Two-hour urgent community response (UCR) services in Humber and North Yorkshire (HNY) ICS are delivered by seven different providers who are at different levels of maturity with services adapted to local conditions.
When the ICB wanted to acquire a greater understanding of the service and its impact, independent evaluation support was sought from Arden & GEM’s Health and Care Transformation (HCT) directorate.
Arden & GEM worked directly with the UCR providers to compare the services they delivered with national standards and identify areas for improvements. Actions for each provider were detailed and recommendations made to assist the ICB in developing plans to support winter pressures.
The challenge
UCR services provide urgent care to people in their own homes if their health or wellbeing suddenly deteriorates. Their aim is to reduce demand on ambulance response and hospital conveyance, which is critically important to winter plans.
All ICSs must provide a UCR service, in line with the operational and clinical requirements detailed in national standards, which delivers urgent, crisis response support within two hours. Providers of UCR services have, however, been able to design the service according to local conditions, for example, staff availability and geographical considerations. Services may also differ in terms of maturity, with some providers still in the early phases of service set up.
These factors, combined with the fact there were seven providers in the geographical area, made it difficult for HNY ICB to understand service delivery as a whole and gaps in provision across its system.
The ICB commissioned independent evaluation support from Arden & GEM, with the project commencing in April 2023.
Our approach
Arden & GEM’s HCT directorate brought together experts from its programme management team with significant strategic and operational experience in acute setting urgent and emergency care. The team used a blended approach to acquiring the information and insight needed from each provider in order to evaluate the service.
Analysing existing sources
Existing data and information were collated and reviewed to better understand processes, activity and feedback. This included:
- Process maps detailing referral routes and service delivery processes
- UCR activity data for the previous six months (including outcome data when available)
- Patient experience feedback
- Primary care experience feedback
- Service financial information
- Directory of Services (DoS) and Community Services Data Sets (CSDS).
Direct stakeholder feedback
These initial findings were then combined with direct provider feedback to further increase insight and understanding. The team developed two initiatives to enable this which were based on service specification requirements and national guidance:
- Key Lines of Enquiry (KLOE)
- An activities, tools and interventions checklist developed from UCR national standards.
All data, information and responses were then analysed, with findings and conclusions drawn, and system actions identified.
The outcomes
The final evaluation findings were collated and distributed via a report and presentation for the ICB and a summary report for each provider in July 2023. The findings covered:
- Service consistency across the ICB
- Referrals and referral sources
- Adherence to the nine key clinical conditions set out in national guidance
- Consistency in interventions, assessments and point of care testing offered
- Completeness and accuracy of the Directory of Services (DoS) record, including information on referrals accepted, conditions excluded and operating hours
- Recording of activity data on local and national databases.
From the findings, the Arden & GEM team recommended:
- Ensuring providers update and accurately reflect their UCR service on the DoS
- Implementing a governance reporting strategy for the national database that clearly identifies the importance of accurately reporting all aspects of patient activity including original patient referral source through to patient outcomes, conveyances, admissions and onward referrals
- Developing a workforce plan to support providers with recruitment challenges, access to professionals, skill mix variation, competency updates and training
- Organising a pre-winter workshop for all key stakeholders to attend and share learning and ideas for future service provision and maximisation
- Developing a clear plan with timescales for each provider expanding their services to open to all referral sources, cover all nine key conditions within their service offer and standardise and expand their assessments, interventions, and point of care testing capabilities.
"The outputs of the evaluation were extremely useful and have enabled us to provide both a system wide overview for our board together with more focussed action plans based on the findings and recommendations at provider level. The provider plan on a page feedback was extremely helpful and this has supported the detailed conversations required to implement the actions going forwards. Providers were grateful of receiving the information as often feel the burden of being asked for information, but do not always have a sense of how the information is used. We found the Arden and GEM team very knowledgeable and professional in their approach and the quality of the work produced was excellent."
Vanessa Burns, Assistant Director at NHS Humber and North Yorkshire ICB