Unscheduled and Emergency Care
Introduction and background
Unscheduled care covers unplanned care ranging from patient attendance at A&E and minor injuries units; urgent telephone advice sought in and out of hours; emergency hospital admissions; paramedic services; and emergency mental health or social care provision.
The unscheduled care system needs to be a safe, efficient and integrated service to provide effective points of access to appropriate NHS, primary, secondary, community, or social services.
The NHS Wales Annual Operating Framework sets out the Welsh Assembly Government's expectations of the NHS for unscheduled care services of a consistently high quality, regardless of where, when or how people contact the service.
Some key aims are to:
- reduce the number of people seeking unscheduled care with an emphasis on prevention and health promotion;
- ensure that those people requiring unscheduled care receive a high quality service; regardless of where, when and how they use it;
- ensure effective care pathways are in place so that the right treatment is provided in the right place by the right person, with the right skills at the right time.
Policy Context
The Delivering Emergency Care Services (DECS) strategy 2008 guides the focus on unscheduled care services in Wales. It encourages organisations to collaborate more closely and effectively with healthcare and social care partners to improve the levels of unscheduled care for patients.
What are we doing now?
Unscheduled care services face considerable pressure and the NHS is making improvements to how patients are triaged through the system. People call 999 with a variety of problems, from lifethreatening health emergencies and serious mental health incidents to serious-butnot- life-threatening incidents/events such as falls and minor health issues.
The range of services that might best meet these needs is not yet in place. A more comprehensive and systematic service could provide accessible, responsive, high quality urgent care services that substantially reduce demand for hospital services.
For example some 20% of 999 calls relate to patients who have fallen – direct access to a community falls assessment and treatment service could provide a high quality, safe service to a significant number of these people in their own homes, improving both the patient experience and reducing cost.
For example some 20% of 999 calls relate to patients who have fallen – direct access to a community falls assessment and treatment service could provide a high quality, safe service to a significant number of these people in their own homes, improving both the patient experience and reducing cost.
Service Planning
Demand is high and ensuring patients get the most appropriate care according to their need is critical. The 5-Year Service, Workforce and Financial Strategic Framework includes an unscheduled care programme which looks at efficient management of all unplanned care.
NHS organisations are required to develop Local Delivery Plans (LDP) which demonstrate a clear vision for unscheduled care in their area together with a set of clear actions for its delivery. An example can be seen below:
Service Delivery
Primary Care and GP Services in and out of hours
The primary healthcare team is organised around General Practitioner (GP) practice populations.
In Wales 97% of GP Practices offer access to an appropriate member of the primary care team within 24 hours of a request for an appointment.
Members of the primary healthcare team are skilled in managing a wide range of conditions and possess skills central to the delivery of a modernised unscheduled care service. Nurse practitioner led triage and minor injury/illness services based in GP practices are available in many areas.
- Hywel Dda Health Board Out of Hours Services
- Cardiff and Vale University Health Board Out of Hours General Medical Service
- Powys Teaching Health Board Out of Hours Services
Community Pharmacists provide a network of pharmacies and have a role in providing advice and helping people manage their medication. Community Pharmacists have a developing role in the provision of near patient testing, an important element in the management of people suffering from chronic conditions.
You can find more information on GP practices and Community Pharmacists in the Services Directory below:
Ambulance Services
Ambulance services in Wales are provided by the Welsh Ambulance Services NHS Trust. The Trust provides accident and emergency services, pre-hospital emergency treatment and care, urgent patient transfer, response to major incidents and non-emergency patients transport services to a population of nearly 3 million people.
NHS Direct Wales
NHS Direct Wales is a nurse led telephone advice and information service. In addition to this role it provides a call handling and triage service for three GP Out of Hours services and four A&E departments, and a dedicated Dental Helpline for a number of Local Health Boards.
Minor Injuries Units
Minor injuries units (MIUs) provide treatment for less serious injuries, such as sprains, cuts and grazes. Many people go to Accident and Emergency (A&E) with minor injuries, when they could be usually treated much more quickly at a minor injuries unit. In A&E staff must give priority to serious and life-threatening conditions, so if you go there with a minor injury, you may have to wait longer to be seen.
Accident and Emergency Departments
Major A&Es are defined as those departments providing a consultant led 24-hour service with appropriate resuscitation facilities and designated accommodation for the reception of accident and emergency patients. These departments must provide the full range of services required at all times.
Social Services
In Wales 22 Local Authorities are responsible for:
- Planning social services for people who live in their area
- Delivery of social services, including supporting people to live independent lives
- Providing personal care and support with the activities of daily living
- Protecting people from harm
There is a partnership role with other organisations, including health, police and housing to provide these services. Within our Local Authorities, social services have a major role in protecting the most vulnerable people in the community. They provide care and support to children and young people, older people, people with mental health problems, learning disabilities, physical disabilities and sensory impairments.
Mental Health Services
Crisis resolution/home treatment services offer a rapid response for adults who are experiencing a mental health crisis in the form of assessment and, where appropriate, support and treatment for a brief period as an alternative to hospital admission.
Initiatives
Health Challenge Wales is the national health improvement programme which focuses on six themes that contribute to ill health. Often this ill health is the result of lifestyle choices and can therefore be prevented if people change their behaviour. Take a look at our advice under the themes that are important to you.
The Expert Patients Programme (EPP) provides a number of self-management courses and workshops for people living with any long-term health condition. These courses provide an opportunity for people to learn new coping skills, which can help improve the quality of daily life. The aim of the EPP is to give participants the confidence to take responsibility for their own care, whilst also encouraging them to work in partnership with health and social care professionals.
Telemedicine (also referred to as telehealth) covers the remote monitoring of physiological data e.g. temperature and blood pressure that can be used by health professionals for diagnosis or disease management. Examples of telehealth devices include blood pressure monitors, pulse oximeters, spirometers, weighing scales and blood glucometers. Telehealth also covers the use of information and communication technology for remote consultation between health professionals or between a health professional and a patient e.g. providing health advice by telephone, videoconferencing to discuss a diagnosis or capturing and sending images for diagnosis.
The Individual Health Record is the ‘cradle to grave’ lifelong record that is held in GP systems. For the first time the important information from this record is being made available to support safer emergency care, beginning with Out of Hours doctor services and means that the healthcare staff caring for patients when the GP surgery is closed will have access to key information to support vital decisions. In time it is beeing extended to provide wider access to all clinicians.
Resources
Publications
The Welsh Ambulance Service NHS Trust document Time to Make a Difference outlines a modernisation plan for Ambulance Services and NHS Direct Wales.
Statistics
The latest National Statistics on the ambulance service performance in Wales are produced by the Welsh Assembly Government .
- Ambulance Services August 2010
- Ambulance Services July 2010
- Ambulance Services June 2010
- Ambulance Services May 2010
- Ambulance Services January 2010
- Ambulance Services, February 2010
The latest statistics on Time Spent in Accident and Emergency Departments produced by the Welsh Assembly Government were released on 21st October 2010 according to the arrangements approved by the UK Statistics Authority.
The latest statistics on calls to NHS Direct Wales produced by the Welsh Assembly Government were released on 4 August 2010 according to the arrangements approved by the UK Statistics Authority.
