Unscheduled Care National Event

John Connaghan, Director for Health Workforce & Performance

Key Messages

• Improving unscheduled care is fundamental to ensuring patient safety

• Investment of £25 million in central funding over 2013/14 and 2014/15 to support improvements through LUCAPs

• UC Performance and Long waits over 8 / 12 hours improved over winter

• We NEED to achieve sustainable performance against the 4 Hour A&E target

• Last winter better than previous winter

• This summer worse than last summer

• Number of contributing factors preventing sustainable performance, for example:

Hospital based capacity planning and managementDischarge and internal transfer processes and

Management Delayed discharges

% of Patients meeting 4 Hour Standard in Accident and Emergency against Accident and Emergency Attendances

July 2013 - June 2014

Source: ISD:Scotland Emergency Care Waiting Times

42%

Of the variation in A&E Performance

reflected in the variation in A&E

Attendances

RELATIONSHIP

And performance tends to be worse when Attendances are lower (Winter)

% of Patients meeting 4 Hour Standard in Accident and Emergency against Total Acute Bed Days lost to Delayed Discharge

July 2013 - June 2014

Source: ISD:Scotland Emergency Care Waiting Times and Delayed Discharge (Bed Days Lost)

75%

Of the variation in A&E Performance

reflected in the variation in Bed

Days lost to Delayed Discharge

RELATIONSHIP

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 00%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

14.2%

20.2%

20 May to 11 Aug 2013 19 May to 10 Aug 2014

A Scottish Hospital: cumulative hourly hospital inpatient discharge profile, 19 May to 10 Aug 2014Proportion of hospital discharges completed (excl. same-day non-emergency admissions and non-admitted ED* attendances), %, by hour of day, nNote: results are intended for management information only; transit areas considered out of hospital wrt discharge

What we are doing to improve unscheduled care

• We have allocated £8.2 million LUCAP funding • We have established a delayed discharge task

force, in partnership with COSLA, and agreed four immediate pieces of work, around:Assessment and fundingUsing technology and assetsSupporting choice and improving quality of

the care sectorWorkforce development and culture

• We have targeted £5 million investment to those facing the most significant pressures

Boards must …• Work collaboratively with local authority

colleagues• Improve capacity management on site by site

basis• Discharge a minimum of 40% of total daily

emergency discharge numbers before noon• Increase weekend emergency discharge rates to

levels much closer to your weekday rates• Commitment given in LUCAPs to get to

95% in September & prepare for winter

 

% of Patients meeting 4 Hour Standard in Accident and Emergency Core Site Departments, by UK Country, July 2013 - June 2014

Sources: ISD:Scotland, NHS England, NHS Wales Informatics Service, Department of Health, Social Services and Public Safety (Northern Ireland)

Imagine a Land……..

• Where waiting times are guaranteed• Where 90% are treated start to finish within 18 weeks• Where 98% are given an operation within 12 weeks• Where over 90% are seen within 4 hours at A&E• Where reports are publicly available • Where reduction in HAI and the key performance

measures are all positive

Fortunately this land already exists – ScotlandREF: National Report into Health Service Performance: Canada 2014

Imagine a Land……..

Performance Comparisons:

Accident and Emergency:93% to 94% within 4 hours (Scotland)90% within 30 hours (ADM), 90% within 7 hours (NADM)

Impatient Waiting Times:98% within 12 weeks (TTG) (Scotland)60% to 90% within 26 weeks for hips/knees (Canada)Unlimited waits for others

Capacity: Staffing

Staffing: Against demand, Correlation with performance

We must be prepared for winter…..