Reforming Emergency Care of the NHS - Case Study Example

Healthcare industry debate focuses on health care service provision. Hospitals are concurrently the most complex of all powerful organisations as they exist in turbulent environment. This is because they deal with matters of life and death and at the same time address customers’ needs. It is therefore important to recognise and reflect upon the above issues since they illustrate the heart of a matter that heath care providers need to address regardless of the reforms originating from the government. In a nut shell, management must continuously improve the quality of relationships within teams as well as communication dynamics amongst and within these teams. This study analyses a report on Reforming Emergency Care of NHS. It starts by examining the objectives of the document and the factors that prompted these reforms. The past years, NHS trust has accomplished a sustained reduction in the time that patients take in accident and emergency department (A&E) and admission to hospitals. To a big extent, this has been contributed by improved working practices. The main objective of this is to initiate access to the right treatment by centring services on the patients and their needs. Changes within the emergency care network of the National Health Service (NHS) are needed to improve the experience and treatment of patients (Howard and Neil 1995). The plan ensures that patients do not wait too long for treatment followed by involvement and a greater choice. The other objective that NHS aims at is to improve the speed in which ambulances respond to life threatening situations the target is that an ambulance is to respond to 75 percent of emergency calls within 8 minutes. It also aims at providing a wider range of services that are appropriate to the needs of the patients such as cleaning. The other objective is to provide enough beds to patients so that those being admitted do not have to wait for long hours. Minimising cancellations of operation cases is the other objective of NHS. If these reforms are achieved, then patience will experience first class standard of service and delivery. The factors that prompt these reforms include, recruiting more A& E consultants by 40 percent. This plan will enable them to cover for patients with emergency care needs especially during busy periods. Some more 600 nurses are to be added to provide sufficient staff to ease the separation of patients with minor injuries from those with serious conditions. There are also efforts to reduce occupancy level of NHS beds from 90 to 82 percent to free up capacity and reduce cancelled operations. The problem of delays especially in discharging patients puts pressure on the provision of beds, delays emergency care as well as damaging the health of patients who prefer recuperating at home. This kind of delays is to be reduced by investing in social care services and increase the number of beds by 1000. According to Barry (2004) to improve preventative care in NHS they have to reconfigure their services and effect organisational change. The problem of competition of needs between emergency needs and routine needs is to be reduced through separating the departments and for each to have dedicated resources. To address the reform, four main challenges were identified these included, workforce, resources, organisational barriers and tribalism. Demand A&E services meant that the workforce was already stretched beyond their means to treat patients effectively and efficiently. This had increased dramatically over the past ten years. 80 percent of patients attending hospital A&E departments spent four hours waiting. The reform aimed to invest in improving ambulance responses and to provide services at night and during weekends. This aim was achieved because by the end of 2004, the maximum hours that patients spent were 4. However, there were other groups of patients who needed to spend more time for example older people. By placing those strategically within the emergency care system would help the reform to accomplish its goals. The hospital also introduced a see and treat method which saves time taken to treat one patient. They also developed new roles of speeding up access to services. Introduction of minor injury unit (MIU) being led by nurses would in turn see patients treated in the right place by the right person, resulting in a more efficient service. The idea was to see and treat patients. NHS has insufficient capacity to deal with routine and emergency care concurrently (Howard and Neil 1995). The reform planned to increase staff capacity by recruiting 183 A&E consultants and 600 nurses. This will help to separate services example for patients with minor injuries from those with serious conditions. A substantial number of patients, especially the elderly, remain in hospital needlessly while social services, community support or nursing homes are sought. This block beds needed for emergency admittance unnecessarily. This was targeted by increasing funding for Local Authorities to invest in social care. To provide an up to date, flexible delivery of service, barriers of traditional working practices needed to be modernised. The reform seeks to adopt best practice from models already in practice throughout the Country. Paramedics assessing patients was one of the introduced practices. The second procedure was to deliver emergency care to the patients’ home. The third was to treat patient with primary care needs within A&E, nurses giving appointments and lastly encouraging teamwork to improve inefficiency. In reference to the NAO report, there were shortfalls of emergency care staff required to offer a 24 hours, seven days a week responsive service. Other issues reported included the design of A&E buildings and finally is that many people could not handle the improved technology in the working practices. Their aim was to integrate the working system to work as one which was to be completed in 2006. Only 22 out of 31 Ambulance Trusts are managing to meet the targets set for them of reaching all life threatening emergency calls within eight minutes (DoH, p. 2). To secure the integration of services, authority is needed and much funding to enhance co-operation within the emergency care. However, some delays are still being seen in the availability of beds. This is brought about by poor management of admissions and discharges, delays caused by specialist’s difficulty in obtaining the right to admit patients and finally delays in accessing psychiatric beds especially in mental health (Debbie 2003). This would contribute to efficient and patient-oriented working environment. There is often competition for resources, resulting in detriment to patient’s health. Elective operations often result in cancellation due to emergency cases taking priority. In 2004 The National Audit Office (NAO) concluded that there had been a significant and sustained improvement in A&E experiences by patients. This transformation has been accomplished by improvement of working practices and funding of A&E departments. However, improvements are still required to integrate work within hospitals, and health and social services. Waiting times within A&E had reduced dramatically; however, the elderly are still prone to spend in excess of the recommended four hours in A&E prior to admission. Further work is still required by hospitals, health and social providers to manage the stream of patients. New procedures are being undertaken to triage emergency calls, resulting in alternative care pathways being sought and not all 999 calls resulting in a response with an ambulance. This is freeing up more ambulances for life threatening calls. A wider range of provisions are being made for patients appropriate needs. These include direct admission by GP’s to Medical Assessment Units, falls prevention projects, nurse led minor injury units, crisis resolution teams and occupational health therapists in A&E departments and NHS Direct. Bed blocking has reduced. However, the report did not consider the relationship within the staff. Over the past six years, I have personally witnessed considerable changes within the emergency care network. The ambulance service has made many positive steps forward to achieve the goals set by the reform. The study of the paramedic profession as a university-based discipline has been prompted by factors such as changes in primary care and thus increased use of emergency ambulance services. This reduces the number of patients visiting the hospital and thus helps to treat the right patients in the right place and at the right time thus fulfilling NHS aim. It is this reason that has made the British Paramedic Association (BPA) to propose that paramedic practitioners should have a university certificate, diploma, honors degree or a Masters degree. This will be important to maintain professionalism and patient care of high quality. For an advanced practitioner to be successfully developed, their roles need professional leadership, standardized competence, higher education and a good title. This redirects a significant number of patients away from unnecessary hospital visits and offers them a more appropriate pathway for their care requirements. At present, there seems to be very little evidence available to ascertain the effectiveness of these changes. However, I believe the changes initiated by the reform for the emergency care network has improved the experience and treatment received by the consumer and that it has increased trust status of the entire organisation. References Barry, L 2004, National Audit Office Improving Emergency Care in England, DOH, viewed on 30 April, 2010, Department of Health (DoH), 2001, Reforming Emergency Care, p. 2, Debbie, L 2003, Reforming emergency care, Journal of Perioperative Practice, Department of Health. Eileen, W 2009, Paramedic education: developing depth through networks and evidence-based research, California, USA. Howard, M & Neil, M 1995,Management objectives in the NHS, Journal Of Management in Medicine, vol.9, no. 2, MCB UP Ltd, pp. 6-13. Read More