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Setting the scene Derek Bell

Setting the scene Derek Bell. Doing the simple hard well as Opposed to intellectual easy o ther wise known as navel gazing. How do we approach unscheduled care. Demand Is it increasing Patients older but ………. Systems we design Access to care Confusion between single point of access

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Setting the scene Derek Bell

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  1. Setting the sceneDerek Bell Doing the simple hard well as Opposed to intellectual easy other wise known as navel gazing

  2. How do we approach unscheduled care • Demand • Is it increasing • Patients older but ………. • Systems we design • Access to care • Confusion between single point of access • Streaming of care • Variation in care • Not patient driven • System driven • Weekend outcomes • August outcomes • Xmas and Easter ? • Poor performing systems respond poorly under pressure

  3. The approach to demand • It’s a surprise • The patients are different • It’s the weather • It’s the flu • It must be something • Scotland is different • While in this paradigm we will not move forward and worse may move backwards • Need to • Continuallyimprove our systems to improve patient flow • Monitor capacity and demand

  4. Demand and capacity Predictable increase in demand Issue is matched Capacity

  5. Matched response ? ?

  6. The approach to capacity • We need • More staff • More facilities e.g. beds • More money • Have we aligned our systems • Services compete for limited resources • Little evidence of joined up action • Do we plan staffing to meet demand - NO

  7. Overall admissions

  8. We need to sort out scheduled care ?

  9. We need to sort out medical scheduled as well !

  10. Scheduled and unscheduled care are NOT competitive

  11. 4hr access target • 4 hr target is a barometer of the ‘whole system’ response to unscheduled care • No better measure at present • Not a quality measure • Poor systems are variable by day and month • Will exhibit 12 hour breaches

  12. How • High volume changes designed to improve care for the majority • Collaborative but …. • Organisational memory • Who now is still doing this job? • Projectitis • Look at bespoke projects

  13. The patient journey ?All parts need to work

  14. Secondary Care Primary Care Better Acute Care in Lothian DBell Acute Medicine

  15. Summary • Need to develop an action plan which is • Practical • Agreed and delivered by all agencies • Does simple hard • Starts with high volume quick wins • Develops a medium term strategy • Avoids projectitis • incurable disease • Scotland is a small country • Delivered so far but …….. • Still has reserve capacity if used well • Now aim for added value and quality

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