Client: Acute NHS Trust working within a local Integrated Care System (ICS) in Staffordshire
Focus: Improving emergency care flow, system governance, and A&E performance
Overview:
An acute NHS Trust within a local Integrated Care System (ICS) was experiencing sustained pressure in its Emergency Department (ED), driven by rising attendances, delayed patient flow, and system-wide capacity constraints. These challenges were impacting the Trust’s ability to meet national A&E constitutional standards and affecting patient experience across urgent and emergency care pathways. A coordinated, whole-system response was required to address flow beyond the ED and strengthen operational governance across the ICS.

Our Approach:
The owner of PALAR Consultancy established and led a multi-agency, ICS-wide improvement team, bringing together senior operational leaders and frontline teams from acute, community, mental health, social care, and ambulance services. We designed and implemented a whole-system governance and escalation framework to support real-time decision-making and collective accountability for system flow.

Support included:
• Establishing ICS-aligned governance structures to oversee urgent and emergency care performance
• Implementing clear escalation processes across providers to manage pressure and unblock flow
• Introducing daily system flow meetings to review demand, capacity, and constraints
• Enabling rapid identification and resolution of internal and external ED bottlenecks
• Supporting a shared focus on end-to-end patient pathways rather than organisational silos

Outcome:
Through strengthened system governance and improved collaboration, the acute Trust achieved significant improvements in Emergency Department flow and performance. Progress was made against A&E constitutional standards, with reduced congestion, clearer escalation routes, and more effective use of system capacity across the ICS.

Impact:
By aligning ICS governance with day-to-day operational practice, Sharon helped shift the system from fragmented responses to coordinated, system-wide working. The approach improved efficiency, strengthened relationships between partners, and ensured patient safety and experience remained central to urgent and emergency care delivery.