Gathering views on the redesign of urgent care
The Scottish Government asked us to gather information about people's views and insights on the newly designed urgent care service in Scotland.
The Redesign of Urgent Care is a new approach, introduced from December 2020, which helps the public to access the right care in the right place.
This has changed the way in which people access Accident & Emergency (A&E) departments. Instead of direct access to A&E departments for non-life threatening conditions, help is firstly available through calling NHS 24 on 111. The 111 service is available 24 hours a day, 7 days a week for urgent care needs - where conditions cannot wait to be seen at the GP practice. In a life-threatening emergency, people should continue to go to A&E or dial 999. However if they need urgent medical help that is not life-threatening, calling NHS 24 on 111 in the first instance ensures they will be assessed over the phone and referred to the right healthcare professional. This can avoid unnecessary trips to hospital and allow people to access care as close to home as possible. GP practices are also there for urgent care during opening hours.
This new approach presents a unique opportunity to improve access and remove barriers to healthcare.
In May 2021 the Scottish Government commissioned us to collate the views, insights and experiences of people and communities in order to support the development of the redesign of urgent care across NHS Scotland.
We spoke to a total of 55 people and 1 group of mental health practitioners, either by phone or video call (via Facebook Messenger, MS Teams or Zoom). The participants represented groups that are more likely to experience barriers or disadvantage when accessing urgent care services by calling NHS 24 111, including:
- people with addictions
- asylum seekers and refugees
- unpaid carers
- disabled people
- people from minority ethnic groups
- homeless people
- LGBT+ people
- older people, and
- people living in remote and rural locations.
We asked participants 13 questions about their experiences of using the new urgent care service, their feelings about using the service in the future, and how the service might be promoted.
The findings from our engagement activities provide an improved understanding of how any potential inequalities can be addressed and shape the development of the new urgent care service accessed via NHS 24. These findings have been submitted to the Scottish Government for consideration on the future direction of the new urgent care service.
Recommendations
We have identified a number of recommendations that would help people who are likely to experience specific barriers in accessing the new urgent care service.
Access to transport and travel
NHS boards to:
- engage and involve people and communities in the design and delivery of redesigned urgent care services to ensure that they mitigate against creating further inequalities to accessing services
Data sharing between organisations
Scottish Government, in partnership with all health and care services, to:
- promote data sharing between organisations and services to ensure people receive positive and clear outcomes from accessing the redesign of urgent care pathway through 111
Define urgent and emergency health care services
NHS boards and Scottish Government to look at how to:
- clarify definitions of urgent and emergency care
- liaise with relevant national organisations and community groups, to provide targeted information to support people to understand when to access urgent care, including next steps in the pathway
Describe the pathway for accessing urgent care through the 111 service
NHS 24 and NHS boards to ensure that people have:
- clarity regarding where they are in their care pathway
- a clear explanation about the next steps in their treatment
- an understanding of the call handler role in terms of knowledge base
- an awareness of the timescales involved.
NHS 24, NHS boards and Scottish Government to:
- explore ways in which the automated processes can be improved, including the offering of translation services
Equality and Diversity
NHS boards and Scottish Government should:
- further explore and understand the process from the perspective of specific protected characteristic groups
- inform clear guidance on the process in line with NHSScotland Interpreting, Communication Support and Translation National Policy
- consider the development of guidance with the support of the participants from the Gathering Views exercise
Public Health Scotland and Scottish Government should:
- monitor potential inequalities in usage of the 111 service to consider whether new or existing barriers should be addressed
NHS 24 and NHS boards to:
- offer quick access to interpretation and translation services to those who require this support
Promote person-centred care
Scottish Government, in partnership with NHS boards and NHS 24, to:
- work together to ensure the principles of person-centred care are embedded throughout the urgent care service, for example, consider further training and staff induction opportunities
Provide support to people receiving care when accessing urgent care through the 111 service
NHS boards, NHS 24 and Scottish Government to consider:
- the need for people to have carer support with them, if required, throughout the redesign of urgent care pathway
- detail prompt questions within the relevant guidance/initial assessment that allows the need for support for the caller to be identified and provided
Reduce barriers in accessing technology
Scottish Government to:
- identify ways through the Connecting Scotland initiative to remove challenges about using technology to allow people to access urgent care through 111
Impact and next steps
We welcomed the opportunity to engage with the groups identified in the national EQIA and previous discovery work carried out by the Scottish Government Digital Transformation team in November 2020.
We have worked to fill some of the evidence gaps to ensure the new urgent care service considers the recommendations to work towards meeting the needs of as many people as possible. While some recommendations are mentioned in specific reference to one characteristic group, they may also be relevant for others in the general population.
This report has been shared with the Scottish Government. The findings will be used to help inform an evidence base, with a view to the improvement of the new urgent care service for as many people as possible.
We will liaise with the Scottish Government to provide feedback to participants about how the views expressed in this report have been used.
In 2021, the Scottish Government published the third of three reports assessing the Scottish Government’s Urgent & Unscheduled Care – Redesign of Urgent Care (RUC) programme. This report was mentioned within it.
We will use the learning and experience of this exercise including the equalities monitoring information within our work to inform future methods of Gathering Views.
We thank everyone who took part and shared their experiences, thoughts, insights, comments and suggestions. We are very grateful to the organisations who supported us to link with groups and individuals and for the time they gave us to discuss the issues covered in this report.