1. 1 ANALYTICAL APPROACH TO SUPPORT THE URGENT CARE AGENDA Joe Clancy - Change & Innovation Manager - NHSL - 16 December 2008 - V2

2. 2 2007/08 - Drivers in NHSL Emergency Response Centre (ERC) Will establish closer working arrangements between the Scottish Ambulance Service, NHS 24, Out of Hours services and NHS Lanarkshire to provide a more integrated emergency service Get the patient to the right place first time Multi agency Referenced in BHBC

3. 3 More about the ERC Pilot Project for emergency GP referrals Developed in 2007 and 2008 Implemented in November 2008 Monitor and evaluate over 2 /3 years Establish evaluation baselines Multi agency evaluation criteria and performance indicators

4. 4 Work in NHSL over the last year Service demand review - SAS/NHS24/OOH SAS emergency call review Review of inter hospital transfers (IHT) by SAS Review of trends in emergency admissions Emergency care workforce planning - A&E activity review

5. 5 What we have learned Is hospital based info fit for purpose? –e.g. referral source type and recording –e.g. diagnosis and outcome Multi agency systems tell us different things (but fit for own purpose) –No direct linkages across the systems –Multi agency systems do not always reconcile Gaps in the information that is required –e.g. routine recording of GP emergency referral phone contact

6. 6 What we need to do – high level Need to understand before we act –How choice is made – which queue to join –Steps in and out of the emergency pathway –Outcomes Suggestion - first steps to do this …….. –Produce a composite matrix of what information is available to each agency –Comprehensively link patient flow data across individual agency systems – use proxy measures where necessary –Beneficial to link datasets at national level

7. 7 NHSL High Level Demand Matrix

8. 8 Some Current NHSL Work Catchment Management Perspective - GP Practice Level Who goes where and why? Opportunities for re-aligning emergency flows –to alleviate pressures Using Building Blocks –e.g. 98 practices, 9/10 localities, 2 CHPs, 3 acute hospitals, 12 SAS stations Compare standardised attendance & admission rates –Benchmark nationally Utilise NAVIGATOR –Emergency admission and bed day rates

9. 9 Annual Demand in NHSL Contacts with NHS24/OOH - C 130,000 SAS emergency incidents - 65,000 A&E attendees - 190,000 Acute emergency admissions - 55,000

10. 10 NHSL Recent A&E Trends - 1

11. 11 NHSL Recent A&E Trends - 2

12. 12 NHSL Recent A&E Trends - 3

13. 13 NHSL - SAS IHT Trends