Insights on emergency care Nigel Edwards, Nuffield Trust

Managing demand Attempts to manage demand have had limited effectiveness Opening hours vs same day appointment Public information – no impact Alternatives – can increase demand 111 has perhaps held the line but not bent the curve Diversion of patients in the A&E can help Requires senior clinicians May not solve the big problem of patients waiting

Report title

NHS 111: disposition of callers over the last 3 years Helps redirect winter demand away from emergency departments, but; Seems to send a disproportionate number to ambulances Report title

Delayed transfers – tip of an iceberg

Per cent change in days transfers of care delayed by cause from 2010/11 to 2015/16

Many more waiting 2-4 more patients waiting for every one officially declared Many of the people who can leave require other services Intermediate care audit suggests a significant deficit in these

Acute medicine and 4 hours The model for managing the acutely ill medical patient is often chaotic Too much of the system driven by the 4 hour target rather than creating flow The key role of medical registrar has become very unpopular

There is a growing body of evidence Not easy to do & hard to make it stick Does require local adaptation and learning Community services are often underpowered Questions about the model of general practice need attention