Establish a range of integrated services that provide a coordinated and personalised response in the community.
This change supports Goal 2: stop crisis becoming an admission.
Making it Real statements
I can plan ahead and stay in control in emergencies. I know who to contact and how to contact them and people follow my advance wishes and decisions as much as possible."
We make sure that people, and those closest to them, know what to do and who to contact if their health condition, support arrangements or housing conditions are deteriorating, and a crisis could develop. We respond quickly to anyone raising concerns."
Tips for success
NHS Planning guidance for 2021/22 asks all systems to develop a two-hour community response covering 8am to 8pm, 7 days a week by April 2022. Crisis response teams can be made up of a range of professionals such as nurses, physiotherapists, occupational therapists, paramedics, social workers and social care staff in order to provide a coordinated response. Make sure frontline staff know how to refer people to these services and also ensure the public and ambulance services can access the service via NHS111.
Comprehensive assessment and streaming services with triage pathways for people who attend A&E either voluntarily or through ambulance conveyance ensure that people are admitted only if clinically necessary to do so.
Consider commissioning local voluntary sector organisations, including housing and homelessness workers, to support individuals in A&E or at the front door to adult social care, providing an alternative to admission.
A carers’ emergency service can provide replacement care so that individuals being cared for are not admitted to hospital or other bed-based care due to a breakdown in informal caring arrangements.
Establish a clear set of options for referral pathways between paramedics, the ambulance service and local urgent care services including rapid response. Ensure frontline staff are informed, understand, and adhere to these options.
Update NHS111 regularly with local crisis response arrangements and how to access them by keeping all services updated on the Directory of Services. Ensure appropriate data sharing processes are in place prior to crises so that personal information, such as medications, is easily available in order that an appropriate response can be provided in the community. Make sure that this information travels with individuals when they transfer between care settings.
Provide the workforce with the technology that enables them to communicate and collaborate with other health and care colleagues when on a call-out.
Reablement services can support an individual as a preventative measure for those most at risk of an admission as well as to support recovery after a hospital stay. Intensive reablement, such as live-in care or 24-hour care, can be used for short periods to stabilise individuals.
The services and approaches described in other changes in this tool can be utilised as a crisis response, such as deploying aids, adaptations or voluntary sector support.
Think creatively about alternative housing options that could prevent a crisis escalating and lead to a care home admission, such as extra care and innovative shared lives models of care. For more information, see the High Impact Change Model: Managing Transfers of Care between Hospital and Home.
Examples of emerging and developing practice
- Ipswich and East Suffolk’s multi-agency Reactive Emergency Assessment Community Team (REACT) has successfully integrated admission avoidance services to stop an average of 23 admissions a day and as a result achieved an annual net cost avoidance of around £3.8 million.
- By providing an immediate response, primarily to people aged over 65, operating 12 hours a day, seven days a week, the East of England Ambulance Service’s Early Intervention Vehicle has reduced ambulance conveyances and unplanned hospital admissions.
- Salford Royal NHS Foundation Trust has used virtual wards to monitor the condition of COVID-positive individuals who have not required a hospital admission but are deemed to be at risk of deterioration using pulse oximetry at home. December 2020.
- Leicester Partnership NHS Trust is able to prioritise referrals requiring a two-hour crisis or two-day reablement response from the urgent community response teams by using software built into the Electronic Patient Record. December 2020.
- Lincolnshire’s hospital avoidance response team helps avoid hospital admissions by supporting the clinical assessment service, LGA, September 2019.
Urgent community response – two-hour and two-day response standards, 2020/21 Technical data guidance, NHS England and NHS Improvement, November 2020.
Ambulatory Emergency Care Network website.
Reducing avoidable ambulance conveyance in England: Interventions and associated evidence, The University of Sheffield, School of Health and Related Research, March 2020.
Rapid Response Teams, NHS news item, January 2020.
Clinical Assessment Services, NHS Digital, November 2019.
Shared Lives Plus website.