1. Unscheduled Care In Cardiff &Vale Taking A Whole Systems Approach to Emergency & Urgent Care.

2. Context Drivers for Change National Policy Local Framework for Delivery A New Integrated Service Model

3. Policy Landscape Designed for Life 2005 Regional Clinical Service Strategy Reforming Emergency Care DH 2001 Taking Healthcare to the Patient DH 2005 National Audit Office Report 2006 WAG Developing Emergency Care Services (DECS) 2005

4. Unscheduled Care Framework Access Assessment Intervention Access – how does a patient with a need for urgent care access those services both remotely (e.g. by phone) or walk up (e.g. by A&E) and what sort of responses should they get ? Assessment – once the patient is in contact with the urgent care services, how should there needs be most appropriately assessed ? Intervention – once the patients needs have been assessed, interventions should match their needs i.e. appropriate care in an appropriate location.

5. Current Model (Access) Highly Efficient ! Multiple access / entry points (remote & walk up) Limited case completion / referral Uncoordinated Audit Fragmented & risk intensive Expensive

6. Current Model (Assessment) Multiple Assessment Criteria Uncoordinated – critical information not shared between providers (Lamming 2003) Limited IM&T and management linkage between providers Limited continuity of information for clinicians in every sector

7. Current Model (Intervention) Limited use of pre - hospital alternatives & direct referral to community based services AMPDS - No Category C pathways Limited use of ECP, ENP & allied professionals A&E is the default

8. Improvements Sought… A model that maximises the strengths of existing providers and infrastructure Earlier case completion in the unscheduled care pathway (remote & walk up) Care delivered closer to home Improved signposting (remote & walk up) Safe & clinically driven Better integration of providers (in & out of hours) Common assessment Value for Money Single point of access ??

9. New Model (Vision) Patient & pathway focussed Strong clinical leadership at every level Enhanced use of pre- hospital alternatives, cat c, community based services, ECPs & UCCs Integrated & educational (multidisciplinary team approach) R&D platform Clear access criteria and working protocols between providers Appropriate Intervention Reduced dependency on hospital admission Cost effective & cost saving

10. Outcomes Managed demand Improved Access, Assessment and Intervention Better case completion at first contact Maximised use of existing providers and infrastructure (IM&T / Estate / People) Better integration between providers & professionals - NAO 2006 Improved workforce & educational development Improved performance (in all sectors)

11. Key Priorities Clinical engagement and leadership in the new service model Education & training priorities for skillspool Governance and accountability framework Assessment Process IM&T Information sharing Pathway development

12. Conclusion / Next Steps Consultation with wider health community Agree strategic direction Integrated into PHSI Detailed commissioning and transition plan Implementation overseen by PHSI & UCB

13. Thank You Mark Ellis, NHS Regional Emergency Care Lead mark.ellis@valeofglamorganlhb.wales.nhs.uk