Transforming Urgent and Emergency Care and the Vanguard Initiative
Oct 16, 2017
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.
Learning from Evaluation of the Southern Cluster
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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.
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.
Other areas of progress relate to site-specific developments.
Evaluating Southern Cluster UEC vanguards: Context, aims and approach
Barking and Dagenham, Havering & Redbridge Urgent and Emergency Care vanguard
South Devon and Torbay Urgent and Emergency Care vanguard
Cambridgeshire and Peterborough Urgent and Emergency Care vanguard, including its Mental Health Crisis Response
Reflecting on progress and impact, associated enablers and challenges and implications for the future
Looking to the future: reflecting on the scalability and sustainability of the vanguard model and recommendations for sites
Barking and Dagenham, Havering and Redbridge CCG vanguard logic model, key progress and recommendations
South Devon and Torbay CCG vanguard logic model, key progress and recommendations
Cambridgeshire and Peterborough CCG vanguard logic model, key progress and recommendations
Cambridgeshire and Peterborough mental health crisis response logic model
Survey results for South Devon and Torbay CCG
Survey results for Cambridgeshire and Peterborough CCG
The Bigger Picture: Aggregates of Cambridgeshire and Peterborough, and South Devon and Torbay
Health economic analysis of the Consolidated Channel Shift Model
The research described in this report was conducted by RAND Europe.
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