Response to NHS England and Improvement’s consultation on transformation of urgent and emergency care : models of care and measurement

This is the RCPCH's response, with the Association of Paediatric Emergency Medicine, to a consultation from NHS England and Improvement on proposals to replace the 4-hour target for care in emergency departments.NHS England and Improvement published a report that described a range of developments across the urgent and emergency care (U&EC) pathway, including a broader role for NHS 111. The consultation focused on the proposal to replace the four-hour standard in emergency departments with a bundle of measures across U&EC settings. Some measures are already collected, some are new and have been piloted in a small number of field test sites in 2019/2020, others have yet to be tested.The measures proposed were:A. Response times for ambulances B. Reducing avoidable trips (conveyance rates) to Emergency C. Departments by 999 ambulances D. Proportion of contacts via NHS 111 that receive clinical input E. Percentage of Ambulance Handovers within 15 minutes F. Time to Initial Assessment – percentage within 15 minutes G. Average (mean) time in Department – non-admitted patients H. Average (mean) time in Department – admitted patients I. Clinically Ready to Proceed J. Percentage of patients spending more than 12 hours in A&E K. Critical Time StandardsFor paediatrics and child health, NHS England indicated that data within the bundle of measures will be disaggregated by age, allowing children and young people’s experience of U&EC to be measured. The proposals also commit to developing paediatric measures within the Critical Time Standards.This is part of a wider piece of work led by the NHS Medical Director to review clinical access standards in a range of settings (emergency care, cancer, referral to treatment, mental health). Recommendations from the RCPCHThese developments are to be welcomed but in its response the RCPCH makes clear that the new bundle of measures can be improved by:I. Reflecting and reporting children and young people's experience of U&EC. This means ensuring data for each measure is disaggregated for CYP, introducing paediatric critical time standards, and engaging with CYP and their families to understand their needs.II. Reflecting the U&EC pathways that children and young people use. This means expanding coverage to parts of the U&EC pathway that are not currently featured - such as short stay paediatric assessment units (SSPAUs).III. Being easy to understand, use, report against, and analyse. This means further work is needed to define each measure clearly, and in a way that easy to capture so that resources are not diverted from the frontline to meet reporting requirements