Care and support in a crisis

What is this and how does it work?

People at high risk of their personal health deteriorating are among those who benefit most from integrated care. They tend to be older, frail, and living with multiple chronic conditions. Despite the best efforts to coordinate their care in the community, their conditions can worsen and urgent needs arise. Unmet needs can quickly spiral into a crisis.

Crisis response services’ main goal is therefore to provide timely access to advice and treatment to prevent an escalation of needs that require emergency care and hospital admission.

Provision of crisis care encompasses a whole range of urgent and emergency services. Some services, such as NHS 111 and GP out-of-hours services, expand access to primary and community care, whilst others, such as 24/7 liaison mental health care or nurse-led rapid response teams, are services specifically designed to provide a rapid response of specialist clinical, mental health or social care support.

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    Care and support in a crisis. What is this and how does it work?

    People who benefit most from integrated care tend to be older, frail and living with multiple chronic conditions. Their conditions can quickly worsen and urgent or unmet needs can spiral into a crisis.

    Therefore, the goal is to provide fast advice and treatment from a wide range of services to prevent an escalation that requires emergency care or hospital admission.

    How do crisis response services relate to integrated care?

    When urgent care is needed having the right services available is critical. These may include guidance on how to access support urgently, a single point of access, GP out-of-hours services, community-based Rapid Response Teams, community pharmacy services and 24/7 liaison mental health service.

    Of course, acute care cannot always be avoided and so multidisciplinary assessment at hospital admission can ensure the transition to post hospi-tal care back in the community is well coordinated and supports re-ablement.

    What do crisis prevention and response services need in order to succeed?

    Some key approaches include targeted interventions for people at higher risk of entering a crisis information sharing across social care and health providers, a multidisciplinary approach including embedding social care staff in A&E departments, linking primary care and community teams before and after a crisis.

    What is the evidence for outcomes and impact?

    An integrated approach to urgent and emergency care is expected to produce timely care at time of crisis in the right place, reduction in emergency admissions and most importantly, improvements in health outcomes.

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How do crisis response services relate to integrated care?

Well-coordinated person-centred care plays a role in reducing the likelihood of a full-blown crisis and containing the demand for urgent and emergency services. When people’s care needs change and urgent care is needed, having the right services available is critical to receiving timely care, such as:

  • information and advice to people who use services so they can access support urgently and know how to navigate the system
  • a single point of access to make accessing urgent help easier
  • extended hours at GP surgeries and with community nursing teams
  • community-based rapid response teams that can be despatched to provide care to people with deteriorating conditions
  • community pharmacy services that can respond to medication needs
  • 24/7 liaison mental health services
  • ambulatory emergency care services.

Acute care cannot always be avoided. An integrated approach to managing emergency care is suggested. A multidisciplinary assessment at hospital admission and again in relation to discharge planning can ensure the transition to post-hospital care back in the community is well-coordinated and supports recovery, rehabilitation and reablement.

What do crisis prevention and response services need in order to succeed?

Like the vision for integrated care, the foundations of an effective crisis prevention and response service require a whole-system perspective, where professionals and providers work in a coordinated and joined-up way. Some key ingredients include:

  • targeted interventions for people at higher risk of entering a crisis and for ’frequent attenders’ of hospital emergency care
  • a community-based, integrated response to a crisis, with a clear model of care and protocols
  • improving information-sharing across social care and health providers in a crisis or following a crisis (shared care records, red bag schemes)
  • a multidisciplinary approach, including embedding social care staff in A&E departments, and to support hospital discharge and admission
  • establishing processes that link primary care and community teams before and after a crisis.

What is the evidence for outcomes and impact?

An integrated approach to urgent and emergency care is expected to produce:

  • timely care at time of crisis in the right place
  • reduction in emergency admissions
  • consistent and better quality of care
  • positive work-based culture for person-centred, safe and effective care
  • improvements in health outcomes
  • better use of resources