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30th May 2022
Issue 9
Welcome to the programme newsletter
Welcome to the latest edition of Humber Acute Services programme stakeholder newsletter. In it you'll find the latest news and updates about the programme, alongside information about how you can get involved, share your ideas or ask questions.

In the next few issues of our newsletter, we want to highlight some of the developments that are taking place, both in and outside of our hospitals, that contribute to the programme’s vision for the future. Some are national programmes others are local initiatives, but in all cases, we are aligning our work with these wider changes. This issue focuses on developments within Urgent and Emergency Care.
SPOTLIGHT ON - Urgent Emergency Care
New Models of Care Explained
picture of staff pushing trolley down hospital corridor
The Humber Acute Services Programme is about designing hospital services for the future. As we have developed potential models of care for Urgent and Emergency Care Services, new concepts and ideas have been developed and discussed. In the following interview with our Urgent and Emergency Care Lead, Dr Anwer Quereshi, we attempt to explain some of these concepts and what they might mean for patients and staff.

  • What is the Acute Assessment Model (AAM)?
The principle of the AAM is to ensure that most patients are assessed and treated as early as possible so that only those who need acute care as an inpatient are admitted to a bed; this allows a significant proportion of patients to be seen, treated and sent home on the same day.


  • What makes AAM different from a traditional A&E (Emergency Department)?
Traditional A&Es have one entrance by which all patients enter, the Acute Assessment Model provides multiple entrances and ensures the Emergency Department only receives patients who have life threatening conditions or require care within the Emergency Department. The alternative entrances include the Urgent Care Service; this is run by GPs and other primary care staff and provides treatment for minor injuries and illnesses, and the Same Day Emergency Care Unit, this service receives patients directly from ambulance, primary care, Urgent Care Service and the Emergency Department, where it has been identified that they can be sent home the same day.


  • What is an SDEC (Same Day Emergency Care)?
Same Day Emergency Care is an initiative whereby a significant proportion of patients who are suitable to be evaluated and treated (if required)on the same day so that they are able to return home without the need for an inpatient admission. This is delivered by teams normally involved in looking after acutely-ill patients, which include acute medicine, general surgery, gynaecology and other surgical and medical specialities. This is available usually 7 days a week and at least 12 hours a day. Instead of moving the patient around the different departments of a hospital, specialists come to the patient to ensure they get the assessment and treatment they need quickly so they can avoid a long stay in hospital.

  • What is a SSU (Short Stay Unit)?
Short stay units are a part of acute care, these are inpatient areas which accommodate and care for acutely ill patients who require an inpatient stay for up to 72 hours during which regular ongoing reviews by senior clinicians take place ensuring the care plan is implemented and followed up as urgently as possible.

  • Would patients notice anything different?
By introducing these new models of care, a patient who needs to attend hospital can access the care they need more quickly and, in most cases, get home more quickly as a result. They will experience shortened pathways requiring fewer clinicians, fewer clinical encounters and a reduction of duration of stay in hospital due to receiving treatment sooner.

These new pathways can also help some people avoid hospital altogether by providing a multi-disciplinary approach involving the patient’s usual GP/clinician and carers to avoid unnecessary hospital attendance.

  • What about staff?
Staff feel well-supported due to the multi-disciplinary approach to patient care. There is enhanced communication through the utilisation of digital systems, enabling quicker consultations, advice and remote review of patients and joint decision making; along with new facilities and an improved environment to work in and hopefully fewer in-patients to be looked after in beds.
Transforming Urgent and Emergency Care - System Developments
The Local Clinical Assessment Service
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The Humber and North Yorkshire Urgent and Emergency Care Network (UECN) is working on a range of initiatives to help ensure people are able to access the right care, first time. This includes helping people to avoid coming to hospital Emergency Departments when they don’t need to be there.

The local Clinical Assessment Service (CAS) has been implemented across Humber and North Yorkshire since December 2020. When a person calls NHS 111 with an urgent care need, instead of NHS 111 having to advise them to attend their local Emergency Department, the caller can instead be passed onto the Clinical Assessment Service (CAS) for clinical review conducted by a group of GPs. The clinicians work in conjunction with NHS 111 to perform virtual assessments and wherever possible re-direct callers to a different service, avoiding the need for them to go to ED. Since the service has been in place around 70% of callers passed through from NHS 111 have been able to be access an alternative service, helping them to avoid an unnecessary trip to the Emergency Departments and many hours of waiting in ED waiting rooms.

The primary aim of the Clinical Assessment Service is to ensure that patients receive the right care, in the right place first time. It also helps by reducing A&E attendances, reducing waiting times, and making it easier for people to get to the service they actually need and spend less time waiting in inappropriate services. Being able to receive earlier clinical assessment also improves safety for patients.

The service has been reducing ED referrals significantly – with 70% of 111 callers who would otherwise have gone to an ED having their needs met a different way – and the initiative aims to sustain this current rate. There are other knock-on benefits to this including, reduced impact on the environment through reduction in overall travel, and improved infection control as assessment can determine clinical risk prior to ED attendance and help to reduce the number of people crowding in waiting rooms.

The CAS ensures consistent support is provided at weekends when Emergency Departments are often under increased pressure due to fewer mainstream services being available. It is an important addition to the urgent and emergency care service offer across Humber and North Yorkshire and will support us to deliver our overall aim of ensuring everyone can access the right care, in the right place, first time.
2-hour Urgent Community Response Service
People in our communities who are frail, particularly those who recently returned home from hospital, are at a much higher risk of attending a hospital Emergency Department and being admitted into hospital in an emergency situation.

To help these people to stay well and avoid hospital wherever possible, partners across Humber and North Yorkshire have been developing the 2-hour Urgent Community Response Service (2UCR). 2UCR – a national initiative and a key element of Ageing Well – is a service for adults, aged over 18 with a medical or social care crisis (excluding mental health), who if not seen within 2 hours are likely to need to attend an Emergency Department and potentially an unplanned admission to hospital. Across the Humber and North Yorkshire, services were rolled out in October 2021, in line with national guidance.

In addition to a 2-hour response, as of 1st April 2022, services are expected to provide care for up to 2 days – e.g., to stabilise and provide wrap around care to prevent an admission. This service is now in place across each ‘Place’ (local authority area) across Humber and North Yorkshire, some delivered in partnership with social care colleagues, providing support for up to 2 days.

The service is structured slightly differently in each locality across the Humber and North Yorkshire to best meet local needs. Across Hull and the East Riding of Yorkshire, for example, the 2UCR service is offered, from 8am to 8pm 7 days per week. The service is led by three community-based Consultant Geriatricians, supported by GPs with Enhanced Roles (GPwER) and a full multidisciplinary professional team.

To date over 90% of calls to the service are made by paramedics on site within patients’ homes (including care homes). The vast majority of patients who access 2UCR are frail and there are clear links to social deprivation and recent hospital admissions. Data around the service is recorded so that demand, activity, reasons for referral and treatment can accurately be analysed.

Dan Harman. Consultant Community Geriatrician,
Strategic Clinical Lead for Frailty, Humber said:

“Urgent Community Response has been a really useful system initiative that has allowed us to deliver urgent clinical care in the patient’s preferred place of care. It has required providers to work collaboratively in terms of service redesign and has facilitated service integration across multiple provider organisations. Feedback from paramedics has been really positive and conveyance rates from ambulance dispatches to patients in crisis are consistently low. As a specialist frailty service, it has also allowed us to trial technological solutions such as point of care testing and virtual stethoscopes. Working collaboratively has helped to create clinical and operational pathways which will enable the roll out of future initiatives such as Virtual Wards.”
What the public are telling us - Urgent and Emergency Care insight
Healthwatch Enter and View Report
To inform our work to improve urgent and emergency care services, we asked Healthwatch – the independent champion for people who use health and social care services – to help us by gathering insight into how and why people access urgent care through our Emergency Departments (ED) in Hull, Scunthorpe and Grimsby.

Healthwatch used their power to ‘Enter and View’ services and conducted 11 ‘Enter and View’ visits throughout November 2021. They sought to listen to patients’ stories in order to understand their journey and experience and provide a qualitative report to support the Humber Acute Servies programme in designing hospital services for the future.

The aim of the engagement was to understand:
  • Why patients have come to their local ED.
  • Whether patients were aware of alternative options for treatment.
  • What the experience was like for patients when using ED services and how the service provided could be improved in the future.

Click here to read the report


The report provides a summary of issues and recommendations from Healthwatch based on listening to the experiences of 153 people across the three Emergency Departments.

The Humber Acute Services programme welcomes the work Healthwatch has undertaken, and the insights provided. Whilst some of the issues raised within the report are not within the scope of the programme, we are working closely with colleagues across the Humber to design ‘out of hospital’ services that are fully integrated with and support new models of care for acute hospital services and will be taking into account the feedback and suggestions in our long-term planning as we work together to design services for the future.
click here to read the report
Can you help?
We have been listening to feedback and ideas from people across the Humber over the past 18 months and these have really helped to influence our emerging ideas.

As we develop these ideas for how services could look in the future, we will be continuing to reach out to particular groups within our community, to help us better understand how they may be impacted by any potential changes to acute hospital services. Throughout our work we are seeking to listen to all communities and individuals and reduce health inequalities in the Humber area.

The groups we would particularly like to engage with include:
  • People living with serious and enduring mental illness
  • People living with poor mental health, including parents and carers.
  • Adults and children with learning disabilities or difficulties, including parents and carers.
  • People from black, Asian or minority ethnic backgrounds
  • People who identify as LGBTQ+
  • People affected by homelessness.
How can you help?
  • Do you work with or support any of these groups, or know someone who does?
  • Do you know of any pre-existing groups we could attend?
  • Would you like to be involved and represent the voices of the people you work with?
If you answer 'yes' to any of the above, then please click here to register your interest in hosting or supporting a focus group or other engagement activity over the coming months.
Your Questions Answered
Community Diagnostic Hubs
Question:
How will the Community Diagnostic centers be staffed? If staff from the department cover these hubs this will surely impact our current services with the hospital unless more are recruited.

Answer:
Within the Community Diagnostics Programme we are working with our clinical and managerial experts to understand what the staffing requirements will be for each service element in the new Centres. We are carefully considering how we can facilitate the proposed changes in service delivery without impacting upon current provision.

Our plans will take account of the need to move some planned diagnostic activity out of the acute (hospital) setting and to create additional activity overall. Changes will happen over a period of time, in a planned way and arrangements may vary by diagnostic modality and service location. New centres need to be planned, built and equipped and this will not happen overnight. As we undertake the planning process, we will develop workforce plans to reflect the short, medium and long term requirements of the programme. We recognise the need to be sensitive to the impact of any potential future change to our existing workforce. We will therefore engage in appropriate conversations about this with any affected staffing groups to establish a shared and realistic view about the rate at which we can develop our workforce, both in terms of recruiting additional staff and upskilling existing staff.

Work that we are doing in partnership with local universities, school and colleges to develop career pathways and new roles will support our longer-term ambitions to increase the diagnostics workforce.We should emphasise that – in addition to improving access and experience for our patients – a key objective of the programme is to improve training and career opportunities, professional experience and the working environment for all staff working in diagnostic services.

Question:
Are the diagnostic hubs including provision for children of all ages?

Answer:
We are at an early stage of planning and have not yet defined all of the services that will be provided in the Community Diagnostic Centres. However, our aim is to improve access to diagnostics and related services for both children and adults. The provision of diagnostic services in all of the new Centres will be considered as part of the planning process and has potential to be included where this will add value to communities and improve access to services. Your feedback is really helpful and has been shared with the planning team for their consideration as they continue to develop plans for community diagnostics provision across Humber and North Yorkshire.
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Ask A Question
You can ask a question about any aspect of the programme at any time by using the online question portal or by sending an email.
Humber and North Yorkshire Health and Care Partnership Annual Report 2021/22
The annual report sets out some of the key successes and achievements from the Partnership and our programmes during the past year, as well as some priorities for this year. A copy of this report is available on the Humber and North Yorkshire Health and Care Partnership website by clicking here.
Read again
We launched our revamped Humber Acute Services programme newsletter in July 2021. Each newsletter includes a range of information about the programme and you can access previous editions by clicking the links below:
For any enquiries, please email: hasr@humberandnorthyorkshire.org.uk
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