Main Report of the National Review of Primary Care Out of Hours Services

12 Role of the Third and Independent Sectors and other Agencies

Recommendation 24 relates to the future role of third and independent sectors and other agencies

Evidence - third sector

The third sector is a major provider of health and social care services, which is contributed over 24/7. A report on the activities and impact of the third sector was submitted to the Review and is summarised in Annex D in full on the Review website.

The contribution of the third sector is summarised in the Key Facts section, Annex B. In addition representatives of the third sector were actively engaged in the Review process as members of groups, during engagement meetings and at workshops.

The third sector plays a vital role in supporting the people of Scotland, particularly the most vulnerable individuals in our society, who are often frequent users of OOH services. Therefore improving these connections has potential to improve personal outcomes, safety and to have a positive impact on inequalities in health. The need to support and understand the contribution of the third sector is now more urgent, as Health and Social Care Partnerships and Integrated Joint Boards and Scottish Government require information to make more effective and efficient use of all community resources and to develop the intelligence required to plan services.

Evidence - independent sector

The independent sector is also an important provider of residential care services reflected in their submission from Social Care to the Review. This is summarised in Annex D and available in full on the Review website.

Key Facts about the residential care sector can be found in Annex B.

In addition to this submission, the role of the independent sector in OOH services was discussed in workshops and was also flagged by Social Work Scotland in their submission. Several recommendations were offered to the Review including:

• Care homes should be recognised as a legitimate component part of primary care. The Review included it in its definition of primary care.
• Data improvements, better anticipatory care planning, use of telemedicine links, better professional support for care homes, and greater co-working and collaboration - all feature in Review recommendations.

Summary - third and independent sector

In addition to the above response to the independent sector's submission, the following recommendations some of which crossover have been assimilated into Recommendation 24:

• Improve understanding and support for the role of the third sector in OOH services prevention and self management
• Improve national intelligence about the contribution of the third sector to Scotland's Health and wellbeing in both daytime and OOH services
• Explore models of governance in statutory and non statutory organisations to ensure a person-centred safe and effective service
• Health and Social Care Partnerships and IJBs should explore models of funding to the third sector to ensure their agreed contribution to both daytime and OOH services is sustainable
• Improve systems for communication and for connecting both statutory and non-statutory providers of care

Scottish Fire and Rescue Service

Evidence

There is a robust international evidence base for the use of fire services personnel in medical first response incidents - particularly in the USA. In Scotland there has been a significant decline in fire incidents and a growing interest in prevention and medical co-response with the SAS to cardiac arrest incidents in pilot schemes, as part of Scotland's Out of Hospital Cardiac Arrest Strategy (Recommendation 2). Further evidence came from the HM Fire Service Inspectorate Report on Emergency Medical Response and the Scottish Fire and Rescue Service (2014), a series of meetings with Scottish Fire and Rescue Service, and a site visit to a first-responder scheme at Maud. This unit also engages in falls pathways and is highly valued by the community it serves.

Summary

The future role and assets of the Scottish Fire and Rescue Service should have more prominence in relation to health and social care provision, particularly in their prevention, co-responder and first responder roles. This has immediacy for community cardiac arrest events, in close partnership working with the Scottish Ambulance Service. The Scottish Fire and Rescue Service is well placed and willing to contribute further to the urgent care and wellbeing of the Scottish people, beyond their traditional roles. Their potential future contributions to prevention and urgent care provision should be carefully considered, defined and valued - including potential involvement in uninjured falls pathways and extension of first-responder roles.

Royal National Life Boat Institution (RNLI), HM Coastguard and SAS

During the national engagement programme it was noted that in some remote areas of Scotland the evacuation/transport of sick people requiring urgent care or assessment was sometimes difficult. In that instance, RNLI might assist evacuation, in liaison with SAS - where alternative transport arrangements were unavailable or inappropriate, particularly in adverse weather condition. Discussions were held with both RNLI and SAS and it was proposed that where there are working linkages between RNLI, SAS and HM Coastguard, these should be supported by a formal Memorandum of Understanding.

Scottish Prison Service and Forensic Medical Services

The care of prisoners in Scotland transferred from Scottish Prison Service to the NHS in 2011. When exploring issues of resilience in primary care OOH services, a number of views were expressed concerning the use of common GP personnel for OOH services, prisoner care, Police Scotland healthcare and forensic medical services. Issues of insufficient capacity and lack of resilience were raised. Preliminary discussions were held with Scottish Prison Service and with GPs. The Review was unable to pursue this further in the available timeframe and therefore recommends that further work should be considered of these issues. In particular, further exploration should be considered of the potential of remote telehealth consultation, electronic national record linkage (Recommendation 21) and quality assurance of OOH services delivered across Scottish prisons (Recommendation 20). In relation to forensic medical services, a multidisciplinary approach should be considered in keeping with the recommendations for OOH services by the Review, in the context of the National Guidance on the Delivery of Police Care Healthcare and Forensic Medical Services (2013).