1. Insights on emergency care
Nigel Edwards, Nuffield Trust

2. 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

4. Report title

5. 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

6. Delayed transfers – tip of an iceberg

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

8. 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

9. 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

10. 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