1. South Tyneside Urgent and Emergency Care Equity Audit
Jack Lewis, Senior Public Health Intelligence Analyst
Amanda Healy, Director of Public Health

2. Purpose of Audit
Follows the response to the relocation of the Jarrow Walk in Centre services to an integrated GP/urgent care hub based at the Emergency Department at South Tyneside Hospital.
The Health and Wellbeing Board endorsed a recommendation in June 2015 that a full equity audit of access to the new Urgent Care Hub be conducted by Healthwatch South Tyneside.

3. Authors Members of original Assurance Group, including Healthwatch
Additional members from
North East Commissioning Support
South Tyneside CCG
South Tyneside Council Public Health

4. Question
“After the relocation of the Jarrow Walk-in Centre to the new Urgent Care Centre, can the South Tyneside population equitably access urgent and emergency care services now in place?”
Unable to look at any one service in isolation.
Unable to distinguish between urgent and emergency care demand.
Limited data showing system after the relocation – focused on access to the system as a whole over 14/15- 15/16.

5. Summary
On the whole, and using information available, there appears to be equity of access to urgent and emergency care services for the residents of South Tyneside.
Provision is comprehensive, accessible and timely for the varying needs apparent across the borough.
Given South Tyneside’s geographical position in the region, there is comprehensive access to services provided in neighboring boroughs and cities, as well as services provided locally in communities, centres of expertise, and people’s homes. These are available both in and out of hours and they are provided relative to need and urgency.

6. Definitions
Urgent needs: illnesses that are not life threatening and injuries that are not serious.
Emergency needs: that require “time- critical” care i.e. care that if not provided within a specified timeframe could lead to a loss of life or a permanent disability.

7. Equity Need is balanced with supply across all population groups
Age, gender, deprivation, ethnicity, geography

8. Need and Access True need is difficult to measure
Requires a proxy: demand (expressed need)
Access: receiving care according to some standard for timeliness
60 second answer time for 111
8 minute wait for ambulance
4-hour standard for A&E
GP patient survey responses

9. The Urgent and Emergency Care System
NHS 999
NHS 111
Ambulance
Urgent Care Hub & A&E
GP OOH, GP In-Hours
Dental OOH, Dental In-Hours
Pharmacies/Think Pharmacy First
Mental Health Initial Response Service
Self Care and A Better U
Equity Analysis
Patient feedback
Activity Data

10. NHS 999/111 93% UK adults own a mobile phone 66,000 contacts a year
60 second response time standard for 111
NEAS achieves 95.1%
Different way of measuring locally that shows some variation
Calls not prioritised within service
Requires further investigation

11. Variation in South Tyneside: 111

12. Variation in South Tyneside: 111

13. Ambulance Calls
Significant national variation

14. Good response times locally
8 minute response for Red1 Calls
Slowest postcode: SR6, median 6 minutes 2 seconds
Whitburn and Marsden
Cleadon and East Boldon
79% of calls <8 minutes
Quickest postcode: NE32, median 4 minutes 45 seconds
Jarrow
Fellgate
97% if calls <8 minutes

15. Some variation for Red, none for Green or Urgent
No association with deprivation
Geographical variation for Red1 and Red2 calls
Distance from hospital largest factor
Slower responses around borders of the borough.
Average response in all wards less than 8 minutes
Also below:

16. A&E
We’ve already established system equity of access through phone support and ambulance response.
79,000 attendances 2015/16
80% to STFT
Sunderland, Gateshead and Newcastle other 20%
4th highest rate in NE
4-hour standard
Equity across deprivation, gender, ethnicity, home address
Variation observed across age groups

17. Age and the 4-hour standard
99.5% 0-4 year olds meet target vs.
83% of 85+ year olds
Likely a combination of factors, but deservers further review:
Higher admission rates 85+
Complexity of care
Delayed transfers of care
Paediatric department at STFT

19. GP in hours and Out of Hours
No individual level data
More satisfied locally than nationally
No correlation between practice survey scores and practice deprivation level
Scores are decreasing locally as they are nationally
More likely than the average patient in England to be very or fairly satisfied with:
the contact they have with their GP surgery by telephone
how much the GP involves them in decisions about their care
the opening hours of their GP surgery
their GP surgery overall.

20. Able to get an appointment

21. Out of Hours

22. Additional Services Dental Urgent Care
Good access. No link to deprivation. Females and young adults access more than males and older adults
Pharmacies and Think Pharmacy First (TPF)
PNA tells us there is adequate access
TPF showing good activity that is on the rise
Mental Health Initial Response
Single point of access that operates 24/7
Self Care
NHS Choices receives 2 million visits daily
Several specific programmes targeting self-care, including A Better U

23. Conclusions
111 and 999 call services that are available to anyone who can access a telephone,
An ambulance service that responds (particularly quickly in South Tyneside) according to need and will convey people to and from care settings, and
Good primary care coverage and accessibility, particularly for GPs and Pharmacy,

24. Conclusions Continued
Emergency and Urgent Care services available in South Tyneside, Gateshead, Sunderland and Newcastle,
An underlying health and care system that supports urgent needs through:
promoting self-care,
pharmacy services,
health and social care integration to support people in their own homes,
urgent dental services, and
a mental health initial response service.

25. Further Analysis Required
Ambulance Red response times at the coastal wards of South Tyneside and in Hebburn North,
The age inequality in the 4 hour wait standard for Accident and Emergency, and
The variation in 60 second responses to NHS 111 across groups of people within South Tyneside.