Our strategy in navigating winter challenges enabled real-time monitoring and prompt adjustments in urgent and emergency care capacity, significantly improving patient outcomes and decision-making processes in the NHS during a critical period.

Background

NHS Midlands and Lancashire (NHS ML) were approached by NHS England (NHSE) to build a report on six key measures which they had selected to monitor urgent and emergency care (UEC) capacity and resilience ahead of an expected busy winter due to Covid and flu. 

These measures entailed: 

•111 call abandonment 

•Mean 999 call answering times  

•Category 2 ambulance response times  

•Average hours lost to ambulance handover delays per day  

•Adult general and acute type 1 bed occupancy  

•Percentage of beds occupied by patients who no longer meet the criteria to reside.

Action

To monitor UEC capacity and resilience using the selected six key measures, our Business Intelligence (BI) team collaborated with system providers and used existing data sources from daily UEC Sitrep, North West Ambulance Service (NWAS) portal, and national discharge sitrep to gather the required data. Our team also augmented the six key measures with other metrics to make them more meaningful. 

Our BI team monitored trends, cause and effect, and predicted change in the UEC services to develop comprehensive reporting that met the customer’s needs. This enabled NHSE to monitor UEC capacity and resilience in real time, make any necessary adjustments promptly, and ensure that the UEC services were better equipped to handle the expected pressures during the busy winter season due to Covid and flu. 

Impact

We established new data sources and temporary collection arrangements which enabled NHSE to monitor UEC capacity and resilience in real time, allowing for prompt adjustments to be made to handle the expected pressures during the busy winter season due to Covid and flu. We recognised that the six key measures did not allow for triangulation or the ability to see the cause and effect of performance changes over time. To address this, we collaborated with the system via the Lancashire and South Cumbria (LSC) System Control Centre (SCC) to ensure that the six key measures were supported by data that would monitor trends, cause and effect, and predict changes. 

As a result, LSC colleagues were better informed when making decisions around mutual aid, NWAS diverts, admission avoidance, re-patriating patients, Operational Pressures Escalation Levels (OPEL) capacity protocol, and pressure predictions for individual providers. The addition of extra filters allowed the data to be viewed for specific days or dates, with colour code formatting highlighting any exceptions immediately. This ensured that UEC services were better equipped to handle the expected pressures during the busy winter season, improving outcomes for patients across acute providers, mental health, social services, and the community. 

Feedback

“The data and reports that were produced by NHS ML in a very short timescale, provided an accurate and effective visual representation of our system’s performance against key urgent and emergency care metrics last winter, as required by the nationally mandated Urgent and Emergency Care Board Assurance Framework.  They were included in important board and executive papers to enable clear oversight of performance and progress against the assurance framework, and they were also used by the SCC.” 

Craig Frost, Associate Director of Urgent and Emergency care, Lancashire & South Cumbria ICB