Redesign Urgent Care: paediatric pathway to flow navigation centres - review

Annex 2: Terms of Reference Purpose of the Group

The National Redesign of Urgent Care launched on 1st December 2020 following a Pathfinder at NHS A&A to consider the national impact on patient and staff experience and outcome. An evaluation of this pathfinder site and the national readiness of all boards was undertaken to inform the national roll out and launch date. There was agreement to launch the de Minimis specification to offer the public a single communication message with local variability of services provided at local level in response to their local population needs and demand.

Scottish Association of Medical Directors (SAMD) and Scottish Executive Nurse Directors (SEND) advised Board Chief Executives and the Redesign Urgent Care Strategic Advisory Group that their recommendation was to delay the inclusion of paediatrics in the new pathway as part of the de minimis and allow the process to fully embedded and remove any early delays, waits and bottlenecks across the urgent care system which could negatively impact on this more vulnerable cohort of attendances.

Helen Maitland, National Director of Unscheduled Care, has commissioned a SLWG on paediatrics to give a broader clinical view of these options.

The group will look to agree an optimal pathways of care for Paediatrics – under 12s, and assess the readiness of the system to include this cohort in the referral criteria to the Flow Navigation Centres that will be capable of delivering safe and effective care.

Background

The Redesign of Urgent Care (RUC) programme promotes a significant change in how we best serve the people of Scotland to provide safe and effective urgent and emergency care on a 24/7 basis and supports access to the Right Care in the Right Place.

To inform this decision the Chief Executive of NHS Scotland commissioned a review of the implementation of the NHS Ayrshire & Arran Pathfinder site prior to national roll out of the programme to all territorial NHS Boards throughout Scotland. During this review there have been a number of discussions about optimal children's (paediatric) urgent care pathways and whether the RUC model should include paediatrics in the de minimis specification.

The NHS A&A pathfinder programme has included both adults and children and to date, in its earliest stages, no adverse impacts have emerged; rather, positive public/parent experiences have been reported. These early findings are encouraging but are limited.

Alternatively, some paediatricians and others have expressed a view that a joint adult and children pathway is appropriate and safe to be implemented, as originally envisaged for the RUC programme and currently in place in the NHS A&A pathfinder site.

A critical point here is the capacity and expertise of staff available at local Flow Centres at any given time and the imperative to minimise delay and maximise call- back response times for the urgent care needs of children. Experience from the NHS A&A pathfinder will inform this, but the scope and scale will be different, particularly in the larger territorial Boards. The potential risks and benefits of both single (adult only) and joint (adults and children) options should be fully explored.

A delay in access to a Clinician via NHS 24 /111, while a new system embeds, has been raised as a safety risk for paediatrics and a decision was taken to offer a single national messaging for all adults and children however any contact from those under 12 who requires a face to face contact will be directly referred to ED / MIU within the hour and will not be referred to the Flow Navigation Centre.

The age range of under 12s was agreed to align to the national age range for COVID pathways and current algorithms in place at NHS 24.

Role and Remit of the Group

To consider the optimal pathways of urgent care for Paediatrics – under 12s This will be achieved by:

• considering the evidence of an optimal pathways of care for paediatrics urgent care assessment and the safety of this in Flow Navigation Centre context
• advising on the minimum specification required and assessing the readiness of the pathways, across NHS 24 and nationally against this to include paediatrics in referrals to Flow Navigation Centres
• reviewing data relating to paediatrics needs, capacity and demand to inform next steps and readiness, e.g. data from the pathfinder in A&A

Governance

This SLWG will report its findings to the National Director and the Strategic Advisory Group (SAG). This will inform advice to the Chief Executive NHS Scotland, Health and Social Care Management Board (HSCMB) and ultimately the Cabinet Secretary for Health and Sport to inform decisions and next steps.

Meetings

Frequency: Weekly

Outputs - The group will consider options and make recommendation for next steps.