Gweledigaeth ar y Cyd i Ofal Heb ei Drefnu
Transformational Step: 1
The current USC system
The system is generally disjointed and fragmented between services, within organisations, across sectors such as health and social care, and between professional groups.
There are no comprehensive local visions for how the model should look within each health and social care community, with the current approach too focused on hospital services without fully considering the role of social services and primary care.
- The public are presented with a confusing variety of telephone numbers and different routes into the system
- A huge amount of USC activity happens in primary care general practice with approximately 5.5 million USC encounters per annum in Wales
- There are relatively small flows between other community services and acute hospital services
Health Boards will need to work with local public health and clinical teams to populate a high level service plan with patient flows and high volume and high impact tracker conditions. This will assist in defining services required and provided, moving towards a whole system service, matching capacity to demand (including workforce) rather than an in/out of hours situation.
Access to the USC system needs to be simplified as a large number of unnecessary 999 calls are created due to a confusing system and lack of an alternative to the 999 service.
A new three digit number for when help is needed quickly but is not a 999 emergency should be introduced. This is consistent with the development of Health Board communication hubs and WAST's intention to reduce the number of unnecessary 999 journeys to acute hospital services Safety too will be enhanced by generic processes for identifying genuine 999s at all points of USC access and by learning from similar initiatives
A standard filtering, triage and signposting process whose essential features include:
- Generic telephone answer messages/excellent telephone access (communication hubs providing this for community services)
- Rapid, robust identification and filtering of possible immediately life threatening calls (ILT).
Clinical triage of selected groups at higher risk because of clinical need or where with undue delay, may default unnecessarily to 999 or self-transport to an emergency department. These might include:
- Sick children
- Frail elderly/acute social care problems
- End of life care
- Home visit requests
Lower risk callers will be signposted and where possible scheduled to the appropriate pathway or service. This will reduce annoying duplication and demonstrate increased trust of the patient/carer's judgement while pulling them through the system.