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Keogh report calls for update to "confusing" community services

More responsive and personal community services are needed as part of a “fundamental” change to urgent care, according to a long-awaited report. 

Professor Sir Bruce Keogh's report into urgent and emergency care calls for more extensive services outside hospital, so that patients with life-threatening conditions can receive treatment in localised emergency centres. 

The report claims that the services outside hospital can be “confusing and inconsistent” but that there is high public trust in the A&E brand. 

Over the next three to five years a system-wide transformation is the only way to create a sustainable solution, Sir Bruce (pictured) said. 

Up to 40% of A&E patients are discharged requiring no treatment, up to one million emergency admissions were avoidable last year and up to 50% of 999 calls could be managed at the scene. 

Sir Bruce said: “We now find ourselves in a place where, unwittingly, patients have gained false assurance that all A&E's are equally effective. This is simply not the case. A&E departments up and down the country offer very different types and levels of service, yet they all carry the same name. 

“We need to ensure that there is absolute clarity and transparency about what services different facilities offer and direct or convey patients to the service that can best treat their problem."

'Big bangs'

Emergency hospitals will be divided into two types, emergency centres, which will be used to assess and initiate treatments, and major emergency centres, which would provide a range of highly specialised services.

Around 40-70 major emergency centres will be spread across England, with the number of emergency centres roughly equivalent to the current number of A&E departments. 

The report, Transforming urgent and emergency care services in England, has also called for easier access to primary care and community services, such as local mental health teams and community nurses to address urgent care needs. 

Sir Bruce said: “This report sets out some principles. How they are developed locally will, and must, vary to suit local circumstances and wishes. We will need different approaches in metropolitan, rural or remote areas. 

“We know people will want to see change as soon as possible, but we need to ensure that there are no risky, ill considered “big bangs”, and that there is a managed transition.

Dr Peter Carter, chief executive of the Royal College of Nursing hailed the report as “thoughtful” but “well overdue”. 

He said: “If the report's recommendations are taken up, it will go a long way to addressing the challenges facing the NHS. Providing better support for people to self-care would take pressure off the health care system and allow nurses to care for those most in need.

“Previously we have also called for more focus on community services with a great deal more investment. We need to have the right numbers of staff with the right skills to deliver the right care in the community.”