Addressing hospital handover delays: actions for local A&E delivery boards

NHS Improvement| January 2019 |  Addressing hospital handover delays: actions for local A&E delivery boards

Addressing hospital handover delays: actions for local A&E delivery boards is advice from NHS Improvement for ambulance trusts and A&E delivery boards on what action to take during busy periods and should ambulances begin to queue. This aims to help reduce delays in handover of patients from ambulance services to emergency departments.

This document sets out the main points from recent guidance documents, and separates them into actions to be embedded as part of normal working practice, and actions to be taken should ambulances begin to queue.

This summary is not exhaustive and local delivery boards should refer to more detailed guidance from NHS Improvement and the Royal College of Emergency Medicine as referenced within (Source: NHS Improvement).

Addressing hospital handover delays: actions for local accident and emergency delivery boards

New report focuses on recommendations to make ambulance transfers safer

Healthcare Safety Investigation Branch | January 2019 | New report focuses on recommendations to make ambulance transfers safer

A new report from the Healthcare Safety Investigation Branch, Transfer of Critically Ill Adults shows that a lack of national guidance and standard practice for ambulance transfers could be putting patients at risk. 

The report puts forward key recommendations aimed at making transfers safer for adults that are critically ill.

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This investigation was launched after the Healthcare Safety Investigation Branch were notified of the case of Richard, a 54-year old man, who died during an emergency transfer to a specialist care centre. He had been diagnosed with an acute aortic dissection after experiencing chest pain during exercise earlier that day. Aortic dissection occurs when the innermost layer of the wall of the aorta tears, allowing blood at high pressure to flow in between the layers forcing them apart.

Safety recommendations

The report sets out two safety recommendations:

NHS Long Term Plan: “Advances in technology mean outpatients appointment are not the fastest or most accurate way to provide specialist advice”

NHS  | January 2019 | NHS Long Term Plan

The NHS’ 10 year plan outlines how a third or outpatients appointments may be reduced as the current model is “outdated and unsustainable”.


Outpatients traditionally serve at least three purposes, and in each case there are
opportunities for redesign. An outpatient appointment can provide: advice and diagnosis for a patient and their GP; follow-up review after a hospital procedure; and ongoing specialist input into a long-term condition. Technology means an outpatient appointment is often no longer the fastest or most accurate way of providing specialist advice on diagnosis or ongoing patient care. 

The plan describes  the traditional model of outpatient care as being “outdated  and unsustainable”.  It outlines its intention to  redesign services so that over the next five years patients will be able to avoid up to a third of face-to-face outpatient visits, removing the need for up to 30 million outpatient visits a year.

The document also includes a case study of Tower Hamlets  Chronic Kidney Disease e-Clinics where a single pathway from primary to secondary care with rapid
access to specialist advice provided by consultant led e-clinics have transformed the way the way this care is delivered.

Four reasons are cited as enabling these technology-driven shifts:


  1. They are already happening
    in parts of the NHS, so this is clearly ‘the art of the possible’.
  2. There is strong patient ‘pull’ for these new ways of accessing services, freeing-up staff time for those people who can’t or
    prefer not to.
  3. The hardware to support ‘mobile health’ is already in most people’s pockets –
    in the form of their smart phone – and the connection software is increasingly available for the NHS to credential from third party providers.
  4. The Long Term Plan provides dedicated funding to capitalise on these opportunities

Read the NHS Long Term Plan at the NHS Long Term Plan website  (Source: NHS Long Term Plan)

See also:

OnMedica | Number of outpatients appointments to be cut

All.Can patient survey

All.Can UK | December 2018| First findings of All.Can patient survey revealed at UK Parliament event

More than a third (36 per cent) of cancer patients reported the greatest inefficiency as being their diagnosis finds the All. Can patient survey sought patients’ and carers’ perspectives on inefficiencies in cancer care.  40 per cent of people who participated in the survey had been initially diagnosed with something else. A similar proportion (34 per cent) also responded to say that they had a surplus of medication left over following treatment.


All.Can worked with Quality Health to develop the patient survey. Quality Health was responsible for all aspects of survey administration and data analysis, with input from All.Can national initiatives and the international research and evidence working group.

The UK piloted the All.Can patient survey ahead of roll-out in other countries throughout 2018. The survey closed in the UK in August, but continued running until 30 November in Australia, Belgium, Canada, France, Italy, Poland, Spain and Sweden.  Data from an international version is also being analysed (Source:

Further details from All.Can

Advice line for GPs saves hours of travel for patients and £100k to be reinvested back into NHS

NHS England | November 2018 | Advice line for GPs saves hours of travel for patients and £100k to be reinvested back into NHS

The Walton Centre in Liverpool – the only specialist hospital trust in the UK dedicated to providing comprehensive neurology, neurosurgery, spinal and pain management services-   runs an advice line which means GPs in the Cheshire and Merseyside area can call neuro consultants for fast advice any weekday reducing extra patient appointments. 


So far the service has received 181 calls 37% were resolved by the GP saving £51,698 which over a year saves around £100k.

Programme Director Julie Riley said: “We want to deliver services closer to home and when patients do come into hospital, support them so they can recover and go home quicker. From a patient point of view, we want to work in partnership with them. We, our consultant colleagues and GPs want to support them in self-management, where appropriate – rather than taking a paternalistic approach.”

Read the full case study at NHS England 

Technology in care

Care Quality Commission | November 2018 | Technology in care

The Care Quality Commission (CQC) have published a series – Technology in care- which shows how technology is used, the benefits of its usage and it also includes examples of best practice .

Introduction: How technology can support high-quality care

Using surveillance in your care service

Check the way you handle personal information meets the right standards

Find out if you need consent to use technology as part of someone’s care


Nutrition and hydration collaborative

NHS Improvement | October 2018 | Nutrition and hydration collaborative

NHS Improvement ran a 180-day programme, with 25 volunteer trusts, to improve nutritional care by increasing the accuracy of nutritional screening and the appropriateness of nutritional interventions.

The overall aims of the collaborative were to support trusts to:

  • increase in the proportion of patients with an accurate nutritional screen
  • increase in the proportion of patients receiving appropriate nutritional interventions
  • introduce and increase the use quality improvement tools and techniques


In addition to these aims organisations could identify their own quality improvement focus if appropriate.

25 trusts volunteered to be part of the programme to drive quality improvements, each shared their good practice, what they have learnt about quality improvement and helpful techniques with each other.

Read the trust stories on the Nutrition collaborative