2 September 2019, written by Joanna Choukeir, Health Director at FutureGov
We’ve come to the end of our 6-month strategic service design work. This marks the start of a whole set of next steps to translate vision into change, where digital can deliver more impact.
It’s been a fascinating yet challenging, complex yet rewarding journey for the team. We wanted to use these final week notes to give a summary of the work we’ve done, where that process has led us and why what we found is so important for the future of digitally-enabled urgent and emergency care in England.
Why we did this work
The goal of our work to design a vision for better urgent and emergency care is to provide national, regional and local decision-makers with an evidence-based understanding of the problems in urgent and emergency care that could be best addressed through digital.
There were four incentives driving the need for this work in urgent and emergency care:
- there’s no shortage of vision and good ideas for improvement, but decision-makers across the system need to make informed choices about priorities to focus energy and investment to deliver the most impact
- work often starts with a single service view, rather than a person-centred view of end-to-end patient experience through an urgent care episode — which often includes interaction with a range of channels and services in a short space of time
- activity in the sector often starts with the technology that needs to be built or integrated, rather than the problems that need to be solved through technology, so this is an opportunity to reframe the approach to focus on what people in the system need from technology first and foremost
- policy is in flux and we need to anchor the future of digital urgent and emergency care against new visions such as the Long Term plan, The Future of Healthcare and NHSX prioritisation
What we did and how
FutureGov worked with NHS Digital over six months as a multidisciplinary, blended team, taking a mixed-method approach.
We undertook in-depth engagement with staff and patients across statutory urgent and emergency care services, data analysis and desk research to understand the as-is state of urgent and emergency care. This was complemented with service design methods such as mapping and co-design to create the target state.
What we learned about patient and staff needs
For urgent and emergency care services to deliver the best possible outcomes for patients, and provide the reassurance and convenience needed to resolve an episode in as few steps as possible, services need to take patients’ emotional, practical and clinical needs into consideration with equal weighting.
For patients, what matters most when seeking urgent help is:
- an emotional need — to trust the service/clinician looking after me, understand what’s happening and feel reassured that I (or my loved one) will get the right care when it’s needed
- a practical need — to quickly decide where, when and how to access urgent care and then receive that care in a way that fits with my life
- a clinical need — to get the right care, or ongoing care, quickly to prevent the situation from happening again in the future
For staff what matters most is:
- quality patient care and outcomes — to deliver the best patient care possible, ensuring patients get the right care at the right time
- an effective working environment — to work in an environment that enables me to deliver the best care possible, with the right tools and support to be efficient and use my skills effectively
- a collaborative UEC system — to collaborate with others in the system, to collectively improve the care we offer patients in a way that is efficient
Problems and opportunities we prioritised for impact through digital
There are multiple systemic challenges facing urgent and emergency care. It’s a large, complex and fragmented system made up of over 19,300 organisations that commission or deliver care which serve over 220 million patient interactions a year. The system is under real pressure, especially Emergency Departments (25 million visits/year) and same-day GP appointments (118 million appointments/year).
Amidst these challenges, we’ve spent the last month prioritising the problems and opportunities where we believe digital has the potential to deliver the most impact to meet the needs of patients and staff. They can be grouped into four key areas as summarised in the table below.
A person-centred future experience of urgent and emergency care, enabled by digital
We piloted co-design workshops with NHS teams and local service teams to imagine what the future could look like across an end-to-end urgent and emergency care journey.
These workshops helped our team form what we believe the future experience could look like, alongside a set of beliefs that could help with its delivery.
“I was struggling to imagine what could come out of this work, but the future experience is very clear and brings it all together.”
“This is not just about NHS Digital. Everyone in the system from national to local would benefit from seeing this service design work to stimulate their thinking around what future they need to work towards. People find it hard to imagine a world different than their own…”
This is only a starting point for co-designing the future and we’re looking forward to engaging more teams and services in the process over the next few months.
NHS Digital will work closely with NHS England, NHSX and local UEC systems to determine the next steps. They’ll be looking at how to share the detailed findings more widely and how it’s possible to use these findings to identify further opportunities where national and local organisations can best focus their investment in digital activities over the next two to three years.
Week notes 9: the end marks new beginnings – a summary of our journey was originally published in FutureGov on Medium, where people are continuing the conversation by highlighting and responding to this story.