Service reviews (formerly AHP) - Review of urgent and emergency care 2007/2008

For full details, including how the review will be carried out and the actions which trusts need to take now, see the document available via the link below:

Introduction to the Urgent and Emergency Care review revised 02/08/07 (pdf 77kb) (opens new window)

A&E audits in conjuction with the BAEM/CEM

What is a ‘service review’?

A service review is an in-depth assessment of the performance of NHS organisations in delivering services relating to particular aspects of healthcare. The main aims of the Healthcare Commission’s programme of service reviews are to provide accountability and assurance to patients and the public that services are of high quality and give value for money and to help trusts improve services for patients and obtain better value for money. Service reviews are carried out where an aspect of health or healthcare is of importance across the country and where there are opportunities for healthcare organisations to make substantial local improvements.

Service reviews draw on the methods and experience gained from previous reviews carried out as part of our acute hospital portfolio, which focused on assessing the performance of acute trusts, as well as our programme of improvement reviews. Service reviews are part of the annual health check, but no longer contribute to the annual performance rating that we produce for individual trusts. The scores for each review are now published independently.

Why review urgent and emergency care services?

Urgent and emergency care covers a number of important services, from life-saving treatment for people who suffer strokes, heart attacks or other serious medical conditions, to providing care, advice and reassurance to people with a wide range of other problems and concerns. They provide support to many people each year – during 2005/2006 ambulance services received six million emergency calls, almost 18 million visits were made to accident and emergency (A&E) departments, and over 10 million calls were made to out-of-hours GP services.

While there have been improvements in the range and responsiveness of many urgent and emergency care services, there are still many concerns. Our work has highlighted significant regional variations in the quality of services across England, as well as variations in how well different services make use of the resources they receive. Demand for urgent and emergency care services continues to rise. For example, the number of emergency calls to ambulance services rose by 6% in both 2004/2005 and 2005/2006, while category A (life threatening) calls rose by 10% in 2004/2005 and by 30% in 2005/2006. Consultation with the public shows that many people are confused about what services are available to them and how and when they should access them.

Government reforms have focused on urgent and emergency care for some time, and have included the introduction of new services, new ways of working and changes to the organisation and responsibilities of PCTs and ambulance trusts. These services also have an important role in delivering Government priorities for healthcare services to be available close to people's homes and for improving the care of people with long term conditions (as discussed in the consultation document Direction of Travel for Urgent Care published by the Department of Health in October 2006).

The review of urgent and emergency care services will provide an opportunity to see what impact these changes are having on the experiences of patients and what progress is being made towards their aims. It will also enable us to update our previous review of accident and emergency services (published in August 2005) and will provide important and useful information for trusts to address the issues raised in Direction of Travel for Urgent Care.

What is the scope of the review?

The review will look at urgent and emergency care from the point that the need for care is identified up to the point that this need is resolved, for example, through treatment, reassurance, or admission to hospital. It will also look at what measures are put in place for follow-up care once the need for urgent care has been met (for example, arranging for a falls assessment for an older person who has fallen at home).

The review will focus primarily on:

urgent primary care services (in-hours and out-of-hours)
ambulance services
accident and emergency services (including children’s A&E services)
urgent care centres – including minor injury units and walk-in centres

It will not look in detail at stand-alone or specialist services such as crisis resolution in mental heath, urgent sexual health or maternity services, specialist A&E departments (except Children’s A&E services) or at the delivery of urgent social care. However it will look at the links between these services and the main services listed above.

Which trusts is the review relevant to?

The review includes:

all PCTs
all ambulance trusts
acute trusts (including foundation trusts) which operate general or children’s A&E departments and/or urgent care centre

What do we mean by ‘urgent care centre’?

The term ‘urgent care centre’ is used to refer to walk in centres, minor injury units and other similar facilities. For the purposes of this review, it is used to refer to units that meet all of the following criteria:

they provide unscheduled care (i.e. care which does not require a booked appointment)
their patients do not need to be registered with them· they open outside usual office hours (but are not open only out of hours, as these centres, usually called primary care centres, will be picked up as part of out-of-hours GP services)
they have a reception and clear point of access for walk-in patients
they have over 50 attendances per week

How was the review developed?

The Healthcare Commission, working with a range of local and national stakeholders, developed the review between December 2006 and July 2007. The framework for the review consists of 10 questions grouped under three areas. A set of indicators has been developed under each of these questions, which aims to give an overview of the performance of the relevant urgent and emergency care services.

Since February 2007 we have been working with a number of local services to develop and test the framework and indicators. The draft performance framework for the review was then discussed with the review's advisory group, which includes representatives from a range of national organisations. This framework was also discussed with representatives from a number of national patient groups at a workshop in June 2007, and we have also conducted further research with people from ‘hard to reach’ groups and those at most risk to feed into the framework for the review and the national report.

How will services be assessed?

The objectives of the review are to

produce a clear, credible and objective assessment of the quality and value for money of local urgent and emergency care services across each PCT area in England
support improvement in the performance and value for money of urgent and emergency care services
highlight key national issues in urgent and emergency care

The main output from the review will be the assessment of the quality and value for money of local urgent and emergency care services across each area in England, which will include a summary score for these services. The choice to assess services at this level recognises the interdependence of urgent and emergency care services and the growing need for them to work together in an integrated way.

This score is intended to provide assurance to patients and the public about the quality of services and act as a basis for identifying areas for local improvement. It will be backed up by a range of detailed indicators, including information about each of the main services providing urgent and emergency care. While the assessment is part of the 2007/2008 annual health check, its results will not contribute directly to the performance ratings for 2007/2008.

The performance framework for the review, along with examples of the indicators it will use, is included in Appendix B. of the introduction document available via the link above.

Some of the indicators will form part of the scored assessment and others will provide benchmarking and context data.

What will the review produce?

The scores for each area will be published and all relevant trusts will receive a summary report on their performance to help identify areas for improvement. We also intend to produce databases of indicators for ambulance services, A&E departments, out-of-hours services (at the PCT level) and urgent care centres.

Most trusts will use the data analysis and benchmarking tools to look at their own performance. However further work and support may be needed in a small proportion of poorly-performing or struggling trusts. A national report will be published to summarise the results from the reviews and a detailed database of the indicators used in the review will be released to trusts, along with computer software tools to aid benchmarking and analysis.

For full details, including how the review will be carried out and the actions which trusts need to take now, see the introduction document availble via the link above:

Data collection guidance and forms

Data collection forms are open until 8pm on 3rd April 2008. These can be accessed via the link below using your username and password.

http://forms.healthcarecommission.org.uk/Login.asp (opens new window)

Please click the links below to access the data collection guides for the review.

Guide for PCTs, Acute Trusts and GP out-of-hours services (pdf 66kb) (opens new window)

Guide for Ambulance Trusts (pdf 46kb) (opens new window)

In order to help trust and unit leads prepare for the data collection, we are releasing the Excel files which list the final data collection questions alongside this guidance. These forms are available on the links below.

These replicas are made available to ensure that leads have a printer friendly version of the form that could be used for off-line discussions and possibly for off-line collation of some of the data. They should not be completed.

PCT form (for local use only) Revised 12/11/07 (xls 299kb) (opens new window)

OOH Form (for local use only) Revised 12/11/07 (xls 428kb) (opens new window)

AE and UCC form (for local use only) Revised 12/11/07 (xls 410kb) (opens new window)

AE and UCC Supplementary guidance Revised 05/12/07 (pdf 59kb) (opens new window)

These forms have been updated from the versions released on 10th October to reflect the final version of the web-based data collection forms