One year on – update on the recovery of urgent and emergency care services in England

NHS England have published a progress update on the recovery plan for urgent and emergency care services in England, and sent a letter to ICB Chairs and regional directors, aimed at supporting planning over the summer and improving system resilience ahead of winter. 
Icon: Magnifying glass

The NHS England two-year recovery plan for urgent and emergency care services was published in April 2023 backed by a £1bn improvement package. At the time, the College highlighted the plan’s predominant focus on the challenges for an aging population and raised the need for targeted investment in paediatric urgent and emergency care and measures that emphasise improving the quality and access for children and young people.

One year on, NHSE explain the ‘significant and substantial progress’ that has been made against a number of the commitments in the delivery plan including: 

  • An increase in the proportion of patients completing their A&E treatment within the 4hr hour target window 
  • Faster ambulance response time for ‘emergency but not life threatening’ calls.
  • 12,000 virtual ward ‘beds’ created allowing patients to receive hospital level care at home
  • 5,000 additional core general and acute beds delivered

However, data shows that despite this more than 1.5 million patients waited 12 hours or more in 2023 and bed occupancy remains dangerously high. 

Children’s emergency departments continue to report high levels of demand and are vulnerable to being overwhelmed when that demand peaks.   

In the accompanying letter to all ICB chairs and regional Directors, NHSE reiterate 3 areas for systems to focus on:

Priority 1 – Maintain capacity across general and acute beds, and ambulance capacity. Further measures include:

  • Supporting the development of services that reduce ambulance conveyances, including increasing clinical assessment in NHS111 which “may include increasing access to paediatric expertise through a NHS 111 Paediatric Clinical Assessment Service”
  • Improving access to virtual wards, with a focus on provision for several priority populations, including children and young people. 

Priority 2 – Increase the productivity of acute and non-acute services and improve flow, length of stay and clinical outcomes by:

  • Reducing admitted and non-admitted time in ED 
  • Decreasing numbers of patients in hospital beyond their discharge ready date – with a focus on join-up with adult social care
  • Improving consistency and accuracy of data reporting – including by disaggregating data based on age to better understand demand and performance for children and young people.

Priority 3 - Continue to develop services that shift activity from acute hospital settings. For example: 

  • Expand provision of acute respiratory infection (ARI) hubs, including paediatric ARI hubs
  • Ensure all Type 1 providers have an SDEC service, with systems encouraged to develop specialist paediatric SDEC
  • To support this requirement, parents and carers should be provided with access to clear, accurate information about common illnesses in children and young people, promoting self-care and access to the right care at the right time.

It is welcome that systems continue to be encouraged to implement high impact interventions to address pressures across urgent and emergency care, and that this letter from NHS England recognises the value of paediatric virtual wards, children’s ARI hubs and SDEC, in addition to a focus on increasing paediatric clinical assessment in NHS 111. However, we are still seeing an underinvestment in these services with funding streams more often allocated to frailty and discharge planning. The College continues to call for ring fenced funding for paediatric urgent and emergency care to ensure children benefit equally from any further investment in urgent and emergency services.