The voluntary sector in Accident & Emergency

Kate Brittain, ACEVO (originally posted February 2015)

In recent months, few newspapers have gone to press without at least one headline mentioning the ‘winter crisis.’ As the political debate over health and care rumbles on, accident and emergency departments have been centre stage – overworked doctors, patients on trolleys in corridors for days, and queues of ambulances lined up outside hospitals across the country.

Crisis?

Winter pressure is not new. But budget worries, an ageing population and cold weather make for a poisonous mix. ‘Bed-blocking’ has become common parlance; a euphemism for the decreasing number of in-the-community care options that is preventing many elderly patients from being safely discharged. Not in need of hospital treatment, but unable to go home.

Charities are obvious partners when a shortfall of community care affects primary care. Last month Age UK, British Red Cross and the Royal Voluntary Service confirmed a strategy with Government for a 12 week targeted intervention in 29 hospitals. This hasn’t merely created services; it has built on existing volunteer services up and down the country to discharge patients and prevent hospital readmission.

But calling on charities when the burden becomes untenable is not going to help in the long term. Charities are key strategic partners for the health and care systems, not only in delivering day-to-day services but in actively preventing the sort of crisis that we have come to expect each winter.

Charities have been working in hospitals for centuries. Today, the modern professional third sector provides much more than ‘tea and sympathy.’ Paid staff and trained volunteers work to improve outcomes alongside clinicians, freeing up doctors to treat patients by providing people with personalised discharge plans, home assessments, and community support packages.

Southern Central Ambulance Service works with the voluntary sector to run a Patient Transport Service which sees 1,100 volunteers providing non-emergency transport. Volunteer Community First Responders provide first aid at a scene before the arrival of an ambulance crew. ‘Home from Hospital’ services are delivered by a diverse group of charities, providing low level yet critical care to the frail and vulnerable who may otherwise be unable to leave acute treatment facilities.

The current system is falling short if it does not take a long-term view of the cross-sector partnerships that are possible. 40% of patients who attend A&E are discharged having needed no treatment at all, but may well be in need of low level care and reassurance. One million emergency admissions in 2012/13 are considered avoidable, indicating a system in which signposting falls short.

Finding solutions

We need responsive, personalised services outside of hospital. This is a long term strategy in which the VSCE has a central role, given its existing expertise and, importantly, the trust that many of the frail and vulnerable already have in their services.

This will only be achieved by taking a wider view of health. This does not just mean recognising the zeitgeist of integration but means strategically thinking about how to flexibly fund and commission services in a way that means people do not simply gravitate to the most ‘negative’ option – visiting A&E ‘just in case,’ or as their only option.

This is not just about the VCSE being valued in public services. This is about the VCSE being valued in a way that will genuinely promote preventative services, effective signposting, and excellent community care. We need to build our evidence base and stay robust about the value, and capacity, that our sector has to offer. In drawing up a vision for the central government grant programme, it is critical that models explicitly invest in outcomes that look beyond admission rates and clinical processes. The VCSE can help people regain important skills and independence, either after being discharged from hospital or as part of a longstanding programme of support and contact.

Building sustainable and independent charities, community groups and social enterprises is one thing. Ensuring they are not built in a void is another. The whole system needs to come together in partnership. Funding and investment must be explored within an environment of cooperation and alliance if we are to achieve fair and co-designed programmes that deliver what we need from a modern services.

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