Urgent and Emergency Care (UEC) vanguards aim to improve the quality, efficiency and effectiveness of UEC services. The three Southern Cluster UEC vanguards have made progress across core activities. Vanguard funding, status, leadership and practical mechanisms to support joint working have driven progress. Public engagement, workforce capacity and data interoperability challenges will need to be addressed for longer-term impact at scale.

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Transforming Urgent and Emergency Care and the Vanguard Initiative

Learning from Evaluation of the Southern Cluster

by Sonja Marjanovic, Bryn Garrod, Talitha Dubow, Emma Pitchforth, Catherine A. Lichten, Julian Elston, Emma Harte, Jon Sussex, Miaoqing Yang, Fahd Malik, et al.

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Research Questions

  1. What are the impacts of the three UEC vanguards?
  2. What were the processes underpinning delivery and impact, and associated enablers and challenges?
  3. What does the learning about their progress and experiences imply for future practice and policy (including any insights pertaining to scalability, sustainability and replicability of the vanguard models and vision for UEC service improvement)?

Urgent and Emergency Care (UEC) vanguards aim to improve the quality, efficiency and effectiveness of UEC services so that patients receive the most appropriate care at the right time and in the right place, and so that unnecessary admissions to accident and emergency (A&E) and hospitals are reduced. The Southern Cluster comprises three such UEC vanguards. RAND Europe's evaluation examined the impacts of the vanguards, the processes underpinning delivery (and associated enablers and challenges), and implications for future policy and practice.

The evaluation used a multi-method approach, including theories of change, document review, workshops, interviews, surveys and data dashboards.

The Southern Cluster UEC vanguards have made progress across core activities. Clinical hubs are operational across the sites. Direct booking capacity into primary care is progressing more with out-of-hours than with in-hours services. Gradual but variable progress has been made towards joint planning and governance of UEC services. Efforts to ensure seamless data sharing between providers, and interoperable IT infrastructure are progressing somewhat slower than originally hoped.

Vanguard funding, committed leadership and practical mechanisms to support joint working helped drive progress. Public engagement, workforce-capacity and data interoperability will need to be addressed for longer-term impact at scale.

Our report makes recommendations concerning: (i) UEC health and care workforce capacity-building, (ii) local-national coordination around UEC transformation, (iii) collaboration across localities and professions, (iv) support for an end-to-end UEC pathway with mutually reinforcing activities, (v) cost and outcome data, (vi) an interoperable data infrastructure, and (vii) capacity for evaluation and learning.

Key Findings

Delivery on overarching aims

The three Southern Cluster UEC vanguards have each been pursuing ambitious goals to transform the UEC landscape in their regions and provide more efficient and effective services. Despite a reduction in originally anticipated resources for vanguard activity, progress has been made across core activities.

  • Clinical hubs are operational across the sites.
  • Direct booking capacity into primary care is progressing more with out-of-hours than with in-hours services.
  • Gradual but variable progress has been made towards joint planning and governance of UEC services.
  • Efforts to ensure seamless data sharing between UEC providers, and an interoperable IT infrastructure, are progressing somewhat slower than originally hoped.

Other areas of progress relate to site-specific developments.

Drivers of progress

  • Vanguard funding and status had a positive catalytic role in pump-priming activities and assisting the pace of transformation efforts; it provided 'permission' and a 'space to innovate' in approaches to improvement.
  • Committed leadership across professions and organisational levels and practical mechanisms to support joint working and interaction have helped support the vanguard vision and nurture increased trust between some providers.
  • Despite examples of effective public engagement informing the design of the Southern Cluster UEC vanguards and supporting awareness raising about service options, the sites recognise a need for greater attention to this space in future efforts.
  • Ensuring a critical mass of diverse health and care professionals supporting NHS 111 and the clinical hub remains a challenge.
  • Data infrastructure and interoperability challenges will need to be addressed for longer-term impact at scale.

Recommendations

  • Establish new incentives, skills and accountabilities in the health and care workforce
  • Coordinate more closely between local and national efforts
  • Nurture and further strengthen collaboration between stakeholders and across professional groups, including with the public
  • Consider how vanguard activities can support an end-to-end UEC pathway, securing a whole that is more than the sum of its parts
  • Improve availability of cost and outcome data to facilitate a robust business case for future scalability and sustainability
  • Reinvigorate efforts to secure physical and relational resources for an interoperable data infrastructure
  • Strengthen evaluation and learning capacity

Table of Contents

  • Chapter One

    Evaluating Southern Cluster UEC vanguards: Context, aims and approach

  • Chapter Two

    Barking and Dagenham, Havering & Redbridge Urgent and Emergency Care vanguard

  • Chapter Three

    South Devon and Torbay Urgent and Emergency Care vanguard

  • Chapter Four

    Cambridgeshire and Peterborough Urgent and Emergency Care vanguard, including its Mental Health Crisis Response

  • Chapter Five

    Reflecting on progress and impact, associated enablers and challenges and implications for the future

  • Chapter Six

    Looking to the future: reflecting on the scalability and sustainability of the vanguard model and recommendations for sites

  • Appendix A

    Barking and Dagenham, Havering and Redbridge CCG vanguard logic model, key progress and recommendations

  • Appendix B

    South Devon and Torbay CCG vanguard logic model, key progress and recommendations

  • Appendix C

    Cambridgeshire and Peterborough CCG vanguard logic model, key progress and recommendations

  • Appendix D

    Cambridgeshire and Peterborough mental health crisis response logic model

  • Appendix E

    Interview protocol

  • Appendix F

    Survey results for South Devon and Torbay CCG

  • Appendix G

    Survey results for Cambridgeshire and Peterborough CCG

  • Appendix H

    The Bigger Picture: Aggregates of Cambridgeshire and Peterborough, and South Devon and Torbay

  • Appendix I

    Health economic analysis of the Consolidated Channel Shift Model

Research conducted by

The research described in this report was conducted by RAND Europe.

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