NHS 24 and the Scottish Ambulance Service Dr George Crooks Medical Director NHS24 and SAS

A&E - Demand (Since introduction of Priority Based Dispatch) 414,000 incidents 332,000 incidents +25% demand

597,118 incidents in 2008 Cat A Performance 72.3% Ave response time 6.96 mins Costs £145M

A&E – Cat A since PBD

A&E – Cat A (Since introduction of Priority Based Dispatch) Actual Cat A jobs reached on target 64,592 92, % 86,000

Ambulance demand

Emergency ambulance demand Emergency2004/052005/062006/07 Public70%69% GP9%7%5% NHS 247%11%15% Other14% 11% TOTAL332,474354,973397,553

Performance – Air missions Demand up 4.4% EMRS – separate co-ordination

NHS24 and A + E

Performance 2006/07 Total calls handled: 1,458, /07 8% increase in call volume 1,508, /08 3.5% increase in call volume

Typical weekly pattern

Typical Weekdays

Typical Saturday

1.Monthly Dispositions

NHS Lothian NHS24 Study Dr M Crooks During the out of hours period, there were a total of 2,269 A&E attendances 1126 patients self-presented to A&E without prior contact with other out-of- hours services 288 had contacted NHS24 and been assigned a disposition leading to A&E attendance, 13% of activity

NHS24 NHS Lothian Study 288 patients were advised to attend A&E by NHS24 during this time. A compliance rate of 85% 4 self-presented following home care advice from NHS24

Outcome of patients self presenting to A&E (n=1,130) AdmissionsDischarges MaleFemaleMaleFemale Total = 65 (6%)Total = 1,065 (94%)

A total of 409 patients that self presented to A&E were deemed to have presenting complaints that may have been more appropriately triaged by NHS24. This represents 36% of patients self presenting to A&E during the out of hours period.

Patient Self Care Education Evidence of Effectiveness: Staywell Empowering Patients LTCs - National Refractory Angina Centre in Liverpool (NRAC) First to have quantified the impact of high quality patient education and properly informed treatment choices on hospital admissions. Study* focused on 271 chronic refractory angina sufferers between 1997 and % reduction in admissions 33% reduction in length of stay £1337 per patient per year saved (£362,440 across their 271 patients) *A brief Cognitive-Behavioral Intervention Reduces Hospital Admissions in Refractory Angina Patients. Journal of Pain and Symptom Management. Vol 33 No.3 March 2007 Health of the elderly - Gloucestershire Practice, creator of Staywell 75 (paper-based)