Unscheduled care is a term used in NHS Scotland to describe unplanned health care which is usually urgent or an emergency. This includes services which can be accessed without a prior appointment or can be arranged by NHS 24 or by your GP. In Scotland Accident and Emergency (A&E) departments are the main unscheduled care service.
We are consistently working to improve the performance of A&E departments to ensure that 95% of patients attending A&E anywhere in Scotland are seen, treated and discharged or admitted with four hours.
In 2015 we launched our six essential actions to improve unscheduled care programme. This programme aims to ensure that every patient attending A&E receives high quality, person centred care in the right place, at the right time without unnecessary delays and duplication. These actions were developed in partnership with the Academy of Royal Colleges.
- clinically-focused and hospital management
- realignment of hospital capacity and patient flow
- patient rather than bed management - operational performance
- medical and surgical processes arranged to take patients from A&E through the acute system
- seven-day services targeted to increase weekend and earlier-in-the-day discharges
- ensuring patients are cared for in their own homes or a homely setting
Since the launch of this programme we have delivered significant improvements and have outperformed the rest of the UK for more than four and a half years. Scotland also has the lowest rate of people experiencing long (12 hour) delays in the UK.
To support this work, we brought together a national team, made up of staff with clinical and improvement experience, to work with NHS Boards, hospitals and local teams.
Specifically we are:
- sharing best practice and implementing change through national learning events and regular workshops
- providing external support to improve hospital processes and deliver optimal health care for every patient attending A&E
- providing funding to deliver improvements in unscheduled care and to strengthen capacity
- supporting health boards and partnerships to provide alternatives to A&E, avoiding unnecessary attendance and admissions, and ensuring that patients are discharge as soon as they are fit and ready without delay
- working to improve capacity and capability around the goal of optimally caring for people in their own homes as well as improving performance and capability in our acute hospitals
- making a concentrated effort to bring the whole health system together as one
- we have published emergency department capacity management guidance (August 2016)
- established a local team to support change and innovation
- published testing the emergency department capacity management guidance document within Hairmyres Hospital (June 2016)
- published patient pathways - basic building blocks guidance (June 2016)
- published guidance on the daily dynamic discharge approach to patient care (June 2016)
We formed the Unscheduled Care Programme Board and the Unscheduled Care Advisory Group to deliver the programme objectives. We will also create a series of project and short life working groups to report to the Advisory Group.