Setting the sceneDerek Bell

Doing the simple hard wellas

Opposed to intellectual easyother wise known as navel gazing

How do we approach unscheduled care

• Demand – Is it increasing

• Patients older but ……….• Systems we design

• Access to care – Confusion between single point of access– Streaming of care

• Variation in care – Not patient driven – System driven

• Weekend outcomes • August outcomes• Xmas and Easter ?

– Poor performing systems respond poorly under pressure

The approach to demand• It’s a surprise• The patients are different

– It’s the weather– It’s the flu – It must be something

• Scotland is different

• While in this paradigm we will not move forward and worse may move backwards

• Need to – Continually improve our systems to improve patient flow– Monitor capacity and demand

Demand and capacity Predictableincrease in demand

Issue is matchedCapacity

Matched response ?

?

The approach to capacity

• We need – More staff– More facilities e.g. beds– More money

• Have we aligned our systems– Services compete for limited resources – Little evidence of joined up action– Do we plan staffing to meet demand - NO

Overall admissions

We need to sort out scheduled care ?

We need to sort out medical scheduled as well !

Scheduled and unscheduled care are NOT competitive

4hr access target

• 4 hr target is a barometer of the ‘whole system’ response to unscheduled care– No better measure at present– Not a quality measure

• Poor systems are variable by day and month– Will exhibit 12 hour breaches

How

• High volume changes designed to improve care for the majority– Collaborative but ….• Organisational memory

– Who now is still doing this job?

• Projectitis– Look at bespoke projects

Community

Hospital

The patient journey ?All parts need to work

04/22/2023 DBell Acute Medicine

Better Acute Care in Lothian

PrimaryCare

SecondaryCare

Summary• Need to develop an action plan which is

– Practical– Agreed and delivered by all agencies– Does simple hard– Starts with high volume quick wins– Develops a medium term strategy– Avoids projectitis

• incurable disease– Scotland is a small country

• Delivered so far but …….. • Still has reserve capacity if used well• Now aim for added value and quality