CHILDREN AND YOUNG PEOPLE’S HEALTH SUPPORT GROUP Unscheduled Care Helen Maitland National Lead

4 Hour Emergency Access Standard No patient should spend longer than 4 hours between arriving at the A&E unit and admission, discharge or transfer, unless there are stated clinical reasons for keeping the patient in the unit. This time limit also applies to other emergency care in minor injury or illness units or areas of assessment units where chairs and/or trolleys are used e.g. if a patient is referred by a GP to an acute medical/surgical unit (see definition of AMU) and is placed on a chair/trolley they should be included in the standard.

Interim Milestone 95% of patients will wait less than 4 hours from arrival to admission, discharge or transfer for accident and emergency treatment by year ending September 2014

* July Local Management Information only

Winter 2009 Winter 2011 Winter 2012 Winter 2010 Winter 2013 Winter 2008 Winter Planning

Flow Management Whole System Acute Patient Flow Whole System Patient Flow Scheduled Care Unscheduled Care Flow 1 – Minor illness injury Flow 2- Acute Assessment Flow 3 – Medical Admissions Flow 4 – Surgical Admission Health & Social Care Acute Care

Unscheduled Care Governance Group Unscheduled Care Expert Group (Chair: Richard Carey) UCEG: In Hospital (Chair : Gerry Marr) UCEG: Out of Hospital (Chair: Pauline Howie)

Local Unscheduled Care Action Plan (LUCAP) Identify changes and improvements across a whole system approach focussing on: –Getting emergency patients to the care they need –Promoting senior decision makers –Assuring effective and safe care 24/7 –Making the community the right place –The primary care response

LUCAP Process June 2013 Guidance issued on development of Local Unscheduled Care Action Plans Board Exec Unscheduled Care leads identified July 2013 Health Boards submitted LUCAP including winter planning arrangements National meeting of Board Exec leads Self Assessment Guidance issued August 2013 Submitted LUCAPs reviewed and feedback given Funding awarded and allocated

Interlinking trio Demand Management –Changing or re-channelling demand –‘how and why people demand health care’ Capacity Management –Response to demand –Organisation has capability to respond to demand –Decisions re allocation of key resources Organisational Performance –Depends on ability to match capacity with demand Jack and Powers, IJOMR, 2009

Demand Management Current service pressures OOH service at risk of delivery –Recruitment and retention incentives Integration/ close working with ED’s Links with NHS 24 SAS see and treat Anticipatory Care Planning

Capacity Management Surge Capacity, including Contingency Plans Beds in the right place Acute beds for acutely ill patients Development of Community Services including Rehabilitation Pathways, Palliative Care etc. Improved Assessment pathways

Organisational Performance Sustainable performance depends on ability to match capacity with demand First contact in care is a measure of effectiveness of healthcare (in reducing morbidity and mortality) Non acute care should shift services from hospital -based to community based Provision of highly specialised and acute emergency care is efficient and effective

Matching Capacity and Demand

Reducing A&E Attendances HEAT (T10) - by 5 % by year end 2014 Milestone 7: Develop specific actions to reduce dependence by parents on A&E for routine advice, care or treatment for children. Analyse pre and post 5 years old attendances with minor illness / injuries. Analyse correlation between access to general practice in-hours and attendance at T10 sites and if so, engage with general practice teams to improve urgent access Engage with partners in review of protocols / algorithms to reduce the number of referrals to A&E for minor conditions Work with public health, CHPs, PFPI representatives and others to develop information for parents and carers on how to access appropriate services. Give practices and health visitors information on child frequent attenders to enable them to determine the cause for attendances and establish what action, if any, is required of them.

Reducing Emergency Admissions National Indicator: Reduce proportion of people aged 65 and over admitted as emergency inpatients 2 or more times in a single year Whole System Approach Every patient is seen by the right person, at the right time, in the right place.. every time 17

Emergency admissions rate per 100,000 population by age group for Scotland

Potential Causes of Short Term Admissions -on arrival at ED Decrease in exposure to (and training for) triage of children with potentially serious illness during general practice training Decrease in hospital clinician’s ability to triage effectively or to accept risk Lack of availability of a Senior Decision Maker to offer second opinion Increase in decision to admit rather than further observe in order to reach 4Hr LoS waiting time standard 19

Next Steps National event 27 th Beardmore Explore reasons for attendances and most appropriate pathway for care Ensure efficient and effective assessment with appropriate senior decision maker Discharge is provided when patient fit and ready Whole system approach is a reality 20