NHS Recovery Plan: annual progress update

Urgent and Unscheduled Care

Whilst we are taking steps to realise the ambition of delivering more healthcare in the community, we know that some people still require care in an acute setting.

Steps we have taken

Over the last year, we have increased the Emergency Medicine Consultant workforce by 15.9 WTE or 6.1% (from 259.1 as at June 2021 to 275.0 WTE as at June 2022) and the number of Paramedics is up 102 WTE or by 6.4% (from 1,592.4 as at June 2021 to 1,694.4 WTE at June 2022).

We established Flow Navigation Centre’s (FNC’s) to offer rapid access to virtual clinical assessment or arrange a scheduled appointment in person. This service is accessed by patients calling the NHS 24 111 service, who refer patients to the FNC who have access to Minor Injury Units, Assessment Areas, and clinics where appropriate. NHS24 figures show that 10.1% of patients in July were referred to FNC in their Boards, reducing attendances at A&E and supporting people to access the right care, in the right place, at the right time.

Most significantly, we have delivered additional virtual capacity through four priority pathways: Hospital at Home; Respiratory Rapid Response Pathway; Out-patient Parenteral Antibiotic Therapy (OPAT); and Covid Remote Health Monitoring. These pathways supporting our commitment to release 150 beds per day for NHS Scotland, the equivalent of a large district general hospital.

Hospital at Home is now available in 20 out of the 31 Integration Authorities (11 out of 14 territorial Health Boards), which is an increase from 7 in 2020/21.

The OPAT pathway has already saved 45,000 hospital bed days this year and is being further rolled out across Scotland over the coming months. This pathway allows patients to receive intravenous antimicrobial therapy or other complex antibiotic treatment in an out-patient clinic at a time convenient to them, and in some areas even at home rather than as an inpatient.

Box 5: Flow Navigation Centres

As part of the national Redesign of Urgent Care programme, all boards have now set up Flow Navigation Centre’s (FNC’s). The FNC is staffed by a Senior Clinical Decision Maker (SCDM) 24/7 and is there to provide professional to professional decision making support to a number of health and social care and third sector staff. Patients could be given a range of options rather than simply attending A&E. Feedback has been positive with patients indicating they felt reassured and supported and being able to receive an appointment to attend the ED at a quieter and more convenient time for them was also a key theme of feedback received.

The established FNC model is one that ensures there is a system wide approach to improving the delivery of urgent care with specialist clinical expertise available when required.

Source: NHS Scotland redesign of urgent care

We have also allocated £62 million to assist health and social care partnerships in expanding care at home capacity. The current pressures on social care support are caused in part by increased need and acuity. This funding aims to prevent this trend growing by appropriate supporting prevention and early intervention. For example the use of community equipment and Technology-Enabled Care (TEC) can supporting people to maintain or even reduce their care needs. This will also help to ease the pressure on unpaid carers and prevent their caring roles intensifying.

Steps we are taking

We recognise our A&E departments are working under significant pressure and like health services across the rest of the UK and globally the pandemic continues to seriously affect services.

We also recognise that the level of performance is currently unacceptable, and to that end we have received improvement plans from Health Boards with the lowest levels of performance and will be monitoring their progress, and providing assistance where necessary.

Through the new £50m Urgent and Unscheduled Care Collaborative, we are taking forward specific areas of work on an NHS Scotland basis to stabilise and improve performance; and, the Redesign Of Urgent Care programme has worked across organisations and multi-disciplinary teams to develop alternatives to unnecessary attendances at A&E.

A set of 8 high impact changes across the whole-system will support the work of the Collaborative to systematically reduce unwarranted variation, waits and delays ensuring improvement. The high impact changes are:

• Care Closer to Home
• Redesign of Urgent Care
• Virtual Capacity
• Urgent & Emergency Assessment
• Rapid Assessment and Discharge
• New models of Acute Care as a Specialty
• Discharge without Delay
• Community Focused Integrated Care

Steps we will take

Notwithstanding the ongoing pressures, we are determined to improve performance and are working closely with Boards on a number of measures to reduce pressure on hospitals.

In preparation for winter, we are working in partnership across health and social care partners we will build on lessons identified from last winter and the pandemic to ensure we maintain organisational resilience with a whole-system approach. This includes sharing and implementing best practice to deliver business improvement and building capability across NHS Boards including the development of national level contingency options for winter 2022-23. This will enable us to actively monitor and evaluate strategic risks and system pressures to allow timely national-level decision making that is closely coordinated with Health Boards and Social Care partners across Scotland.

We will also continue to work with Health Boards to ensure patients access the right care, in the right place, at the right time, by enhancing work through the Urgent and Unscheduled Care Collaborative.