NHS Scotland redesign of urgent care: second national staging report

Appendix L: - Recommendations Gathering Views

Recommendations

This section of the report sets out recommendations based on what participants have told us during the Gathering Views exercise. These recommendations are not ranked in order.

Access to transport and travel

People's ability to access the care and treatment they need through the redesigned urgent care service may be limited if they need to travel to a treatment centre. However, this is not a new issue for people and should have been considered by those delivering services.

Transport and travel to services will remain an issue when delivering health and care services and this underpins the need for good engagement and involvement of people and communities in the design and delivery of services.

With the redesign of urgent care services consideration should be given to additional travel that may be required to access any treatment centres which is more than people would have had to travel if using A&E.

Recommendation NHS Boards to:

• engage and involve people and communities in the design and delivery of redesigned urgent care services to ensure that they mitigate against creating further inequalities to accessing services, and
• consider additional cost and access issues for who may need to travel further to treatment centres, particularly people living in remote and rural areas and develop plans for mitigating against these issues.

Data sharing between organisations

Some people who participated highlighted the need for their personal data to be shared across services to reduce the need for staff to ask the same questions.

Many people spoke about their reluctance to use this service. Some people who had experience of using the service highlighted their frustration that outcomes did not fulfil their expectations.

Recommendation

Scottish Government, in partnership with all health and care services to:

• promote data sharing between organisations and services to ensure people receive positive and clear outcomes from accessing the redesign of urgent care pathway through 111.

Define urgent and emergency health care services

It is clear from the findings that people have a limited understanding of the definition of urgent and emergency care, which resulted in confusion around when to access the new service for accessing urgent care.

Recommendation

NHS Boards and Scottish Government to look at how to:

• clarify definitions of urgent and emergency care, and
• liaise with relevant national organisations and community groups, to provide targeted information to support people to understand when to access urgent care, including next steps in the pathway.

Describe the pathway for accessing urgent care through the 111 service

People raised some concerns that derived from them feeling they did not have a full understanding of the pathway and whether this new urgent care service would replace existing services.

People also said they experienced difficulty understanding the automated service and felt the options did not cover their specific need.

Recommendation

NHS 24 and NHS Boards to ensure that people have:

• clarity regarding where they are in their care pathway
• a clear explanation about the next steps in their treatment
• an understanding of the call handler role in terms of knowledge base, and
• an awareness of the timescales involved.

NHS 24, NHS Boards and Scottish Government to:

• explore ways in which the automated processes can be improved, including the offering of translation services.
  

Equality and Diversity

People said they were not confident their needs would be understood and accommodated when using the urgent care service. In particular, people who participated highlighted the need for translators and for call handlers to explain things slowly and clearly.

Recommendation

NHS Boards and Scottish Government should:

• further explore and understand the process from the perspective of specific protected characteristic groups.
• inform clear guidance on the process in line with NHSScotland Interpreting, Communication Support and Translation National Policy, and
• consider developing guidance with the support of the participants from the Gathering Views exercise.

Public Health Scotland and Scottish Government should:

• monitor potential inequalities in usage of the 111 service to consider whether new or existing barriers should be addressed.

NHS 24 and NHS Boards to:

• offer quick access to interpretation and translation services to those who require this support.

Provide support to people receiving care when accessing urgent care through the 111 service

Many people told us that carer support, both paid and unpaid status, would help them access the urgent care pathway in its entirety. Almost half of those who completed an equality monitoring form termed themselves as an unpaid carer. Although the actual number of unpaid carers living in Scotland is not known, recent polling suggests that number could have since grown to over a million during COVID-19, representing approximately a fifth of the population of Scotland.

People also told us they would find it supportive if they were asked if they required specialist support in the initial call and this support was provided throughout their consultation.

Recommendation

NHS Boards, NHS 24 and Scottish Government to consider:

• the need for people to have carer support with them, if required, throughout the redesign of urgent care pathway, and
• detail prompt questions within the relevant guidance/initial assessment that allows the need for support for the caller to be identified and provided.

Promote person-centred care

Many people reported the positive difference it makes to them when healthcare professionals connect with a compassionate approach.

Recommendation

Scottish Government, in partnership with NHS Boards and NHS 24 to:

• work together to ensure the principles of person-centred care are embedded throughout the urgent care service, for example, consider further training and staff induction opportunities.

Reduce barriers in accessing technology

People told us about barriers they may have in accessing the new service for urgent care as they have no/limited access to broadband services or the knowledge and understanding to use the devices required.

Recommendation Scottish Government to:

• identify ways through the Connecting Scotland initiative to remove challenges about using technology to allow people to access urgent care through 111.