1. Setting the scene Derek Bell
Doing the simple hard well as
Opposed to intellectual easy
other wise known as navel gazing

2. How do we approach unscheduled care
Demand
Is it increasing
Patients older but ……….
Systems we design
Access to care
Confusion between single point of access
Streaming of care
Variation in care
Not patient driven
System driven
Weekend outcomes
August outcomes
Xmas and Easter ?
Poor performing systems respond poorly under pressure

3. The approach to demand It’s a surprise The patients are different
It’s the weather
It’s the flu
It must be something
Scotland is different
While in this paradigm we will not move forward and worse may move backwards
Need to
Continually improve our systems to improve patient flow
Monitor capacity and demand

4. Demand and capacity Predictable increase in demand Issue is matched

5. Matched response ? ?

6. The approach to capacity
We need
More staff
More facilities e.g. beds
More money
Have we aligned our systems
Services compete for limited resources
Little evidence of joined up action
Do we plan staffing to meet demand - NO

7. Overall admissions

8. We need to sort out scheduled care ?

9. We need to sort out medical scheduled as well !

10. Scheduled and unscheduled care are NOT competitive

11. 4hr access target
4 hr target is a barometer of the ‘whole system’ response to unscheduled care
No better measure at present
Not a quality measure
Poor systems are variable by day and month
Will exhibit 12 hour breaches

13. How High volume changes designed to improve care for the majority
Collaborative but ….
Organisational memory
Who now is still doing this job?
Projectitis
Look at bespoke projects

14. The patient journey ? All parts need to work
Community
NHS 24
Ambulance service
GP OOH
GP in hours
Hospital

15. Better Acute Care in Lothian
Secondary
Care
Primary
Care
1/13/2019
DBell Acute Medicine

16. Summary Need to develop an action plan which is Practical
Agreed and delivered by all agencies
Does simple hard
Starts with high volume quick wins
Develops a medium term strategy
Avoids projectitis
incurable disease
Scotland is a small country
Delivered so far but ……..
Still has reserve capacity if used well
Now aim for added value and quality