Improving health and social care service resilience over public holidays: report

1 Executive Summary and Key Messages

1.1 Context

In January 2017, the Royal College of Emergency Medicine Scotland ( RCEM) called for a review of the resilience of all urgent care services over public holidays, primarily prolonged Christmas and Easter festival periods, recognising increased pressures on these services. These concerns were also shared by other professionals and organisations.

Recognising these shared concerns, the Cabinet Secretary for Health and Sport announced on 17 January 2017, the Scottish Government’s intention to review the way health and social care services are provided over public holiday periods, in order to improve resilience and sustainability.

Evidence provided shows that there is a range of issues that are common during public holiday periods, including reduced staff availability, making it particularly difficult for health and social care systems to deliver optimal services. Service resilience must be achieved and assured on a continuous basis. Over the Christmas and Easter Festival periods, the availability of mutually dependent and effective collaboration of health and social care services, is both challenging and essential.

Information Services Division, NHS National Services Scotland ( ISD, NSS) has prepared an analysis to support the Public Holiday Review (‘the Review’). Key findings are summarised in Section 3 and detailed in a Supplementary Report on Data Analysis of Service Usage, co-published alongside this Review Report. This provides intelligence on what happens in terms of demand and delivery for health and social care services over the Christmas and Easter holiday periods. It also sets out the available evidence, drawn from national information sources, illustrating what is distinctive about these holiday periods. For example, there is increased prescribing of the most common antibiotics; there are reduced discharges from hospitals; and discharges to care homes are significantly diminished. It can take longer for OOH services to see patients at local Urgent Care Centres (formerly referred to as Primary Care Emergency Centres – PCECs) or for home visits during these public holiday periods.

The Review has examined existing availability of services across health and social care sectors over public holiday weekends. It has sought to address how hospital, community and social care services could be better coordinated and aligned more effectively to optimise patient and carer experience. The proposed recommendations aspire to support individuals, their carers and loved ones, to receive care from the right person, in the right place and at the right time. This includes best use of acute hospital services over public holiday periods and optimising timely discharges with commensurate community support services, where appropriate.

1.2 Key Messages

23 recommendations are offered – a summary list is provided in Section 7 and a full list of these recommendations with detailed rationale, is attached at Appendix 2.

Available and accessible urgent care services over public holidays are under pressure, particularly over the Christmas and Easter festive periods. This is not sustainable and will worsen unless robust measures are taken to promote enhanced, collaborative working practices within and across the health and social care sectors.

Future service design and delivery should be based on best meeting the needs of the public and those who deliver services. This should enable tailored advice, support and self-care where appropriate, and when required, direction to the right service, at the right time.

The recommendations take account of the Independent Review of Primary Care Out- of-Hours Services ^[5] and the Six Essential Actions to Improve Unscheduled Care. ^[6] A number of complementary recommendations are made, to enhance service resilience.

The Review primarily focuses on what can be done to ensure that good working practices and processes are rapidly put in place to ensure that appropriate levels of service are available throughout public holiday periods. The recommendations take account of other relevant Scottish Government policies already in train, for example the Mental Health Strategy. ^[7] These policies are listed throughout the report. In order to secure necessary transformation of urgent and emergency care services, both in and out of hours, they need to be linked together and progressed without delay.

As part of the review process emerging recommendations were shared with services represented on the Review Group ( Appendix 1). Review findings have already been incorporated in 2017/2018 Winter Planning Guidance. ^[8] Going forward, these recommendations should be built into local resilience planning. They should be implemented in collaboration with all health and social care partners, including the third and independent sectors, taking account of the national Health and Social Care Delivery Plan. ^[9] We recognise that effective implementation of these generic recommendations will require adjustment for the particular needs and circumstances of individual areas and localities throughout Scotland.

We considered not only service requirements but also the need to value and support all those who provide health and social care services over public holiday periods, as part of comprehensive workforce planning.

Aside from the specific message regarding integrated local crisis services for people with mental health difficulties, these Key Messages are equally applicable for individuals with urgent mental or physical health problems.

Key Messages for Public Holiday Periods

Transforming urgent and emergency care is of paramount importance for the people of Scotland and for those who provide care for them. In order for people to transfer seamlessly through the care system, rapid and cohesive whole system action is essential.

Key messages:

• Promote community pharmacies as a key resource for supporting self-care and to allow better urgent access to medicines
• NHS 24 should provide enhanced support for:
  - self-management, where appropriate
  - direction to attend and receive the right care service, where needed

• Develop quality assured integrated local crisis services for people with mental health difficulties, if not already in place
• Ensure that sufficient levels and numbers of senior decision makers from all sectors are duty rostered at all times
• Implement timely and continuous access to local infrastructure services within hospitals - including staff duty rotas, pharmacy, information technology, equipment stores and transport
• Instigate proactive discharge planning before public holidays
• Enable clear and timely social care support arrangements for hospitals, care homes and other community based services
• Improve arrangements for enhancing staff uptake of seasonal influenza (flu) vaccine - as well as promoting better uptake in population target groups ^[10]
• Develop and evaluate timely, integrated health and social care urgent care resilience plans on a 24/7, 365 day basis - including winter planning arrangements

• Ensure that partnership and professional organisations are fully engaged in the design and delivery of all planned changes to the workforce
• Ensure that developing national social and primary care workforce plans fully consider the recommendations in this review - including sustainable resourcing