NHS Scotland redesign of urgent care - first national staging review report: 1 December 2020 – 31 March 2021

8. Person Centred Redesign

Equitable access for all citizens is central to the RUC Programme. An Equality Impact Assessment (EQIA) of the national policy consulting with relevant stakeholders to assess the potential impact this service change has been undertaken and will be published following the election period.

A number of engagement exercises have been carried out:

Discovery Project:

This was undertaken to understand the needs, motivations and potential issues that self-presenting citizens accessing urgent and emergency care may encounter, with a specific focus on the impact the change in service may have on vulnerable citizens.

The research suggests utilising digital alternatives to ED attendance may create additional barriers for vulnerable groups. Suggested actions to mitigate this include: improving digital access; improving telephone services for those with language barriers; ensuring call handlers are trained to support equitable care; targeting national messaging at vulnerable groups and ensuring collaborative working with partner agencies.

The analysis performed suggests that those who encounter little or no difficulty interacting with current urgent care services may experience benefits from the changes including:

• Accessing medical consultation from the comfort of home
• Scheduling visits to the hospital around care responsibilities
• Access to local specific information hubs
• Avoiding or minimising the discomfort of attending A&E
• Minimising risk of infection
• Minimising crowding in waiting areas
• Avoiding unnecessary travel and the cost of transport
• Source of reassurance

Broader public engagement is planned by Healthcare Improvement Scotland (HIS) Spring/Summer 2021 to support the co-design and communication strategy. This work will concentrate on equalities-related engagement gaps identified in the EQIA focusing on protected characteristics and marginalised communities to deepen understanding of potential enablers and barriers to accessing urgent care services.

The Community Engagement's network will collate comments and experiences from across Scotland to provide local, regional and national perspectives. A range of methods are planned including focus groups, interviews, questionnaires and events. Findings will be available by June 2021.

An RUC Citizens Panel will be established in Summer 2021 focusing more widely on general population, to explore the redesign of urgent care including the service configuration, barriers to access, and opportunities for improvement.

Recommendations - Person-Centred redesign

• Patient experience should be part of the planned external evaluation.
• Establish a process to collect more standardised locally and centrally available patient experience data
• Boards to ensure they have the appropriate privacy statements and DPIAs in place which are clear and transparent about how personal information is used reflecting that patients may be contacted to discuss their experience.
• Ensure processes are in place to continually consult with those likely to experience barriers to care to shape, refine and improve pathways to better meet citizen's needs, mitigate against harm and minimise inequalities and inform national programme approach.