Time to act together: two-hour crisis response

Last year I wrote about the care I would want for my mum and dad a year on from the launch of the NHS Long Term Plan.

All our lives have changed since then in so many unexpected ways. I certainly didn’t expect a global pandemic and all the challenges that led to. But one thing that has remained is the importance of enabling people in a crisis to access care in their own homes where appropriate.

Having worked as a district nurse, I have seen first hand the importance of accessing the care at the right time and how people often would prefer and benefit from care in their own home if those services existed.

I know from personal experience as both a carer for my dad and listening to others who have needed a community crisis response that services are not as easily available or visible as you would hope.

Imminent changes to crisis response care

This is set to change. By April next year, everyone over the age of 18 in England will have access to crisis response care in their homes or usual place of residence within two hours, 8am-8pm, seven days a week.

The clock starts ticking on crisis response when someone has a sudden deterioration in their health and wellbeing

To drive this national rollout, we published guidance in July that sets out the essential operational and clinical requirements for NHS-funded crisis response services that integrated care systems,  providers and commissioners must achieve.

The clock starts ticking on crisis response when someone has a sudden deterioration in their health and wellbeing.

If urgent treatment can be safely delivered in the home setting, then the crisis response is deployed, often ensuring that the patient can remain at home without the need for avoidable hospital admission.

We’ve already launched accelerator sites that have put in place teams of health and care professionals, referral pathways, demand and capacity modelling, assessment and diagnostic tools, monitoring and benchmarking

There are dozens of situations where this is the right course of action.

For example, when someone has a fall, providing they have not sustained a serious injury like a fracture or lost consciousness, they can be treated at home and the appropriate support put in place. Those with frailty – usually associated with old age but increasing prevalent in younger people - will also benefit if their condition gets worse, perhaps because they’ve contracted a urinary tract infection which often leads to hospital admission when they can be treated at home.

We’ve already launched accelerator sites that have put in place teams of health and care professionals, referral pathways, demand and capacity modelling, assessment and diagnostic tools, monitoring and benchmarking.

A snapshot of the guidance

The guidance covers all these requirements and more to ensure crisis response is coordinated through a single local point of access, and aligned to unplanned urgent care services, such as NHS111, urgent treatment centres, same-day emergency care and 999, as well as GP practices and hospital discharge teams.

We’ve spent time co-developing and testing the guidance with clinicians and professionals. Essentially, it’s built on good practice - we know what’s already possible, we know what’s working well – and hope this will get others off to a flying start to meet the two-hour standard.

Forthcoming webinars

In the coming months we will running a series of webinars to hear from others about how new crisis response services are evolving, the service changes they are making and sharing the opportunities as well as those knotty issues that are hard to resolve.

The first webinar: Implementing two-hour crisis response at scale will be held on 30 September. Please register here. You can also submit questions in advance here.

Kath Evans is urgent community response deputy director at NHS England. Follow her and NHS England on Twitter @kathevans2015 @NHSEnglandCHS