Is 24/7 Integrated Urgent and Emergency Care Something for the Future — or Something We Need Now?

This blog wasn’t planned.

It started with a question I asked at 07:30 in a WhatsApp group — one of those conversations that begins with a practical operational issue and quickly exposes something much bigger.

“Does anyone have processes in place for ED to refer to UCR out of hours?”

What followed was familiar:

• Different local models

• Workarounds and informal processes

• Some optimism

• Some concern

But underneath it all sat a shared tension:

• Patients being discharged overnight in less-than-ideal situations

• Services trying to stretch across 24 hours a day, 7 days a week, 365 days a year

• Clinicians balancing risk without always having the right support, workforce, or system around them

What started as a discussion about referrals quickly became a discussion about something much wider:

How fragmented urgent and emergency care still is outside of traditional working hours.

And it left me reflecting on a bigger question:

Why are we still trying to deliver 8–8 care in a system that demands 24/7 access?

The Reality: Demand Is 24/7 — The System Isn’t

Urgent and emergency care does not switch off.

Falls happen at 2am. Functional decline happens overnight. Crisis points do not wait for weekday MDT meetings or Monday morning services.

Yet the conversation highlighted something many of us working across urgent and emergency care already recognise:

• Complex decisions are being made without full system support in place

• Community services such as Urgent Community Response (UCR) are increasingly available — but not always accessible in real time

• Much of Allied Health Professional clinical input remains weighted toward daytime hours

• Overnight pressures create bottlenecks and backlogs that emerge the following morning

This is not about individuals making poor decisions. In fact, most of the examples discussed reflected thoughtful, risk-aware clinical reasoning.

The issue is bigger than that.

It is about a system increasingly relying on clinicians — and sometimes digital technology — to bridge gaps that should not exist in the first place.

The Tension: Financial Constraint vs System Expectation

This is where the conversation becomes uncomfortable.

On one hand, clinicians and services are being told:

• There is no additional money

• Services need to “stretch” rather than expand

• Productivity must increase without increasing capacity

On the other hand, senior leaders — including figures such as Jason Killen — are rightly calling for:

• Whole-system transformation

• Greater primary and community care capacity

• Reduced pressure on urgent and emergency care services

Both perspectives are understandable.

But right now, they do not fully align.

Because genuine 24/7 integrated urgent and emergency care cannot be delivered through:

• Overstretched services

• Fragmented teams

• Or pathways that only function effectively during daytime hours

At some point, the system has to confront a difficult question:

Are we redesigning care — or simply redistributing pressure?

The Real Challenge: Working Across Boundaries (Especially at Night)

Integration sounds straightforward in strategy documents.

Operationalising it at 3am is something very different.

The barriers are real.

1. Clinical Risk and Accountability

Who owns the decision when someone is discharged or left at home overnight without confirmed follow-up in place?

How confident are organisations in shared risk models across pathways and providers?

Integrated care requires shared accountability — not just shared referrals.

2. Variation in Access

Some areas now have effective overnight access to UCR and community pathways.

Others still rely on:

• Emails

• Voicemails

• Referral books

• Or goodwill

That variation matters.

Because variation in access ultimately becomes variation in patient safety and experience.

3. Communication Gaps

Without real-time communication and feedback loops, referrals become one-directional transactions.

And integration without communication is not integration.

It is outsourcing.

4. Professional Identity and Role Boundaries

There is also a legitimate professional tension underneath these conversations.

If decisions are increasingly being made without the input that was once considered essential, what does that mean?

Are we genuinely redesigning care around patient need?
Or are we gradually normalising reduced access to expertise because the workforce is not there?

Those are difficult conversations — but important ones.

5. Workforce Reality

A true 24/7 system requires a workforce capable of supporting it.

That means more than changing rotas.

It means:

• Workforce planning

• Capacity

• Flexible roles

• Different career models

• Cultural change

• Contractual change

• And honest conversations about what 24/7 care really requires

And understandably, not everyone is comfortable with that.

So What Are the Options?

There is no single solution.

But there are clear directions the system needs to move toward.

1. Strengthen Ambulance ↔ Community ↔ Hospital Interfaces

The interfaces between ambulance services, UCR, primary care, hospital teams, and community services need to become more seamless.

That includes:

• Shared referral criteria

• Real-time or near-real-time triage

• Clear escalation routes

• Outcome feedback loops that build trust across services

Because when the interface is weak, the pathway fails.

2. Develop True 24/7 Pathways — Not Just Individual Services

It is not enough for services to exist.

The pathway itself has to function:

• Overnight

• At weekends

• Under pressure

• During periods of peak demand

Otherwise clinicians default toward admission or discharge — not necessarily because it is the best option, but because it is the only viable option available at that moment.

3. Rethink Traditional Team Boundaries

One of the most interesting questions raised in the discussion was this:

Should each part of the urgent and emergency care pathway remain operationally separate — or should we move toward more integrated workforce models?

Should roles work across settings?
Should hospital and community teams function as part of the same urgent care system rather than separate entities?

Integrated governance, aligned objectives, and shared workforce models could remove many of the friction points currently built into the system.

4. Expand Out-of-Hours Clinical Decision-Making

Whether through:

• Advanced practice roles

• Integrated multidisciplinary teams

• Enhanced community pathways

• Or out-of-hours specialist support

The principle remains the same:

Right decisions, in the right place, at the right time reduce pressure everywhere else.

5. Design Around the Patient — Not the Service

Perhaps the most important question raised during the discussion was also the simplest:

Is it better for someone to spend 8 hours overnight waiting in the same environment — or be supported in a safer and more appropriate place with follow-up the next morning?

If we are honest, most of us already know the answer.

But that answer only works if the system surrounding it is safe, connected, and reliable.

Where AHPs Come In

This is where Allied Health Professionals are not simply supporting the solution — but helping lead it.

Because these challenges are fundamentally about:

• Safety and risk

• Function

• Environment

• Home versus hospital

• Clinical accountability

• Real-world decision-making

This is core AHP practice.

AHPs can:

• Lead risk-stratified decision-making

• Bridge hospital and community thinking

• Shape integrated pathways

• Influence future workforce models

• Support recovery, function, and independence beyond immediate clinical treatment

And perhaps most importantly, AHPs help keep the focus on what actually matters:

Not just flow.
Not just targets.
But whether people can function safely, recover well, and remain supported in the environments that matter to them.

Final Thought

That early morning WhatsApp conversation was not unusual.

And that is exactly the point.

These tensions are playing out every day:

• In ambulance services

• In emergency departments

• In urgent treatment centres

• In community teams

• And increasingly in people’s homes

The system is already trying to integrate.

But right now, many parts of it are overstretched, fragmented, and lacking the capacity needed to sustain genuine integration.

The opportunity now is not simply to patch gaps.

It is to design a model of urgent and emergency care that genuinely reflects how and when people need support:

• 24 hours a day

• 7 days a week

• 365 days a year

In the home.
In the community.
In urgent treatment centres.
In emergency departments.
Across organisational boundaries.

And if we get that right, many of the pressures currently overwhelming urgent and emergency care begin to look very different.

So if you share a passion for how AHPs can shape and lead the future of urgent and emergency care, please use the contact form below to join my mailing list and be part of the conversation shaping what comes next