Unscheduled Care Improvement

Unscheduled Care Improvement

What is Unscheduled Care?

Unscheduled care (USC) is a term used to describe any unplanned health or social care. The range of USC provision includes support to patients at their home, booking of urgent or emergency GP appointments, 999 ambulance services and emergency department/hospital treatment.

What happens now?

The current USC system can be confusing and complicated to negotiate.

Many people access USC through a route that may not be appropriate to their actual needs e.g. via an emergency department or 999 ambulance service, when they could have visited their GP or remained at their home and had access to community care services. In Wales, a consequence of this has been a significant acute-care focus to USC, often resulting in unnecessary hospital admission, investigations and delay.

USC activity levels can be an indicator of how effective and efficient a health and social care system is. An overreliance on USC suggests a reactive rather than proactive health and social care environment. 
 

What happens next?

In Wales, in recent years, significant changes have been undertaken across the health and social care environment and nationally and locally many initiatives exist that aim to improve clinical outcomes and the patient’s experience. There is a need for a model that follows a step-up approach to USC. The process should facilitate a system of community-based stages of care that assist people to remain safely in the community, whilst supporting a fast, effective and efficient response for life-threatening episodes of care need events.

In 2008, a Welsh strategy document Delivering Emergency Care Services: an Integrated Approach for Delivering Unscheduled Care in Wales (DECS) published recommendations outlining the broad principles of unscheduled care. Two further documents challenged existing views of USC in Wales Setting the Direction-primary and community services strategy and the Welsh Audit Office Report Unscheduled Care Developing a Whole System Approach (2009) focus on service transformation and a whole system approach to USC provision.

Recommendations put forward in good practice guidance produced by the National Leadership and Innovation Agency for Healthcare (NLIAH) suggest that a USC model should; be based upon current best practice; ensure joint working across health and social care; give consideration to the best available model and adapt to the provision of care for each community.

The Way Forward

Draft principles developed by the National USC Programme Board acknowledge that services will be designed to support the delivery of the model through the following key principles:
  • Patients should find unscheduled care services simple to access
  • The care a patient receives should be designed around their specific needs and be delivered by the professional best able to meet the needs
  • Services must have clear specifications and be continuously reviewed to meet the needs of service users.
  • The quality of care should be consistent whether care is provided over the telephone, in a patient’s home or at a fixed location such as A&E.
  • Unscheduled care services should be supported by integrated IT systems which facilitate information sharing and aide to diagnosis.

Services should be cost effective and where appropriate this will be determined by benchmarking.

The National USC Programme Board propose a 10 key steps approach to transform USC services, support key work programmes and reflect the needs of the USC service users and workforce. The aim of the 10 key step principles is to reduce preventable admissions and to make those admissions that are necessary as effective, safe and efficient as possible.

The Ten Unscheduled Care Transformational Steps