• Alan Hunter
• 20 September 2018
• Posted in: Healthcare

In Scotland we recognise that planning for urgent care, while it needs dedicated focus and expertise, cannot take place in isolation from planning for both elective and longer term care needs.  This is why we created the Unscheduled Care 6 Essential Actions (6EA) Programme three and a half years ago.  A key component of the 6EA Programme is effective and integrated elective and emergency demand and capacity planning.  Since its introduction, performance stabilised and improved against similar health systems.

To build on this and address both the elective and emergency care challenges, in the Autumn of 2017 we established, with the Academy of Scottish Medical Royal Colleges, the Scottish Access Collaborative to create a whole system framework for planning the improvements we know we need to make across all the interlinked areas of health care.  This has allowed us to bring together a number of separate improvement areas:

• The Six Essential Actions (6EA) Programme for Unscheduled Care
• The Modern Outpatient Programme
• The Whole System Flow Programme
• The Access Support and Performance Team

The Access Collaborative leadership includes patients, NHS Chief Executives, primary and secondary care clinicians, service management leaders and a range of professional bodies.

The core objective for the Access Collaborative is to reach a sustainable balance between demand and capacity in our health service.  The approach is based on six Founding Principles:

1. Patients should not be asked to travel unless there is clear clinical benefit and that any changes should not increase workload for primary, secondary or social care in an unplanned way.
2. All referrals should either be vetted by a consultant/senior decision maker or managed via an agreed pathway/protocol.
3. Referral and destination pathways, including patient self-management options should be clear and published for all to see.
4. Each hospital and referral system should have a joint and clear understanding of demand and capacity and how this matches with unscheduled care pathways and capacity.
5. Clear understanding of access to diagnostics as part of pathway management.
6. Improve metrics, including how we record and measure virtual/telehealth/technology enabled care.

The Collaborative has two main areas of focus.  The first is a series of twelve Specialty Workshop groups which are taking place through 2018/19.  These will provide a series of three design-led workshops for each of the Specialties, where primary and secondary care clinicians, service managers and patients are able to come together and create high level maps of symptom pathways, and then explore current challenges and solutions to these.  The second is a multidisciplinary Combined Action Forum where cross-cutting issues, which cannot be resolved by a single specialty, can be explored and framed into Challenges and action plans.

Current Challenges that have been endorsed by the Collaborative include:

• Waiting List Validation
• Virtual Attendance.
• Enhanced Recovery after Surgery
• Active Clinical Referral Triage (ACRT)
• Team Job Planning

Although many of these Challenges are directed towards elective care processes, the impact that addressing these will have on urgent care is clear.  We know that when patients are waiting a longer time for elective care, many require increased urgent/emergency care.

We also know that if we increased weekend discharge rates to the same level as weekdays for emergency care patients, we would have approximately 300 empty beds on a Monday morning across Scotland.  To say that this would help both elective and emergency care performance is an understatement - we have set this as a priority for all Health Boards this winter.