Supporting a large NHS region to implement Same Day Emergency Care and improve patient care
The PSC supported NHSE/I South East to work with partners across the region to implement and expedite acute and community-based same day emergency care (SDEC) – a national priority in the NHS Long Term Plan to improve care outcomes for patients.
Between August and December 2021, we supported more than 20 provider and commissioner organisations across five Integrated Care Systems to translate national and regional SDEC policy priorities into practice.
The scope of our work was wide-ranging, as we responded flexibly to the needs of clients at different stages of delivery. In some instances, we provided operational support to generate immediate impact on the ground. In other instances, we offered strategic support as a foundation for both short and long-term impact.
Our support spanned:
- Performance improvement – facilitating PDSA rapid experiment cycles
- Pathway and service design – writing of standard operating procedures; developing of models for how services interact
- Mobilisation – delivery planning and prioritised action planning
Example 1: Boosting the number of patients through Tunbridge Wells (TW) medical Ambulatory Emergency Care Unit – support to Maidstone and Tunbridge Wells NHS Trust
The Tunbridge Wells AEC team wanted to increase the number of medical SDEC patients they saw in the unit – to reduce pressures on the Emergency Department (ED) and admitting wards. Lack of space and missed opportunities for referrals were two of the principal challenges they faced.
With The PSC’s support, the team devised three rapid improvement experiments: (i) increase available space for the unit; (ii) optimise ED referral processes; (iii) optimise GP referral processes.
From a baseline average of 56 AEC patients/week, the team saw 105 patients in week 1 of the experiments, 70 in week 2 and 86 in week 3. Averaged across all 3 weeks, this equated to a ~ 54% increase compared to baseline. In addition, the number of patients admitted on the medical take, and not seen in AEC, dropped from an average of ~29 a day (October), to ~25 a day (November), a ~ 14% reduction.
The key ingredients of success were fostering strong nursing and medical team-working, and instigating regular weekly meetings to review progress, solve problems and keep up momentum.
Example 2: Building a community-based same day urgent care programme in North & Mid Hampshire
The Associate Director for System Resilience in North & Mid Hampshire Integrated Care Partnership (ICP) wanted to systematically develop the provision of same day urgent care services in the community and establish concrete workstreams to achieve this.
The PSC supported her to collaboratively develop a definition and vision for same day urgent care, together with an assessment framework of best practice. The next step was using this framework to capture the strengths, gaps and maturity of 17 individual services via interviews with a range of service leads. Informed by this gap analysis, the final step was to develop an action plan, with workstreams prioritised by time horizon and ease of implementation.
The impact for the ICP was a newly established programme of work and set of clear and locally owned plans for making short and long-term improvements to same day urgent care services.
Example 3: Mobilisation of “quick-win” 111 to SDEC pathways at East Sussex Healthcare NHS Trust (ESHT)
The ESHT team wanted to accelerate the development of pathways connecting 111 to existing paediatrics and gynaecology SDEC services. The PSC supported by defining the SDEC services in detail and setting out the infrastructure requirements and practical steps required for linking them to 111. Following this, we developed a comprehensive standard operating procedure for both services – establishing clarity on access and referral points, patient pathways, information flows and governance.
The impact for ESHT was equipping service leads to go live with the new 111 pathways in time for winter.
Our support spanned:
- Evidence-based insight – conducting stock-takes and gap analyses; developing data-driven cases for change
- Stakeholder engagement – raising awareness of new services; developing new governance structures for service planning and assurance
- Best practice curation – developing practical toolkits; writing up case study examples for dissemination
Example 1: Increasing the proportion of medical patients treated in Basingstoke and North Hampshire Hospital (BNHH) Medical SDEC – support to Hampshire Hospitals NHS Foundation Trust
The BNHH team wanted to understand the limitations to their current medical SDEC provision and the options for improvement. The PSC produced a diagnostic report – using a blend of quantitative data analysis and qualitative staff interviews – to identify the main barriers limiting current performance, followed by an options analysis to identify a pragmatic solution for expanding the SDEC’s physical footprint. This equipped senior decision-makers with the information they needed to agree an expansion.
In the first three weeks of opening the expanded area, an average of 37% of the take of medical patients was seen by the medical SDEC – compared to a historic baseline of 20%.
The key ingredients of success were engaging a wide range of stakeholders to gain varied perspectives and securing senior buy-in at an early stage.
Example 2: Improving ICS-wide governance and oversight of community same day urgent care services in Surrey Heartlands
The Surrey Heartlands ICS team wanted to set up a new governance structure for better oversight of community same day urgent care services. The PSC supported by collaboratively developing the scope and terms of reference of a new assurance group, and equipping the group with an agreed set of service standards and outcomes to assure against.
The impact for Surrey Heartlands was a robust governance framework to assure equity of access, delivery standards and outcomes of priority same day urgent care services – and a heightened profile of these services at ICS level.
Example 3: Developing a Community SDEC framework for dissemination across the South East region
The NHSE/I South East regional team tasked The PSC with developing a framework to codify shared learning in the nascent field of community SDEC. The same day emergency care model was originally developed for and talked about in acute settings; translating the idea into community-based provision was potentially quite confusing. The framework we developed comprised of (i) definition, principles and illustrative patient journeys, (ii) a toolkit of approaches for developing community SDEC provision, (iii) examples of practical implementation.
The impact of this framework was a comprehensive set of resources to better equip partners across the region understand the nuances of community SDEC and develop services in their local area.
The value of The PSC’s practical and collaborative approach shone through in feedback from senior staff we worked with across the region:
‘It has been a real pleasure to work with the team … who have been excellent and … a real asset to getting points across to the clinicians. I realise how difficult it must be coming into someone else’s patch and asking them to try something new. It was dealt with expertly and sensitively. I think your team’s approach really got the best out of our team.’
‘Thanks for all the energy and expertise that you have brought to this programme for us. I hope that we get to work together in the future.’
‘Having the additional capacity that The PSC brought was critical to being able to mobilise this programme at pace. The South East region was able to restore SDEC activity to above pre-pandemic levels and continue to push development of this programme.’
The PSC performance team