Post on 02-Jan-2016
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Unscheduled Care National Event
John Connaghan, Director for Health Workforce & Performance
Key Messages
• Improving unscheduled care is fundamental to ensuring patient safety
• Investment of £25 million in central funding over 2013/14 and 2014/15 to support improvements through LUCAPs
• UC Performance and Long waits over 8 / 12 hours improved over winter
• We NEED to achieve sustainable performance against the 4 Hour A&E target
• Last winter better than previous winter
• This summer worse than last summer
• Number of contributing factors preventing sustainable performance, for example:
Hospital based capacity planning and managementDischarge and internal transfer processes and
Management Delayed discharges
% of Patients meeting 4 Hour Standard in Accident and Emergency against Accident and Emergency Attendances
July 2013 - June 2014
Source: ISD:Scotland Emergency Care Waiting Times
42%
Of the variation in A&E Performance
reflected in the variation in A&E
Attendances
RELATIONSHIP
And performance tends to be worse when Attendances are lower (Winter)
% of Patients meeting 4 Hour Standard in Accident and Emergency against Total Acute Bed Days lost to Delayed Discharge
July 2013 - June 2014
Source: ISD:Scotland Emergency Care Waiting Times and Delayed Discharge (Bed Days Lost)
75%
Of the variation in A&E Performance
reflected in the variation in Bed
Days lost to Delayed Discharge
RELATIONSHIP
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 00%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
55%
60%
65%
70%
75%
80%
85%
90%
95%
100%
14.2%
20.2%
20 May to 11 Aug 2013 19 May to 10 Aug 2014
A Scottish Hospital: cumulative hourly hospital inpatient discharge profile, 19 May to 10 Aug 2014Proportion of hospital discharges completed (excl. same-day non-emergency admissions and non-admitted ED* attendances), %, by hour of day, nNote: results are intended for management information only; transit areas considered out of hospital wrt discharge
What we are doing to improve unscheduled care
• We have allocated £8.2 million LUCAP funding • We have established a delayed discharge task
force, in partnership with COSLA, and agreed four immediate pieces of work, around:Assessment and fundingUsing technology and assetsSupporting choice and improving quality of
the care sectorWorkforce development and culture
• We have targeted £5 million investment to those facing the most significant pressures
Boards must …• Work collaboratively with local authority
colleagues• Improve capacity management on site by site
basis• Discharge a minimum of 40% of total daily
emergency discharge numbers before noon• Increase weekend emergency discharge rates to
levels much closer to your weekday rates• Commitment given in LUCAPs to get to
95% in September & prepare for winter
% of Patients meeting 4 Hour Standard in Accident and Emergency Core Site Departments, by UK Country, July 2013 - June 2014
Sources: ISD:Scotland, NHS England, NHS Wales Informatics Service, Department of Health, Social Services and Public Safety (Northern Ireland)
Imagine a Land……..
• Where waiting times are guaranteed• Where 90% are treated start to finish within 18 weeks• Where 98% are given an operation within 12 weeks• Where over 90% are seen within 4 hours at A&E• Where reports are publicly available • Where reduction in HAI and the key performance
measures are all positive
Fortunately this land already exists – ScotlandREF: National Report into Health Service Performance: Canada 2014
Imagine a Land……..
Performance Comparisons:
Accident and Emergency:93% to 94% within 4 hours (Scotland)90% within 30 hours (ADM), 90% within 7 hours (NADM)
Impatient Waiting Times:98% within 12 weeks (TTG) (Scotland)60% to 90% within 26 weeks for hips/knees (Canada)Unlimited waits for others
Capacity: Staffing
Staffing: Against demand, Correlation with performance
We must be prepared for winter…..