NHS recovery plan: progress report 2023

Urgent and Unscheduled Care

We remain committed to delivering sustainable improvement to A&E waiting times however despite a significant focus on maximising our NHS capacity, performance remains below the expected level. Scotland’s core A&Es have been best performing in the UK for 8 years and in the latest month (August 23) were 8.8 percentage points higher than England. This shows the challenges we are experiencing are similar across the country.

Our Urgent Care Collaborative approach

We are seeing improvements through our Unscheduled Care Collaborative approach, which is being driven forward by the Centre for Sustainable Delivery (CfSD) where they are working with NHS Boards to develop local which focus on 5 key recovery areas:

• Improving urgent care pathways in the community and improving links across primary and secondary care.
• Ensuring patients receive the right care in the right place by optimising Flow Navigation Centres and increasing the routes for professional-to-professional advice and guidance, signposting and scheduling of appointments to A&E where possible.
• Improving access to Hospital at Home services by supporting Boards and partnerships to adopt evidence-based best practice.
• Optimising assessment and care in our Emergency Departments by improving access to ‘same day’ services, the use of early and effective triage, rapid decision-making and streaming to assessment areas.
• Reducing the time people need to spend in hospital by promoting early and effective discharge planning and robust and responsive operational management.

Innovative approaches to Urgent and Unscheduled Care

Avoiding the need to attend A&E is frequently better for people who need urgent treatment, and therefore we are committed to providing alternative to A&E attendance. The Redesign of Urgent Care worked across organisations and multi-disciplinary teams to develop an alternative to unnecessary attendances at A&E for those who self-present. Offering a route for sign-posting and redirection, NHS24-111 service offers rapid clinical triage directing patients to the most appropriate care. Flow Navigation Centres have been established which offer rapid access to clinical assessment either virtually or in person and scheduled, as far as possible. Throughout the year we have been focussing on enhancing access the interface between professionals across the system such as those working in care home or the Scottish Ambulance Service to further prevent unnecessary attendance to A&E.

The combination of services has significantly contributed to reduced attendance, with self-presentations during the latest 12 months (up to August 23) at Emergency Departments down by over 92,000 (around 11%) compared to pre-Covid levels. NHS 24 have undertaken significant recruitment and planning which has seen an improvement in call answering time which means patients are getting the care they need quickly and safely.

NHS 24 helps to ensure that patients are directed to the most appropriate source of support as quickly as possible and manage referral to local services within NHS Boards where needed, and the Recovery Plan supports improved NHS 24 call handling times. NHS 24’s planned recruitment aim of 200 new staff by the end of March 2023 has been exceeded, with over 250 new staff members recruited. Its rolling recruitment programme continues, and includes call handlers, clinical supervisors, MH practitioners, and Psychological Wellbeing Practitioners.

NHS 24 have also been holding open recruitment events to promote their current clinical and call handler vacancies, with a longer-term view to successful recruitment and retention of high-calibre candidates. These events have had a very positive reception and the Service reports that they have successfully recruited candidates via engagement which in turn, supports improved call handling times for the Service.

We are supporting our ambulance service through enhancing our Scottish Ambulance Service (SAS) specialist practitioner workforce. The SAS Integrated Clinical Hub is embedded as part of the chain of response to calls from 999 and NHS 24, and SAS are optimising its clinical and operational effectiveness.

We are continuing to manage ongoing pressures on acute care by expanding our Virtual Capacity across the country exceeding our commitment to increase bed capacity by 150 beds per day. Over 2023/24 we are investing over £15 million towards maximising our Hospital at Home capacity Throughout the year we have been focussing on expanding virtual capacity across Hospital at Home Older People; Respiratory Rapid Response Pathway; and Out-patient Parenteral Antibiotic Therapy (OPAT). Heart Failure and Paediatric pathways will come on stream this winter (23/24).

Through the Hospital at Home Older People’s service, between April and June 2023 we provided acute level care at home to nearly 3,500 people, avoiding an admission to an acute hospital ward - this is a 34% increase on the same period last year. On average, Hospital at Home is the busiest geriatric medicine ward in Scotland with an average of 265 patients a day with a maximum of 296 patients managed on the busiest day.