New measures to improve patient care ahead of winter

  • NHS 111 piloted as ‘front door’ for urgent care so patients can access the right service and avoid unnecessary visits to emergency departments

  • Consultation to launch on A&E performance measurements to ensure they reflect modern emergency care and deliver what patients need

A&Es in 25 hospitals across England will receive an additional £150 million to expand and upgrade, ensuring they have the physical space to treat patients, manage patient flow and improve infection control, the Health Secretary Matt Hancock has announced today.

This is in addition to the £300 million announced recently for 117 trusts to upgrade their facilities, meaning the government has now invested £450 million to upgrade A&Es this winter.

The funding will expand waiting areas and increase the number of treatment cubicles, helping boost A&E capacity by providing additional space and reducing overcrowding. Projects will be completed by the start of next year so hospitals benefit from the upgrades during the peak of winter.

Alongside this, a new offer to patients is being piloted in trusts across England, with NHS 111 being the first point of contact for accessing urgent medical care.

To ensure patients get the right care in the right place and avoid unnecessary visits to emergency departments, NHS 111 will build on its role during the pandemic to direct patients to the most clinically appropriate service, including emergency departments, an urgent treatment centre, a GP or mental health professional.
Based on what works best during the pilots, this approach will be rolled out to all trusts from December this year.

Health and Social Care Secretary Matt Hancock said:

We are investing £450 million to make sure our A&E departments are ready for winter. Hospitals around the country will be able to expand and upgrade to ensure they can continue safely treating patients in the coming months.

During the peak of the pandemic we saw millions of people using NHS 111 to get the best possible advice on COVID-19, and other urgent NHS services. These pilots will build on this and test whether we can deliver quicker access to the right care, provide a better service for the public and ensure our dedicated NHS staff aren’t overwhelmed.

We all need to play our part by washing our hands regularly, using a face covering and keeping our distance from those not in our household. We are determined to protect the NHS as we did during the peak.

NHS 111 will also book appointments for patients with the appropriate service to cut out unnecessary queueing and ensure they get the right care first time. This will be safer and more convenient for patients as it will reduce the amount of time spent in waiting rooms.

Those facing a life-threatening emergency should continue to dial 999 immediately. If someone is unsure how serious a condition is then NHS 111 can offer advice and if necessary, dispatch an ambulance.
To support this expansion the NHS is investing £24 million to increase 111 call handling capacity and will have more clinicians on hand to provide expert advice and guidance.

Each year there are 14.4 million A&E attendances in England that arrive without referral by 111, a GP or in an ambulance, as well as 2.1 million attendances that don’t result in any admission or treatment. Reducing this unnecessary use of emergency departments will ease the pressure on the NHS this winter and reduce transmission of COVID-19.

Dr Cliff Mann, NHS National Clinical Director for Urgent and Emergency Care, said:

While emergency admissions are now back to near normal levels and 999 calls are actually above usual, COVID-19 infection control means rethinking how we safely look after people who might previously have been to an emergency department for a more minor condition. Local teams are working hard to expand and adapt services to ensure people can continue to get the care they need safely, whether that’s in hospital or closer to home.

This additional investment will help us continue the development of NHS 111 and provide a broader range of services, with direct booking that will ensure all patients can see the right clinicians in the right setting, and address the extra challenges posed by COVID-19 so that emergency departments can safely treat those patients who do require their services.

Dr Katherine Henderson, President of the Royal College of Emergency Medicine, said:

Expansion of NHS 111 will help patients to be seen more quickly by the service most appropriate to their needs. We are pleased to have reached the consultation phase of how A&E performance is measured with a focus on the safe, timely care of the very sickest patients, and look forward to the publication of the proposals.

A further boost to capital funding to help redevelop our most challenged emergency departments is very welcome and vital to help ensure social distancing and reduce the spread of infection. Crowding must be eliminated from emergency departments – now more than ever – and this is a helpful step towards tackling that problem.

The pandemic has shown NHS 111 can play a more prominent role in triaging patients to make sure they get the right care, first time round.

As winter approaches and we continue to tackle the COVID-19 pandemic, these additional measures will help to reduce overcrowding in A&E, protecting both staff and patients and making the NHS as safe as possible.

If a patient without a life-threatening condition in the pilot areas arrives at an A&E department without contacting NHS 111, they will continue to be given the assistance they need, but may end up waiting longer than patients with similar health issues who booked an appointment through NHS 111.

A public communications campaign ‘Help Us Help You’ will also launch later this year to direct people to the right NHS service.

Alongside this, NHS England has been exploring whether improvements could be made to emergency care performance measures as part of its ongoing clinically-led review, which has also considered how to accurately measure performance while the service meets the continuing challenges of COVID-19.

Before December, a consultation will be launched on standards to ensure they reflect modern emergency care and deliver what patients need. The existing standards remain in place and – if any updates are subsequently made – this will only be on the basis of strong evidence and after thorough consultation.


In July 2020, 1.48 million calls were made to NHS 111 with the vast majority (91%) of calls answered within 60 seconds.

The £450 million forms part of an extra £1.5 billion capital funding announced by the PM this summer.

The 111 pilots are currently live in Cornwall, Portsmouth and SE Hampshire and Blackpool, and have just begun in Warrington.

The 25 trusts receiving a share of £150 million for A&E upgrades are below:

RegionTrustSite2020/21 £’000Summary of scheme
East of EnglandMid and South Essex NHS Foundation TrustSouthend Hospital9,700Bring urgent and emergency care specialties together to allow effective flow of patient referrals between teams with increased capacity to avoid overcrowding and ensure patients are treated in the right environment.
East of EnglandBedfordshire Hospitals NHS Foundation TrustLuton and Dunstable5,700Expansion of department to incorporate current Same Day Emergency Care and children’s assessment unit areas, with temporary relocation of minor injuries.
East of EnglandEast and North Hertfordshire NHS TrustLister Hospital6,005Front Door Triage and Streaming.

Increased Capacity within the Emergency Department (specific focus on children).

Co-located Assessment and Same Day Emergency Care Services. Dedicated radiology support to Emergency Department and Assessment.

LondonBarking, Havering and Redbridge University Hospitals NHS TrustKing George Hospital3000Emergency Department improvements to waiting area, streaming, Major trauma and resuscitation area.

Provisions of dedicated emergency department X-ray facilities.

LondonKing’s College Hospital NHS Foundation TrustDenmark Hill9603Emergency Department remodel and major trauma capacity, Same Day Emergency Care and children’s emergency department.
MidlandsThe Shrewsbury and Telford Hospital NHS TrustRoyal Shrewsbury Hospital6300Avoidable admissions & emergency department expansion. Removing an existing modular building and replacing to support Same Day Emergency Care.
MidlandsUniversity Hospitals Coventry and Warwickshire NHS TrustUniversity Hospital Coventry3000Emergency Department expansion.
MidlandsWorcester Acute Hospitals NHS TrustWorcestershire Royal Hospital2500Re-locating Medical Assessment Unit, ambulatory emergency care and Stroke ward, releasing capacity for the emergency department expansion and increased same day emergency care.
MidlandsUnited Lincolnshire Hospitals NHS TrustLincoln County Hospital7000Emergency department new build and urgent care enhancements (avoidable admissions). Increase the footprint of the front door.
North East and YorkshireNorthern Lincolnshire and Goole NHS Foundation TrustDiana Princess of Wales Hospital4000Create an urgent care hub that brings together an expanded emergency department and a priority admission area.
North East and YorkshireYork Teaching Hospital NHS Foundation TrustYork Hospital2000Provision of appropriate isolation capacity, Resuscitation Area, children’s waiting area,

Clinical Decision Unit.

North East and YorkshireNorthern Lincolnshire and Goole NHS Foundation TrustScunthorpe General Hospital4000Upgrade the mental health assessment room, ensure sufficient waiting area space, suitable single rooms and social distancing measures, and an appropriate area for assessment and admission in the emergency department.
North WestCountess of Chester NHS Hospital Foundation TrustCountess of Chester Main site7000Redevelopment of Urgent and Emergency Care Services.
North WestMid Cheshire Hospital NHS Foundation TrustLeighton Hospital9000Reconfiguration and expansion of Emergency Care services.
North WestEast Lancashire Hospital NHS TrustRoyal Blackburn Hospital6000Expansion of emergency department.
North WestLiverpool University HospitalsAintree Hospital7500Emergency Village & Regional Emergency Hub Expansion and redesign of assessment (Medical, Frailty, Surgical and Specialist Services), same day emergency care and waiting capacity.
South EastEast Kent Hospitals University NHS Foundation TrustWilliam Harvey Hospital3000Emergency department expansion and increasing same day emergency care.
South EastEast Kent Hospitals University NHS Foundation TrustQueen Elizabeth The Queen Mother Hospital4000Emergency department Expansion and improved Flow.

Re-modelling the existing space will provide more clinical treatment space. Extending major trauma cubicles will assist with efficient patient flow. The scheme will provide additional cubicles for adults and children.

South EastBuckinghamshire Healthcare NHS TrustStoke Mandeville15000Modular build of integrated children’s emergency department.

(currently no children’s emergency department at Stoke Mandeville) and inpatient ward.

South EastAshford and St Peter’s Hospitals NHS Foundation TrustSt Peter’s Hospital Chertsey6000Expanded emergency department and urgent treatment centre.
South WestRoyal Devon & Exeter NHS Foundation TrustRoyal Devon & Exeter Hospital (Wonford)6000Provision of new emergency department majors, including 6 additional major trauma cubicles for infectious patients and reprovision of Minor injuries/Musculoskeletal due to major trauma expansion.
South WestDorset Country Hospital NHS Foundation TrustDorchester Hospital2000Triage and minor injuries, a Priority Assessment Unit.
South WestTorbay and South Devon NHS Foundation TrustTorbay Hospital & Newton Abbot Community Hospital9000Establishment of a Medical Assessment Unit for Adults and Children, emergency department expansion and enhanced

same day emergency care capacity.

South WestUniversity Hospitals Bristol NHS Foundation TrustBristol Royal Infirmary7700A purpose built emergency department and up to three admission wards (medicine and surgery).

Refurbishment of current admin space into a surgical same day emergency care unit and medical assessment area.

Emergency department and acute medicine front Door Remodelling and point of care testing.

South WestGreat Western Hospital NHS Foundation TrustGreat Western Hospital5000New single initial assessment area. Increase waiting capacity, urgent treatment centre and same day emergency care consulting rooms of 50%. New area with elevated infection control measures to act as ‘Blue Zone’ where patients identified as potentially infective will be managed. Increases in same day emergency care.

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