Ten hospital trusts challenged with ED overcrowding and high attendances of frail older patients took part in two phases of the CLEAR urgent and emergency care transformation programme – resulting in a series of recommendations to improve patient care and projected productivity gains of £15 million.

The recommendations included enhancing front-door triage, better use of existing streaming pathways, an older person’s emergency department, and new roles dedicated to the care of frailty patients.

Both phases identified improvements to the quality, safety and efficiency of care, including reductions in patient length-of-stay in ED and overall overcrowding, fewer unnecessary admissions for older frail patients, enhanced patient experience and improved staff satisfaction.

Dr. John Jeans, Consultant Anaesthetist and CLEAR’s National Programme Lead said: “Faced with system-wide problems with patient flow and a significant increase in the number of people attending A&E, hospitals have been facing considerable overcrowding.

“By putting clinicians in the driving seat of workforce redesign and using big data analysis to evidence the problems and solutions, the UEC programme demonstrates that transformational change is possible.”

 Dr Mark Davies, Clinical Lead for Transformation and Reconfiguration, Calderdale and Huddersfield NHS Foundation Trust, said:

“It was refreshing to see CLEAR using insights from the clinicians on the ground to identify issues and then co-create solutions. Data was displayed in a way what was easily accessible to confirm or refute problems highlighted by our clinical team. This clinically-led approach is the reason why I stayed on to steer the programme’s UEC project nationally.”

The key challenges and recommendations are published today (23 March) in a new report CLEAR Urgent and Emergency Care Programme: key findings and learning.

The CLEAR programme was commissioned by Health Education England (HEE) to improve UEC services in line with the NHS Long Term Plan and support NHS trusts with service innovation, workforce redesign and new ways of working.

Six NHS trusts from different regions in England took part in the pilot phase of the CLEAR UEC Programme in 2019 and another four serving a total population of 1.5 million people, took part in phase two of the programme in 2021.

Both phases of the programme were focused on tackling four key challenges: congestion in ED resulting in patients waiting longer than necessary, misalignment of streaming pathways to meet patients’ needs, challenges in managing high volumes of frail, older patients and ensuring clinical staff have the right skills mix for managing different patient groups.

The predicted productivity gains for the NHS trusts involved in phase one of the programme are £10.5 million with £4.5 million of savings expected to be generated for the phase two hospitals.

The 10 trusts taking part were: Blackpool Teaching Hospitals NHS Foundation Trust, Oxford University Hospitals NHS Foundation Trust, East and North Hertfordshire NHS Trust, Calderdale and Huddersfield NHS Foundation Trust, Taunton and Somerset NHS Foundation Trust and North Middlesex University Hospital NHS Trust (phase one) and Mid Cheshire Hospitals NHS Foundation Trust, Hampshire Hospitals NHS Foundation Trust, Mid Yorkshire Hospitals NHS Trust and Kettering General Hospital NHS Foundation Trust (phase two).

The national Clinically Led workforcE and Activity Redesign (CLEAR) programme trains clinicians to use a combination of big data analysis, clinical insight and local knowledge to deliver new models of care and workforce redesign.

Both programmes ran over 24 weeks and comprised four key elements: clinical engagement, data interrogation, innovation and recommendations. Projects were delivered under the supervision of the CLEAR national faculty.

The report details the recommendations and forecast impacts for each of the 10 hospitals.

Read the CLEAR Urgent and Emergency Care Programme: key findings and learning report.