1. www.ors.org.uk Evaluating Pilot Urgent Care Centres in England: a Case Study Dale Hall Managing Director Opinion Research Services

2. University spin-out company – rigorous but practical Social research: problematic, sensitive, controversial issues 45 social research/IT staff (+ 30 in Call Centre) Qual/Quant, plus modelling, GIS, evaluations, consultations Health, housing, LG, equality- diversity, emergency services Opinion Research Services

3. THE PROBLEM – A&E ATTENDANCES 65% target

4. HERTFORDSHIRE A&E and UCCs Centralising A&E – Watford and Stevenage Proposed network of 7 UCCs – to reduce demand for A&E (by c.65%?) 85% of people can access UC within 20 mins; 97% in 30 mins 2 pilot UCCs – Cheshunt and Hertford 18-month ORS evaluation – concurrent with services

5. HERTFORDSHIRE A&E and UCCs – HINDSIGHT! Complex contract model – public and private partnership High tariff set for UCCs patients Optimistic assumptions re A&E flows and cost-neutrality Evaluation circumscribed  satisfaction But… NHS value for money and patient flows!

6. WHAT HAPPENED? UCC User Satisfaction

7. THE GAMBLE… (Launched in October 2009) Invest £1.4M in pilot UCCs Hope to recoup via fewer A&E attendances No data on patient behaviour – hence 2x18-month pilots Assumption that A&E patients would go to UCC But…other factors…?

8. A&E IMPACT? THE OTHER FACTORS… Patient awareness of UCCs – varied widely initially Location of UCCs relative to A&Es – and patients’ homes UCC opening times (8 to 8) ‘Habit’ of A&E attendance Patient flows from GPs instead – no data available!

9. WHAT HAPPENED? Time of A&E attendances

10. WHAT HAPPENED? “Users UCCs are alternative to…”

11. WHAT HAPPENED? Conditions Treated Sample of 200 cases treated (2 X 100) CLASSIFICATION Green = appropriate Amber = possibly appropriate Red = inappropriate FINDINGS Even combining Green and Amber… Hertford 50% appropriate Cheshunt 44% appropriate Most should have gone to GPs!

12. WHAT HAPPENED? Annual UCC Presentations

13. WHAT HAPPENED? A&E attendances  Nothing? East & North Herts Princess Alexandra Hospital Barnet & Chase Farm Hospitals

14. WHAT HAPPENDED? Impact on A&E attendances East & North Herts Princess Alexandra Hospital Barnet & Chase Farm Hospitals From Feb Feb-July 12-months from October ESTIMATED IMPACT = 9,500 £0.66M

15. THE OUTCOME… Invested £1.4M in UCCs to reduce minor A&Es Neither UCC achieved this sufficiently Both UCCs terminated New focus on access to GP services One much cheaper nurse-led Minor Injuries Unit opened

16. ORS EVALUATION AND INTERPRETATION Secondary Data Primary Data Qualitative Context Specific Measure Understand What/Why Evidence Strategy

17. www.ors.org.uk Dale Hall Managing Director Dale@ors.org.uk Opinion Research Services The Strand, Swansea SA1 1AF 01792 535300 info@ors.org.uk