Roundtable Summary: How are healthcare leaders responding to urgent and emergency care pressures?

The roundtable, chaired by Lord Victor Adebowale,  featured a presentation by The PSC on the current state of UEC funding and performance, three case studies from Dr. Lara Alloway, Professor Lesley Dwyer, and Andrew Burnell, followed by an open discussion amongst attendees. The discussions explored implementation challenges and opportunities for system-wide improvement.

Participants discussed several key themes and insights for transforming UEC services, including:

• Pathway Redesign and Care Setting Optimisation: Leaders discussed redesigning urgent care pathways with an emphasis on home-based care where appropriate. By matching patients with optimal care settings and implementing new pathway designs, both system efficiency and patient outcomes could be significantly improved.
• Data-Driven Discharge Management: Comprehensive tracking and action allocation systems, together with expanded care services have demonstrated significant improvements in discharge processes. Digital tools show promise in improving patient flow, though implementation challenges need careful consideration and planning.
• Resource Allocation and Early Intervention: Attendees highlighted how strategic resource reallocation towards preventative care could help reduce pressure on emergency services. This includes enhanced community care and GP access as alternatives to hospital treatment, creating more options for patients before they reach crisis points.
• System and Cultural Transformation: The group agreed that bold, systemic changes would be more effective than incremental adjustments, emphasising the importance of cultural change and collaboration. This includes evolving performance metrics to better reflect health outcomes and prevention, supporting a more holistic approach to care delivery.

Read on for more information on the roundtable context, panellist presentations and case studies, the open discussion, and next steps.

Context: What is Urgent Emergency Care and why does it matter for delivering Planned Care performance? 

The end-to-end Urgent and Emergency Care System encompasses a wide range of healthcare provisions, including ambulance services, accident and emergency departments (A&E), urgent community response services, inpatient wards for patients admitted as an emergency, domiciliary intermediate care discharge services (“Pathway 1”) and bedded intermediate care services (e.g., “Pathway 2”). This system is designed to respond when patients have immediate or acute medical needs, supporting the patient’s diagnosis with any required treatment, rehabilitation or reablement. 

Understanding UEC services is essential as, not only are they a critical component of NHS service delivery, but they also increasingly affect how other hospital services are delivered. When UEC services become overwhelmed, they will often appropriate capacity and resources from other areas because their patients’ needs are the most immediate. This creates a domino effect that impacts everything from routine procedures to preventive care initiatives, forming part of the "right drift" of resources emphasised by Lord Darzi in his review into the current state of the NHS. 

Opening Presentation: What are the Growing Financial and Operational Pressures on Urgent and Emergency Care Services? 

The roundtable opened with a presentation by The PSC's Senior Partner and founder, Russell Cake, on the challenge of UEC optimisation and healthcare capacity management strategies. He highlighted The PSC’s analysis of UEC expenditure, demonstrating how it has overtaken planned and social care funding, creating critical capacity management challenges. For more details on this analysis, readers can explore our recent blog on UEC expenditure and performance. 

The impact extends beyond resources to A&E waiting times and patient safety. Patients now regularly experience extended waits for admission, raising mortality concerns. This stems from multiple factors: increasing demand outpacing population growth, longer hospital stays (particularly since COVID), and rising operational costs per bed – showing a 44% real-terms increase since 2011. 

Building on this, our panel speakers and the subsequent roundtable discussion demonstrated that there are effective strategies – being implemented in local systems - for addressing these root causes, addressing the cost of urgent and emergency care services and its quality and safety performance.

Panellist Presentations and Case Studies: What are some System-Wide Solutions for Urgent and Emergency Care Transformation?

The roundtable featured three exemplar presentations from healthcare leaders who have successfully implemented hospital capacity management best practice, at different levels of the NHS — Integrated Care Boards (ICBs), Acute Trusts and Community Trusts:

• Hampshire and Isle of Wight ICB (Dr. Lara Alloway, Chief Medical Officer): Their approach prioritises data-driven decision making, value-based healthcare and patient safety with a focus on moderately and mildly frail populations. They have implemented a 1% shift in resources to fund schemes with early impact on UEC, including same day access GP, Single Point of Access (SPOA), and integrated neighbourhood working and community health initiatives, with risk-sharing arrangements to reduce emergency admissions.
• Norfolk and Norwich University Hospitals NHS Foundation Trust (Professor Lesley Dwyer, Chief Executive): After reviewing their urgent care access points and identifying 14 different “front doors”, they have redesigned their UEC pathways to empower decision-making staff to only admit patients via the front door whom their care add value to. To do this, they have adopted innovative healthcare delivery models, including frailty hubs in elderly population areas, emphasising home-based care as the primary option.
• City Health Care Partnership CIC, Hull and East Riding (Andrew Burnell, Chief Executive): In partnership with The PSC, their urgent care NHS transformation has achieved a 70% reduction in delayed discharges through practical solutions. By optimising facilities, implementing patient tracking systems, expanding intermediate care, and developing home care services, they've demonstrated significant improvements in patient flow NHS-wide. Key to this, the system established a clear case for systemic change across Hull and East Riding, based on quantitative and qualitative evidence of poor patient experience and outcomes.

Open Discussion: How can the NHS Implementation Urgent and Emergency Care Transformation Solutions?

Following these panel presentations, participants engaged in an open discussion about how NHS organisations can learn from these examples of healthcare system transformation and address barriers to implementation.

Should Systems Adopt Radical Change or Incremental Improvements?

The attending healthcare leaders advocated for comprehensive UEC optimisation rather than incremental changes. There was clear consensus that NHS organisations must implement bold transformation strategies rather than minor adjustments.

Whilst acknowledging financial constraints, participants emphasised that current challenges demand decisive action. Running parallel services was identified as inefficient, hindering innovative healthcare delivery models and making improvements appear cost-prohibitive.

What is the Role of Cultural Change and System Leadership?

The discussion emphasised how successful urgent care NHS transformation requires cultural evolution alongside technical improvements. Participants shared how open dialogue between providers and challenging established practices drove positive change.

Leaders emphasised that healthcare metrics are a reflection of organisational behaviour patterns—indicating that cultural transformation leads to better performance metrics, rather than the other way round.

Social enterprises were also highlighted as potential catalysts for NHS system redesign, as they are able to challenge conventional approaches without typical organisational constraints.

Why is Digital Transformation so Challenging as well as Important?

Participants shared experiences with implementing healthcare capacity management strategies through digital solutions, noting that – typically – time to implement and realise benefits from these solutions is long, with process barriers to overcome. Despite these obstacles, successful implementation of patient flow management systems has occurred across various settings.

The group stressed that community healthcare systems require complete redesign rather than adapted hospital models. One system reported significant improvements in reducing transfer delays through digital transformation.

Should the NHS Rethink Metrics Beyond Counting Beds and Activity?

Discussions explored moving beyond traditional capacity metrics to consider value-based healthcare metrics (e.g. health outcomes), particularly for measuring the efficacy of community health integration. Participants noted the vast potential of home-based care resources, highlighting the disconnect between hospital and community care assessment.

The group advocated for measuring prevented admissions and health outcomes instead of focusing solely on bed occupancy. Developing community health integration metrics was identified as crucial for evolving performance measurement.

However, leaders still cautioned against viewing all admissions negatively, noting appropriate hospital care remains essential – the focus should be on preventing unnecessary admissions and reducing length of stay.

Next Steps: What are Some Key Ways that the NHS can Successfully Transform Urgent and Emergency Care Services?

As NHS England prepares to release its UEC Improvement Plan, along with the 10-Year Health Plan, our roundtable discussions highlighted several critical considerations that could enhance its implementation. Key insights on optimising UEC pathways and performance included:

• Adopt system thinking: Successful NHS pathway redesign requires breaking down organisational barriers and implementing shared risk arrangements, moving from blame culture to collaborative problem-solving.
• Build improvement capability: Organisations need enhanced transformation skills and capability development. Creating a culture of continuous improvement supports sustainable change.
• Implement technological solutions: Digital systems can enhance transparency and accountability, though implementation requires persistence and adaptation across different care settings.
• Challenge traditional metrics: Focus on measuring outcomes meaningful to patients and communities, developing new approaches to track admission prevention and community health impact.
• Focus resources on early intervention: Invest in preventive care impact on emergency services, particularly for moderately frail populations where reducing A&E waiting times is most achievable.
• Scale quickly: Avoid limited implementations that appear unsustainable. Bold, rapid scaling demonstrates value in urgent care NHS transformation.
• Ensure right environmental conditions: Before implementing initiatives, establish sufficient leadership capacity, healthy workforce with good morale, and effective use of data.
• Consider end-to-end value: Look at value along the entire UEC pathway instead of managing costs in individual silos.
• Address workforce health: Maintain psychological safety for front-line staff and keep vacancy rates and agency staff use below threshold levels.

Traditional approaches cannot meet growing demographic demands. As one participant noted, meeting projected needs would require weekly ward expansion for a decade – highlighting the critical need for healthcare system transformation.

For NHS organisations seeking to optimise UEC and address the planned care backlog, the message is clear: implement bold NHS system redesign solutions, think systematically, and act decisively. The UEC transformation case studies shared at this roundtable prove that significant improvement is achievable and already occurring across the NHS.

The PSC extends its sincere gratitude to Lord Victor Adebowale for his expert chairing of the roundtable, and to our distinguished panellists Dr. Lara Alloway, Professor Lesley Dwyer, and Andrew Burnell for sharing their invaluable insights and experiences. We also thank all attendees for their active participation and candid contributions to this crucial discussion.

If you are interested in further discussion of the topics raised here, please contact hello@thepsc.co.uk. To stay informed about future events and receive updates on our latest healthcare transformation insights, we invite you to sign up for our mailing list. Join our growing community of public sector leaders working to improve public services, including healthcare services and patient outcomes.