Healthcare technology leaders have cautiously welcomed the publication of the Government’s new Delivery Plan for Recovering Urgent and Emergency Care Services, but have warned it does not take full advantage of the key role digital solutions could have in reviving the NHS.
The joint NHS and Department of Health and Social Care plan sets out urgent actions to meet the current challenges facing the NHS, and also the first steps in transforming urgent and emergency care.
Its ambition is that every person will get the very best urgent and emergency care as well as raiding standards of quality and safety for the most-vulnerable patients and their families, including older people living with frailty, children and young people, people with disabilities, and people with mental health needs.
And it includes two ambitions for the next two years – a 30-minute mean response time for Category 2 ambulance callouts, and 76% performance in A&E wait times, measured through the four-hour target.
There will also be improvements across the patient pathway, including on 12-hour waits from arrival and on discharge from acute, community, and mental health hospital settings.
Building on the experience from this winter, the plan sets out actions across five key areas:
- Increasing capacity – investing in more hospital beds and ambulances, but also making better use of existing capacity by improving flow
- Growing the workforce – increasing the size of the workforce and supporting staff to work flexibly for patients.
- Improving discharge – working jointly with all system partners to strengthen discharge processes, backed up by more investment in step-up, step-down, and social care, and with a new metric based on when patients are ready for discharge, with the data published ahead of winter
- Expanding and better joining up health and care outside hospital – stepping up capacity in out-of-hospital care, including virtual wards, so that people can be better supported at home for their physical and mental health needs, including to avoid unnecessary admissions to hospital
- Making it easier to access the right care – ensuring healthcare works more effectively for the public, so people can more easily access the care they need, when they need it
But, while health tech leaders have largely welcomed the plan, they have noted that only virtual wards are specifically mentioned and have called for increased investment in technology to achieve the ambitions.
Craig Oates, UK managing director at Doctrin, told BBH: “The current model of care simply isn’t working, to the frustration of all.
“Having been on both sides of the service, both as a manager and as a patient, it is clear that the service is not what either wants.
“Many patients end up in an urgent care or emergency setting because they are unable to determine or access other more-appropriate services that will safely and more readily meet their needs.
Expanding and better joining up health and care outside of hospitals with the use of virtual wards marks a significant opportunity in the way that healthcare can be provided to reduce pressure on urgent and emergency services. However, virtual wards cannot tackle waiting times on their own. They are not a silver bullet
“Therefore, it is right for the two-year plan to look at improving triage processes and re-directing patients away from these care settings.
“Redesigning services – combined with implementing next-generation digital navigation solutions that improve access, workflow, communications, and outcomes, and triage patients to the right service or caregiver – is critical to delivering the high-quality, sustainable services patients and NHS caregivers need and want.
“And, with that in mind, it is disappointing to see technology’s role centre largely around virtual wards in the plan.
“While these clearly have a role in the solution, there needs to be much more of a mantra of ‘digital wherever possible, physical where needed’.”
Paul McGinness, chief executive of Lenus Health, adds: “Expanding and better joining up health and care outside of hospitals with the use of virtual wards marks a significant opportunity in the way that healthcare can be provided to reduce pressure on urgent and emergency services.
“However, virtual wards cannot tackle waiting times on their own. They are not a silver bullet.
“Long-term conditions account for five of the top 10 causes of emergency admissions and these patients will continue to require urgent care if we do not improve their diagnosis and management.
“Using digital pathways that are proven to keep patients with chronic disease out of hospital in the first place must be part of the digital funding for it to have any lasting impact.”
To support the recovery plan, the Government has committed to additional targeted funding including:
- £1billion of dedicated funding for 2023/24 to support capacity in urgent and emergency services, as set out in Planning Guidance, and to increase their overall capacity and support their staff
- £1.6billion of additional funding in the Adult Social Care Discharge Fund in 2023/24 and 2024/25 to be pooled into the Better Care Fund
At a national level implementation of the plan will be led by Sarah-Jane March, the NHS’s new national director of urgent and emergency care and deputy chief operating officer, working closely with key partners nationally, regionally, and locally.
In the foreword, she said: “Delivering this plan over the next two years will mean putting in place the fundamentals for improvement: accountability at every level, genuine transparency, on-the-ground support, and effective spread of best practice and innovation.
Using digital pathways that are proven to keep patients with chronic disease out of hospital in the first place must be part of the digital funding for it to have any lasting impact
“However, delivery will depend on the leadership of local health and care organisations and their partners.
“Through this year’s planning round we have asked all systems to develop plans for UEC recovery and we look forward to working with them over the coming weeks as we develop the operational detail to ensure delivery of this plan.”
While welcoming the proposals, health tech leaders claim a greater uptake of digital solutions could have more-widespread benefits
Reactions from health tech leaders
We spoke to a number of leading healthcare technology companies to find out their response to the report. Here’s what they had to say
Alan Payne, development director at The Access Group, said:
“The two-year delivery plan rightly recognises that solutions for recovering emergency services are to be found beyond A&E’s front door.
“And while in part the plan includes a summary of already-announced initiatives and government funding, it effectively articulates the different components of the care continuum that contribute to the pressures on urgent care and require resolution.
“With technology having the largest focus in the context of scaling virtual wards by 500% now, more than ever, it is vital that this initiative moves beyond short-term ‘tactical fixes’.
“While early rollouts have achieved some meaningful success locally, to meet the delivery plan’s targets, implementation needs to go a step further and include a scalable infrastructure platform and integration with care services.
“To enable a clinician-friendly and frictionless future operating model that also meets the near-term demands on services, the components of virtual wards need to step up, in order for the initiative to scale-up.”
While early rollouts have achieved some meaningful success locally, to meet the delivery plan’s targets, implementation needs to go a step further and include a scalable infrastructure platform and integration with care services
Dr Constantin Jabarin, international chief medical information officer at Altera Digital Health, said: “I am pleased to see the ambitious approaches set out in the urgent and emergency care recovery plan, including the expectation that all trusts will have appropriate bed management solutions implemented by the end of 2023.
“As well as the many welcome improvements being prioritised to increase current capacity, it is important to ensure existing capacity is used as effectively as possible, across all care settings inside and away from hospitals.
“As the focus of the frontline digitisation programme has rightly been on levelling up trusts’ digital maturity through foundational systems like electronic patient records, the next step for these organisations needs to be digitising bed management and patient flow processes so that near real-time decision making can be achieved.
“By integrating clinical information with operational data, patients can be safely moved through the hospital and between services with more predictability and efficiency.
“This will enable discharges to be better planned, provide better experiences and outcomes for patients, and, in some cases, avoid having to use urgent and emergency services altogether.”
As the focus of the frontline digitisation programme has rightly been on levelling up trusts’ digital maturity through foundational systems like electronic patient records, the next step for these organisations needs to be digitising bed management and patient flow processes so that near real-time decision making can be achieved
Paul Landau, chief executive of Careology, said: “The Government’s ambition and targeted plan for virtual wards is very encouraging.
“Technology-enabled virtual wards are a sustainable solution in the treatment of long-term conditions like cancer.
“People going through cancer treatment often require urgent care if symptoms and side effects of treatment are not detected early, which could be easily avoided if remote monitoring was in place.
“The Government is clearly making a targeted effort to reduce waiting times and provide people with a better patient experience, but this needs to extend beyond urgent and emergency care.
“To truly empower patients we need to roll out remote monitoring technology across every stage of the care journey, rather than simply seeing it as a way of easing discharge from hospital.
“This would completely redefine care pathways and provide a step change in how we deliver long-term care.
“If digital is used to do this, particularly for cancer care, we could significantly reduce the numbers of people needing to come into contact with emergency and urgent care services in the first place.”
To truly empower patients we need to roll out remote monitoring technology across every stage of the care journey, rather than simply seeing it as a way of easing discharge from hospital
Andy Meiner, chief revenue officer at ReStart, said: “The delivery plan, along with the increase in resources is welcome – but it’s also important to improve efficiency around the existing processes in order to maximise the benefit of this resource.
We view interoperability as being vital in three main areas:
- Increased adoption of virtual wards using remote monitoring solutions, but which are safely integrated into EPR systems in order to minimise clinical risk
- Increased integration between ED systems and ambulance teams so ED capacity can be better managed and patient flow is improved because ED teams are primed and ready and ambulance teams already have shared information
- Improved integration with social care and community services to improve the discharge process through more-efficient communication around the provision of care packages, enabling inpatient beds to be freed up more quickly
