NHS Scotland redesign of urgent care: second national staging report

2. Background

The focus patient population for the RUC programme is a sub-group of patients who historically self-presented to A&E services (includes Emergency Department (ED) and Minor Injuries Unit (MIU)) who may be safely managed through patient pathways with alternative entry and exit points to health and care services. The RUC programme has been developed at pace during the COVID-19 pandemic.

The RUC pathway (Figure 1) aims:

• To increase care nearer to home for patients and carers
• To convert some unscheduled care activity to planned care activity
• To reduce patients who self-present to A&E services
• To reduce overcrowding in A&E services

The RUC pathway includes 3 main Interventions:

• Public messaging to encourage patients and carers to use NHS 24 111 more frequently including routine working hours
• Increase capacity in NHS 24 111 service to:
  • manage increased demand and
  • create appropriate options and pathways for patients including to FNCs.
• Establish new local FNCs to:
  • help navigate patients to most appropriate local services and provide rapid access to a SCDM by phone or digitally to provide self-care advice or as necessary onward referral.

To inform the development of the new pathway, the Scottish Government explored different UK and international models, including Denmark^[4] and the RUC SAG (Appendix A) was established to lead the development of a conceptual model tailored for NHS Scotland.

NHS Ayrshire and Arran ^[5] acted as a pathfinder board to test the conceptual model. Followed by the First RUC National Staging Report (December 2020 to March 2021)^[6] reviewing progress after the RUC pathway based on a minimum specification was 'soft' launched nationally on 1 December 2020 (Appendix B).

The evaluation programme is overseen by the RUC Evaluation Advisory Group (EAG) (Appendix C) which reports to the RUC SAG.

This Second National Staging Report covers the period April 2021 – September 2021.

An independent external evaluation is being commissioned by Scottish Government during 2022. This will focus on the experience of staff, patients, and carers using the RUC pathway and will include economic impact and return on investment.

The RUC Programme is provided by the Health Performance and Delivery Directorate, Scottish Government under the wider Urgent and Unscheduled Care Programme which aims to deliver the 4-hour emergency access standard by; reducing attendances, reducing admission and length of stay and optimising discharge. The Urgent and Unscheduled Care programme now aligns to the work plan of the Centre for Sustainability Delivery (CfSD).

CfSD aspires to be an internationally recognised centre of excellence, promoting and embedding best practice through a 'Once for Scotland' approach and enabling redesign programmes to support a sustainable health and care system which is aligned with the priorities of the Scottish Government.