NHS Ayrshire and Arran - redesign of urgent care - pathway finder programme: rapid external review

Purpose and background

Purpose

To provide a rapid external review (the Review) of the implementation of the Redesign of the NHS Ayrshire and Arran (A&A) Urgent Care Programme Pathfinder site to inform decisions on the national roll-out, anticipated start date: 1 December 2020. The key focus of the Review has been on monitoring preliminary issues and impacts of this transformational redesign across all care sectors within NHS A&A, which seeks to help inform and advise on early learning to be shared throughout Scotland.

Background

The Redesign of Urgent Care (RUC) programme seeks to promote significant transformational change in how optimal urgent care can be delivered for the people of Scotland. The programme offers a number of potential benefits in modernising our wider urgent care (unscheduled care) pathways, but also carries implementation risks, which need to be recognised, addressed and mitigated.

It is acknowledged that not all Boards were in the same state of readiness as NHS A&A to undertake urgent care reform. Initial issues reported and considered by the Redesign of Urgent Care Strategic Advisory Board (chaired by Calum Campbell, Chief Executive NHS Lothian and Angiolina Foster, Chief Executive NHS 24), include: sustainability of local GP Out of Hours (OOH) services, Covid-19 hubs and clinical assessment centres (CACs). The potential longer-term impact of changing public access and use of urgent care services within in-hours periods may impact on increased service demand for NHS 24. These issues are considered within this report.

In preparation for the RUC programme all territorial Boards, NHS 24 and SAS have been conducting detailed and regular readiness assessments for many weeks and these have been scrutinised in detail by Scottish Government (SG) officers. In addition, SG officers have been meeting each Board on a weekly basis to discuss in detail plans and issues arising. Weekly meetings of all Board RUC implementation leads are also taking place to share learning, plans, issues and solutions.

The Cabinet Secretary for Health and Sport examined several options offered to her in October 2020 and concluded that a local pathfinder approach should be undertaken, rather than immediate national full or partial roll-out in all Boards. NHS Ayrshire and Arran (NHS A&A) was agreed to be the founding pathfinder site, implementing the full specification of the redesign programme from 3 November 2020, onwards. It is envisaged that roll-out of the RUC model will take place throughout Scotland, in early December 2020, if deemed safe and appropriate by SG to do so. Learning and experience arising from the NHS A&A pathfinder continues to be assimilated and disseminated to all Boards in Scotland, on an ongoing basis.