Harnessing transformational change in emergency care and across the wider health and care system
Chief Inspector of Hospitals, Professor Ted Baker, discusses how emergency departments have responded to the coronavirus pandemic, highlights some of the challenges they face, and calls for the positive transformational changes to be locked in as we move beyond the peak of the pandemic.
The immediate health and care response to the challenges raised by the coronavirus (COVID-19) outbreak has been phenomenal. We have seen health and care staff go to extraordinary lengths; demonstrating resilience in the face of unprecedented pressure and adapting quickly to work in different ways to keep people safe. The fact that the NHS has not been overwhelmed is a huge achievement, made possible by the rapid transformation in clinical practice, introduction of new and innovative approaches to delivering care and a greater understanding of the skill, value and flexibility of every part of the health and care workforce.
Part of this has involved important changes in the way that emergency care has been delivered. In recent weeks our regular engagement with front line emergency department (ED) clinicians has highlighted a range measures employed to manage patient flow and prioritise safety during the pandemic. Departments have been reconfigured into streams to separate infected and non-infected patients; clinical expertise at the “front door” has increased, with improved access to face-to-face specialists, and closer working with other departments such as radiology. In some cases, we have also heard how greater collaboration between hospitals, primary care and community services has helped to maximise capacity, drive support through NHS 111 and embrace new practices that ensure effective social distancing and infection control.
As we move beyond the peak of the pandemic the number of COVID-19 hospital admissions is in gradual decline, and we are starting to see ED attendances increase. During April attendances fell sharply, allowing departments greater flex to increase staffing numbers and adhere to social distancing. But the expected rise in demand for emergency care coupled with the continued burden brought about by COVID-19 is likely to make maintaining increased staffing levels and bed capacity incredibly difficult and will present wider practical challenges for staff. This is particularly concerning as we head into winter, with the additional risk that subsequent waves of the virus may coincide with seasonal flu, creating further pressures.
The Royal College of Emergency Medicine (RCEM) is absolutely right that we must act now to ensure patient safety is not jeopardised through issues such as poor infection control, physical crowding and corridor care. It is important that we seek to strengthen alternative routes of access for lower acuity patients, whilst maintaining adequate access for those who need to visit an ED. Additionally, efforts to maximise capacity, maintain flow, enable social distancing and ensure robust infection control must continue if we are to safeguard against avoidable risks to patients and staff.
As more and more routine services resume, many of the practical challenges faced by EDs will be replicated across services and systems. While we have seen some examples of good collaboration in response to the crisis, it has not been evident everywhere and barriers to effective system working have been clear. There is an opportunity for providers, regulators and system partners to work together to lock in the positive transformational changes we have seen — many of which have been delivered at pace. We must ensure that the learning from the peak of the crisis is not lost but used to drive a new way of working that is supported at a national, regional and local level by the whole health and care system. The way we plan, commission and deliver health and care must be shaped by the experience of recent weeks which has demonstrated so very clearly how interdependent health and care truly are.