, which patients know and trust, and during the speech Dr Mann launched the College’s ‘A&E brand’ video.
On the co-location of services with emergency departments, Dr Mann commented:
"There is currently a large mismatch between what A&E departments were set up to do and are commissioned to deliver, compared with the volumes and case-mix of patients who actually attend. A&Es have become the default facility for ‘any and every’ out-of-hours care need, with the Emergency Medicine workforce treating patients who could best be seen by another service. Consequently, we believe that other services should be co-located with A&E, so that patients attending A&E who could best be seen by another service can be redirected to the most appropriate service right away. These other essential services which should form part of a reconfigured ‘A&E hubs’ include out-of-hours primary care for urgent conditions, community pharmacy services, community mental health teams, links to palliative care teams and district nursing teams.
"This approach, which we call the co-location of primary care services with A&E, is supported by the Trust Development Agency, Monitor, the Royal College of Physicians, the Royal College of Surgeons, the Royal College of Paediatrics, and NHS England."
Dr Mann also made the case for two new performance metrics to be introduced alongside the four hour standard, saying:
"These new metrics would look in closer detail at the amount of time patients waited in A&E in cases where the four hour target was breached; and at the number of people being discharged from hospital compared with those being admitted. Data for both metrics is already collected by hospitals, meaning there would be little additional bureaucratic burden on staff, and these metrics would incentivise more and quicker discharges of patients from A&E."
Finally, Dr Mann argues that funding of emergency departments needs to be better directed, saying:
"There are two aspects to the situation as regards funding. First, the system for the payment of treatment received by patients in A&E is not fit for purpose, and needs to be reformed. Secondly, doctors’ terms and conditions currently being renegotiated must ensure that those who work at weekends, evenings and nights nevertheless achieve an equitable work life balance."
For further information, or to speak with a spokesperson for The Royal College of Emergency Medicine (between 9am and 5pm), please contact Matt Chorley at firstname.lastname@example.org or on 0207 067 1275.
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About the Royal College of Emergency Medicine
The Royal College of Emergency Medicine is the single authoritative body for Emergency Medicine in the UK. Emergency Medicine is the medical specialty which provides doctors and consultants to A&E departments in the NHS in the UK and other healthcare systems across the world.
The Royal College works to ensure high quality care by setting and monitoring standards of care, and providing expert guidance and advice on policy to relevant bodies on matters relating to Emergency Medicine.
The Royal College has over 5,000 fellows and members, who are doctors and consultants in emergency departments working in the health services in England.