Unscheduled Care National Event

1. Unscheduled Care National Event John Connaghan, Director for Health Workforce & Performance

2. 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

3. 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 management • Discharge and internal transfer processes and Management • Delayed discharges

4. % of Patients meeting 4 Hour Standard in Accident and Emergency against Accident and Emergency Attendances July 2013 - June 2014 RELATIONSHIP 42% Of the variation in A&E Performance reflected in the variation in A&E Attendances And performance tends to be worse when Attendances are lower (Winter) Source: ISD:Scotland Emergency Care Waiting Times

5. % of Patients meeting 4 Hour Standard in Accident and Emergency against Total Acute Bed Days lost to Delayed Discharge July 2013 - June 2014 RELATIONSHIP 75% Of the variation in A&E Performance reflected in the variation in Bed Days lost to Delayed Discharge Source: ISD:Scotland Emergency Care Waiting Times and Delayed Discharge (Bed Days Lost)

7. 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 funding • Using technology and assets • Supporting choice and improving quality of the care sector • Workforce development and culture • We have targeted £5 million investment to those facing the most significant pressures

8. 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

9. % 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)

10. 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 – Scotland • REF: National Report into Health Service Performance: Canada 2014

11. 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

12. Capacity: Staffing Staffing: Against demand, Correlation with performance

13. We must be prepared for winter…..