The National Picture Mike Griffiths General Manager Emergency Services & Critical Care

1. The National Picture • Mike Griffiths • General Manager • Emergency Services & Critical Care

2. NATIONAL PERSPECTIVE • 21million attendances last year went to A&E or Urgent Care Centre (UCC) • 18% increase in A&E activity between 2003 and 2011 • 40% rise in admissions between 2003/4 and 2011/12 • Rise in people presenting with Long Term Conditions (LTC) and older adults with an increase in emergency readmissions • Difficulty discharging patients into appropriate care outside of hospital • Acute providers failing to achieve the four hour access target • Efficiency drives has seen a reduction in beds with increased occupancy over 90% • Failures in other parts of the system –Out of Hours

3. The cost of managing the demand • Emergency Department spending on average £600,000 on locums totalling £120million a year • Increased clinical staff, including 4,300 more doctors since 2010 “£500m bailout to NHS as A&E on brink of collapse” “The NHS is to be given a £500m bailout to Accident & Emergency departments across England after warnings that the system is on the brink of collapse”

4. “A prescription to the future” • Spring 2013 RCP, NHS confederation, College of Emergency Medicine and SAM set out 10 point vision for addressing the challenges • Alternatives to hospital • Financial incentive to support the demand of Unscheduled Care • Supporting patients to leave hospital 7 days per week • Consultant led services across 7 days • Greater collaboration within the hospital and community – e.g. mental health • Sufficient capacity both beds and staffing to meet the demand • Focus on ambulatory pathways • Developing a sustainable workforce • Show Leadership • Focus on public health and preventative health strategies

5. FRONTLINE CHALLENGE • GMC survey in April 2012 found:- • Lack of supervision during weekdays & OOH • Doctors in training working beyond their competence • Poor quality of locum doctors filling rota gaps • College of Emergency Medicine in 2012 found :- • 117 doctors applied with a view to emergency medicine training, 115 were offered places – 61 accepted. Second lowest acceptance rate of speciality An interim report by the emergency medicine taskforce, which includes BMA and medical royal college representatives, recommends: • Developing routes into emergency medicine training from other specialties • Ensuring trainee numbers are matched with consultant workforce expansion.

6. URGENT & EMERGENCY CARE REVIEW • Professor Willett & the medical director for NHS England, Professor Sir Bruce Keogh, will publish their plan for reforming emergency services later this autumn. It is expected to be implemented two years from now. • The plan will acknowledge that demand for care will continue to rise with an ageing population. But it will set out a series of measures for reducing pressure on A&E departments. • They are expected to include: • A&E units will have to ensure a consultant is available seven days a week • Other senior doctors, such as elderly care specialists, will be expected to help assess and treat patients arriving at A&E • Paramedics will treat more patients at home or by the roadside so they don't need hospital care • Patients will be encouraged to 'ring first', using the NHS111 helpline to be directed towards appropriate care

7. STATE OF EMERGENCY ? • Today is important because :- • Sharing good practice • Promoting & ensuring new and innovative ways to deliver efficient services • Demonstrating leadership • Planning for Urgent Care Review recommendations Ensures we provide the right care in the right place, by those with the right skills, the first time

8. Any Questions ? Thank You