NHS Recovery Plan 2021-2026: annual progress update report 2024

Urgent and Unscheduled Care

Although we have the best performing core A&E departments in the UK, performance remains below the level we all wish to see. There were more than 1.5 million (1,568,764) attendances at A&E in the 12 months to September 2024, 2% more than in the year ending September 2023 (1,538,704). In the last year (to September 2024), over 1 million patients were seen within 4 hours– around 1 patient every 30 seconds.

We are supporting Boards through our Urgent and Unscheduled Care Collaborative Programme to improve patient flow through our acute sites and reduce A&E delays. We have strengthened arrangements to avoid unnecessary hospital admissions such as Same Day Emergency Care services and are optimising our virtual A&E systems by signposting patients to the most appropriate services for their needs, and scheduling A&E appointments where possible.

In addition, we continue to work to ensure patients are able to leave hospital as soon as they are able - focusing on discharge planning, so plans are in place to allow patients home as soon as they are medically able. We also continue to focus on reducing length of stay by ensuring daily ward-rounds with senior-decision-makers and undertaking whole-system reviews of long-stay patients.

Progress on Delivering Commitments During 2024

Provide alternatives to attendance at A&E reducing attendance at emergency departments – We allocated £3.6m funding for Hospital at Home for 2024/25 to ensure older people receive acute care in a setting that best supports their recovery and longer-term outcomes. Continued investment has enabled more areas than ever to either deliver, or work to develop, a Hospital at Home service. This includes some of the most remote and rural areas of the country.

In September 2024, there was the equivalent of 510 beds with an occupancy rate of 80%. This is similar to the size of Royal Alexandra Hospital and larger than University Hospital Wishaw. In the most recent quarter (July – September 2024) H@H services prevented over 4,000 people spending time in hospital relieving pressure from A&E and the Scottish Ambulance Service.

In addition, the “Right Care Right Place” campaign launched on 28 October ahead of winter - across radio, TV and digital and has been designed to communicate the appropriate use of the urgent care services, specifically A&E in an effort to help reduce pressures being felt across the system.

Reduce Delayed Discharges – The Collaborative Response and Assurance Group (CRAG) continues to provide a positive space for discussion and action on delivering against the delayed discharge mission, agreed with CoSLA to reduce delays to create capacity in advance of this winter. One of the key drivers is to utilise CRAG to gain an understanding from the local systems of the local barriers they face in order to support and challenge where necessary.

However, while over 96% of all hospital discharges happen without delay, there are various, and often complex, reasons why individuals are delayed in hospital, and it is critical that people are cared for in the right setting and that hospital beds are there for those who need them. There has been enhanced scrutiny and assurance of local areas’ progress in reducing delayed discharge, with a focus on supporting those local areas experiencing the most challenge.

We are targeting activity in those areas with disproportionately high levels of delay and at the heart of these efforts is a collective need to improve the experience and outcomes of patients.