NHS plan to cut avoidable admissions to further boost efforts to reduce waiting times

NHS hospitals are being encouraged to refer more patients directly to virtual wards where they can receive treatment from the comfort of their own home, while freeing up hospital beds for the sickest patients.

More people suffering from respiratory conditions or heart failure are set be treated through an intravenous drip or a nebuliser – a machine that turns liquid medicine into a mist that can be easily inhaled – from home, instead of needing to be cared for in hospital. While more people living with frailty are also set to benefit from the virtual ward programme.

It comes as the largest evaluation of the effectiveness and benefits of virtual wards found one non-elective hospital admission could be avoided for every 2.5 virtual ward admissions.

It found that if the South East virtual ward model is scaled up across England, 178,000 admissions could be avoided over the next two years according to NHS analysis.

The enhancement of the virtual ward programme forms part of an NHS England letter to every local hospital and health system in the country, setting out evidence-based actions to continue to boost urgent and emergency care performance in the year ahead.

For the first time ever, funding incentives will include 12-hour A&E waits, with hospitals asked to focus on ensuring that patients don’t wait beyond this timeframe.

National guidance, backed by £150 million, will focus on helping patients to avoid an A&E admission in the first place, with patients admitted to virtual wards straight from home and measures to support regular A&E attenders who don’t need urgent care to get the help they need.

The updated framework also sets out how local areas can allow direct referrals by GPs and 999 to same day emergency care, which sees patients receive timely diagnosis, care and treatment while avoiding an overnight stay.

The plan builds on last year’s improvements in performance thanks to the Urgent and Emergency Care Recovery Plan, which saw the first improvement in the proportion of patients seen within four hours in A&E since 2009, outside of the pandemic.

NHS national director for urgent and emergency care, Sarah-Jane Marsh, said: “Thanks to the hard work of NHS staff, last year saw considerable progress in the recovery of urgent and emergency care services with the first improvement in A&E performance outside of the pandemic in nine years, and Category 2 ambulance response times 17 minutes faster than the year before, all despite a record year of demand for A&E and ambulance call-outs.

“However, it is clear there is still much further to go and with the rollout of ambitious new measures like more direct referrals to same day emergency care, more ‘step-up’ virtual wards, and targeted support for patients who regularly attend A&E, we are confident this plan can deliver further improvements for patients and continue to bring down the longest waits for care.”

Minister for Urgent and Emergency Care Helen Whately said: “Last year, we started planning for winter earlier than ever before and that plan worked.

“We got A&E waits down and ambulances to people quicker – and over 200,000 more people received NHS same day emergency care. That was thanks to the hard work of our NHS and social care staff, and by doing things differently to improve care.

“We’re learning from what worked to do better again this year, like helping people get home sooner when they are well enough to leave hospital and preventing people needing to go to hospital in the first place.

“We’re making our health service faster, fairer and simpler, and urgent and emergency care is at the forefront of that.”

Other actions from the UEC letter include:

• Clinical assessment of 111 and 999 calls to direct patients to the best service for them
• Frailty assessments at the A&E front door to identify patients over 65 who may need access to specialist clinicians
• More flexibility for urgent and emergency care staff to boost retention and increase capacity

Last year, NHS staff worked hard to recover urgent and emergency care services with the first improvement in the proportion of patients seen within four hours in A&E since 2009, outside of the pandemic, and an average category 2 ambulance response time 17 minutes faster than the year before. An improvement in ambulance handovers outside hospital meant a 40% reduction in ‘lost’ hours on the road.

This year, two new targets have been set to improve waiting times further, with the aim of ensuring 78% of patients are treated, admitted, or sent home from A&E within four hours by March 2025, and ambulances get to Category 2 calls within an average of 30 minutes this year.

As well as those targets, this year, working with colleagues in social care and local authorities, hospitals will focus on reducing the number of 12 hour waits in A&E, particularly for mental health patients, alongside going further on reducing ambulance waits outside hospitals, sending people home sooner, and keeping the high levels of bed capacity delivered this winter with an average of 99,500 beds to be open each day across the year.

The chief executive of NHS Providers, Sir Julian Hartley, said: “Trust leaders and their teams are working hard to deliver urgent and emergency care against a backdrop of unprecedented pressure on ambulance services and emergency departments. Driving down long waiting times for patients rightly remains a top priority for leaders across hospital, mental health, ambulance and community services and their health and care partners.

“It is right that the next phase of the urgent and emergency care recovery plan focuses on rolling out successful initiatives to help reduce waits, improve care and ensure patients are seen in the right place, at the right time, according to clinical need. From financial incentives across the whole system to help reduce the longest A&E waits, better data on total ED waiting times and targeted support for the trusts that need it, to greater use of same day emergency care and virtual wards, every avenue should be explored to enable trust leaders and their teams go further and faster in caring for their patients.”

Director of the NHS Confederation’s Acute Network, Rory Deighton, said: “The NHS has been working incredibly hard to care for patients in the face of rising demand, industrial action and an ongoing shortfall in social care funding.

“We welcome the focus on 12-hour waits in the plan. We also welcome the subtle shift in focus away from hospital discharge to a greater focus on supporting people to stay healthy in their communities and avoiding hospital admission.

“The commitment to keep the 5,000 extra beds opened this winter is sensible, but we need to know what resources will be available for NHS leaders to keep these beds open, and at the same time continue to improve performance.”

Chair of the Association of Ambulance Chief Executives (AACE), Daren Mochrie, said: “AACE and its members welcome the publication of year two of the NHS urgent and emergency care recovery plan and its ask of systems to bring together in one place what we know works in support of the planning guidance requirements. In the context of the publication, we ask that commissioners and integrated care system partners continue to support NHS ambulance services in maintaining the capacity expansion delivered in 2023/24.

“We know that this, alongside initiatives such as a sustained commitment to reducing hospital handover delays, will lead to the improved wellbeing of our people, faster response times for patients and ultimately, more lives being saved.”

President of the British Geriatrics Society, Professor Adam Gordon, said: “We are particularly pleased to see the focus on frailty assessments at the front door, which brings the expertise into Emergency Departments and Admission Units which is needed to support people with the most complex care needs.

“This approach is feasible through careful redeployment of existing teams.  It helps more vulnerable patients start treatment sooner and can, in many instances, help people get out of hospital with appropriate care days earlier.”

The updated Urgent and Emergency Care framework is available online here.

A summary of the South East virtual wards evaluation, carried out by PPL, can be viewed online here.