CHILDREN AND YOUNG PEOPLE’S HEALTH SUPPORT GROUP Unscheduled Care

1. CHILDREN AND YOUNG PEOPLE’S HEALTH SUPPORT GROUPUnscheduled Care Helen Maitland National Lead

2. 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.

3. 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

4. *July 2013 -Local Management Information only

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

6. Flow Management

7. Unscheduled Care Governance Group

8. 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

9. LUCAP Process

10. 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

11. 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

12. 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

13. 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

14. Matching Capacity and Demand

15. 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.

17. 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

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

19. 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 4HrLoS waiting time standard

20. Next Steps • National event 27th September @ 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