Let me tell you a story about 78-year-old Edward, who was seen by a paramedic after falling at home. The paramedic referred him to the 2-hour community crisis response team with concerns about his mobility and a suspected chest infection. The team nurse visited within 2 hours. Bloods were taken, and a full holistic assessment completed. Edward was adamant that he did not want to go into hospital. The nurse diagnosed a chest infection, confirmed by the blood test results. She talked to a frailty consultant, and a course of antibiotics was started by the advanced nurse practitioner on the 2-hour crisis response team. She arranged for antibiotics to be collected from the pharmacy and delivered to Edward that evening.
The nurse visited Edward again the next morning and continued to monitor him for 3 days. He was then handed over to the district nursing for management of a skin tear that he sustained during his fall.
If the 2-hr community crisis response service was not there, what would have happened? In all probability, Edward would have been taken to hospital and kept there for a number of days. From some of the data collected by crisis response teams, the average length of stay for such a patient would be around 7 days. That is a fairly long period of occupation of a hospital bed when that patient could be supported at home, where they actually want to be.
It is stories like this one that are at the very heart of the national rollout of the 2-hour crisis response standard that is underway at present. This standard is being introduced for the first time in the UK–and, in fact, the world-and it will mean that, by April 2022, anyone over the age of 18 years should have access to a 2-hour crisis response service in their own home if their health and wellbeing suddenly deteriorates.
By scaling up 2-hour crisis response services consistently across the country, we have got a real opportunity to have a significant impact in preventing unnecessary admissions, supporting recovery from COVID-19 and addressing hospital waiting list backlogs.
There is some compelling evidence to back this up. Mid and South Essex Health Care Partnership, for example, carried out a review of acute admissions in October 2020 and identified an opportunity to avoid up to 9% of acute admissions for those aged over 65 years through increased use of 2-hour crisis response teams. West Cheshire has identified an unmet demand of 166 cases a week in their emergency departments that could be handled by their 2-hourr crisis response service. Similarly, Kirklees in West Yorkshire looked at the primary diagnoses of emergency admissions and identified about 200 different diagnoses that could have been referred to their team.
Some fantastic 2-hour crisis response teams have already been established in various parts of the UK. We want to build on this through the national waiting time standard. The guidance sets out the minimum requirements for a 2-hour crisis response team: a 7-day service, available 8am to 8pm, co-ordinated 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 have set our ambitions high, but we are convinced that this standard will benefit thousands of patients who need our help. Community nurses are absolutely pivotal to the success of the programme, and we look forward to support from this group of professionals.