Setting the scene Derek Bell - PowerPoint PPT Presentation

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Setting the scene Derek Bell

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  1. Setting the sceneDerek 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 • Continuallyimprove our systems to improve patient flow • Monitor capacity and demand

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

  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

  12. 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

  13. The patient journey ?All parts need to work

  14. Secondary Care Primary Care Better Acute Care in Lothian DBell Acute Medicine

  15. 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