Simon Lucas, Livi UK managing director, explores how the emergency care landscape has transformed over the past 20 years the role of digital solutions in relieving system-wide pressures
Continued adoption of technology will prove vital in relieving pressure on A&E departments
The past two decades have seen walk-in centres steadily evolve into what are now more systemically known as urgent treatment centres (UTCs).
But, throughout all the changes we have seen over the last two decades, the goal has remained the same − to reduce pressure on A&E departments.
Some of the biggest changes, of course, have come in recent times during the COVID-19 pandemic when, almost overnight, we saw the widespread adoption of digital clinical tools to facilitate patient access, reduce overcrowding, and prevent the spread of infection.
As the NHS navigates enormous post-pandemic challenges, using digital technology to deliver safe care and reduce overcrowding will be essential
Fast-forward two years following a nationwide vaccine programme, and the same digital tools we relied on during the pandemic continue to support providers grappling with capacity challenges and unprecedented levels of pressure on A&E.
With many of the demand pressures the system faces today, it can be tempting to view the past through rose-tinted glasses. But were the ‘good old days’ really as good as we like to remember?
In short, the answer is no.
Many of the challenges we face today were present 20 years ago, too.
In the 2000s, walk-in centres were widely adopted across the NHS, with more than 200 opening across England.
This was the result of a strategy to improve primary care access, modernise the NHS, and offer more choice to patients.
However, between 2010-2013 more than 50 walk-in centres closed, with many commissioners citing funding pressures as a reason.
“We are spending far too much money on treating people in walk-in centres and A&E with primary care-type conditions which could be managed by the GP practice,” noted Barking and Dagenham CCG at the time on its decision to close a centre.
Another commonly-cited reason for the closure of the first wave of walk-in centres was their failure to fulfil their very raison d'être − reduce A&E attendances.
In fact, some walk-in centres were contributing to the fragmentation of care as they were not set up to refer patients onto secondary care services.
And, as a result, commissioners started to reconfigure walk-in-centre services within, or alongside, A&E departments in a bid to reduce patient attendances and waiting times, adopting a more-integrated approach.
These reconfigured services weren't without their challenges though as well.
Indeed, it was estimated in 2019 that up to three million people attending A&E each year could have had their care needs met elsewhere in the urgent care system.
So why weren’t they?
One significant reason noted by NHS England was patient attendance at A&E by default, stemming from the sheer breadth of urgent care services on offer.
It took a pandemic to accelerate the adoption of digital solutions, but now the value of technology has been realised, there is no going back
With walk-in centres, urgent care centres, minor injury units, and many other centres in operation, some patients were simply visiting A&E out of confusion.
To address this, UTCs were introduced to bring clarity and commonality of service.
UTCs were announced in 2017 with a service specification to be fully adopted by 2020 as part of a consistent local ‘integrated urgent care service’, which included the option to book UTC appointments via NHS 111.
The COVID-19 pandemic precipitated another evolution in 2020 when social distancing restrictions meant physical appointments across the NHS had to be avoided wherever possible to limit overcrowding and cross infection.
Like so many NHS services, most urgent care systems began operating a digital policy, with some positive outcomes – for example, the rollout of home pulse oximetry ‘virtual wards’ to carefully monitor COVID-positive patients who were at risk of deterioration.
We also saw the establishment of the COVID Clinical Assessment Service within the 111 pathway, which included the ability to consult with patients over video in many parts of the country.
Certainly, the pandemic illustrated that not every person who visits a UTC always requires face-to-face assistance.
When this is the case, digital appointments can help reduce pressure, freeing face-to-face clinical time for patients who need it most.
Indeed, at Livi, we have been able to support a number of urgent care systems to reduce the pressure on physical services by safely and effectively treating patients remotely.
This is vital at a time when urgent care systems face increasing challenges.
Total emergency care attendances across England in August 2022 reached 1,988,779, representing an increase of 117% from April 2020.
Technology in healthcare isn’t just a COVID novelty, it’s essential to support a more-sustainable future for the NHS
And the BMJ reports that England had at least 4,519 excess deaths in 2020-21 as a result of overcrowding and stays of 12 hours or longer in emergency departments.
As the NHS navigates enormous post-pandemic challenges, using digital technology to deliver safe care and reduce overcrowding will be essential.
One solution is to partner with a remote service provider to add clinical capacity and ensure patients are seen in the right setting at the right time.
It’s exactly how we’re working with our urgent care partners, supporting NHS 111 and clinical assessment services (CAS) as well as managing cases from emergency departments (EDs) that can be treated remotely.
Taking our CAS work as an example, we focus on building optimal pathways between urgent and primary care.
Through one of our partnerships in Sussex, we helped to prevent 5,000 ED attendances, protected over 1,000 clinical hours, and exceeded the consult-and-complete target by 12% in just five months during the busy winter period.
It took a pandemic to accelerate the adoption of digital solutions, but now the value of technology has been realised, there is no going back.
Trusts that have embedded digital into their systems are seeing the benefits.
Technology in healthcare isn’t just a COVID novelty, it’s essential to support a more-sustainable future for the NHS.