Unscheduled Care In Cardiff &Vale

Taking A Whole Systems Approach to Emergency & Urgent Care.

Context Drivers for Change

National Policy

Local Framework for Delivery

A New Integrated Service Model

Policy Landscape

Designed for Life 2005

Regional Clinical Service Strategy

Reforming Emergency Care DH 2001

Taking Healthcare to the Patient DH 2005

National Audit Office Report 2006

WAG Developing Emergency Care Services (DECS) 2005

Unscheduled Care Framework

Access Assessment Intervention

Access – how does a patient with a need for urgent care access those services both remotely (e.g. by phone) or walk up (e.g. by A&E) and what sort of responses should they get ?

Assessment – once the patient is in contact with the urgent care services, how should there needs be most appropriately assessed ?

Intervention – once the patients needs have been assessed, interventions should match their needs i.e. appropriate care in an appropriate location.

Current Model (Access) Highly Efficient ! Multiple access / entry points (remote & walk up) Limited case completion / referral Uncoordinated Audit Fragmented & risk intensive Expensive

Current Model (Assessment) Multiple Assessment Criteria

Uncoordinated – critical information not shared between providers (Lamming 2003)

Limited IM&T and management linkage between providers

Limited continuity of information for clinicians in every sector

Current Model (Intervention) Limited use of pre - hospital alternatives & direct

referral to community based services

AMPDS - No Category C pathways

Limited use of ECP, ENP & allied professionals

A&E is the default

Improvements Sought… A model that maximises the strengths of existing

providers and infrastructure Earlier case completion in the unscheduled care

pathway (remote & walk up) Care delivered closer to home Improved signposting (remote & walk up) Safe & clinically driven Better integration of providers (in & out of hours) Common assessment Value for Money Single point of access ??

New Model (Vision) Patient & pathway focussed Strong clinical leadership at every level Enhanced use of pre- hospital alternatives, cat c,

community based services, ECPs & UCCs Integrated & educational (multidisciplinary team

approach) R&D platform Clear access criteria and working protocols between

providers Appropriate Intervention Reduced dependency on hospital admission Cost effective & cost saving

Outcomes Managed demand Improved Access, Assessment and Intervention Better case completion at first contact Maximised use of existing providers and infrastructure

(IM&T / Estate / People) Better integration between providers & professionals -

NAO 2006

Improved workforce & educational development Improved performance (in all sectors)

Key Priorities Clinical engagement and leadership in the new service model

Education & training priorities for skillspool

Governance and accountability framework

Assessment Process

IM&T

Information sharing

Pathway development

Conclusion / Next Steps Consultation with wider health community

Agree strategic direction

Integrated into PHSI

Detailed commissioning and transition plan

Implementation overseen by PHSI & UCB

Thank YouMark Ellis, NHS Regional Emergency Care Lead

mark.ellis@valeofglamorganlhb.wales.nhs.uk