Priority One. Ensure people receive care at home, or as close to home as possible, where clinically appropriate
Primary and community care is, for many people, the front door to the health service, where their needs are first raised. Each week in Scotland, there are around 680,000 GP consultations, with 28,000 people being seen in our hospital Emergency Departments. The Scottish Government is supporting primary care to provide essential care where it is needed most – in our local communities - with funding for multi-disciplinary teams which has been increased to £170 million this year.
For many, A&E may not be the best place for their healthcare needs and our Urgent and Unscheduled Care Collaborative improvement programme offers patients alternative routes to urgent care. The ‘home first’ approach is not only better for people, but supports acute and primary care services too. This includes expanding Hospital at Home services. The Scottish Government is investing over £15 million in 2023/24 to deliver additional virtual beds this winter, significantly increasing capacity in our system and reducing the need for emergency admissions every week, and of course better for people who need acute care.
Unpaid carers and social care services, alongside other community-based health and social care services, play a vital role in supporting people to live well at home. Ensuring safe, effective person-centred care through an integrated and co-ordinated health and social care approach will be critical year-round but particularly over winter. The use of telecare and digital technology to detect and alert health professionals when a person is needing support is a crucial tool, as is the ability to maximise existing community and third sector supports.
Everyone in need of emergency mental health care must receive that support quickly, and wherever possible, close to home. People presenting with stress and/or distress are often conveyed to hospital when there can be community-based alternatives that support the patient as well as the system as a whole. This will also ensure that people seeking mental health support receive the right care, in the right place, at the right time, regardless of where, or what time of day they present – there should be no wrong door.
The Scottish Government and local government are also continuing to maximise the use of digital tools such as increased use of Near Me in Flow Navigation Centres, Connect Me. Telecare and M365 collaboration to improve our systems and widen access, investing in Pharmacy First and community nursing teams to support people in their communities, and actively managing demand for urgent and unscheduled care to ensure that patients are triaged appropriately and directly.
How we will jointly deliver this priority:
- Proactively support people at highest risk of hospital admission within our communities. Critical to this is the strong partnership working between Integration Authorities and local partner providers and third sector interface, as well as nationally through our engagement with sector leaders which helps us better understand and respond to the pressures and challenges facing the sector.
- Through the actions underway in the Urgent and Unscheduled Care Collaborative Programme, we will improve urgent care pathways in the community including enhanced links across the primary and secondary care interface.
- Work with NHS 24 and Boards to review alternative pathways for people with urgent care needs both in and out of hours. This could include opportunities for Primary Care Multi-Disciplinary Teams (MDTs) to provide resilience to Primary Care OOH teams to address capacity issues and divert care from A&Es, though it is important that community MDTs function both in and out of hours, to reduce unnecessary conveyance to hospital.
- Ensure that Community Pharmacy are able to deliver core services, including NHS Pharmacy First Scotland, both in and out of hours.
- Increase the use of Flow Navigation Centres to reduce avoidable visits to A&E, optimising use of Call Before You Convey and Near Me video consultations. Continue to optimise the roll-out of Near Me for social work and out of hours services.
- Through the SAS Integrated Clinical Hub multi-disciplinary team, undertake a remote clinical assessment of patients to care for people closer to home through self-care advice or referral to other pathways.
- Further expand the Hospital at Home service with an additional £3.6 million of funding to enable people to be treated at home, where appropriate, and to expand access to acute care at home with expansion of Hospital at Home to other specialty areas such as Respiratory, Heart Failure, Paediatrics and OPAT services.
- Involve people and their carers in decisions that relate to their care to enhance choice and control over their support. In hospital, this means engaging with the patient, their families, and carers in hospital discharge discussions to ensure their needs and wants are central to decision-making.
- Develop a data-based understanding of people who return to hospital upon discharge with a care package.
- Drive improvement through the Mental Health Unscheduled Care Network to allow people to access care in the most accessible setting.
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