Evaluating patient and staff experiences of Scotland’s redesign of urgent care
Picker was recently commissioned by the Scottish Government to evaluate the redesign of urgent care (RUC) pathway. Working with our partners at Healthcare Priority Solutions, we completed a comprehensive review that revealed both successes and challenges in efforts to transform how patients access urgent and unscheduled care. In this blog, lead researcher Dr Esther Ainley describes how people reported positive experiences of the new pathway – and identified continued room for improvement around access and coordination.
Launched in December 2020, NHS Scotland’s redesign of urgent care pathway aims to improve the way members of the public access urgent and unscheduled care in non-life-threatening situations. It encourages people to first contact the NHS 24 111 service in order to better direct them to appropriate support, with the aims of offering the right care closer to home and reducing overcrowding and waiting times in emergency departments.
Our evaluation sought to gain insight into patient and staff experiences of the pathway to find out what is working well and to identify areas for improvement. Understanding patient and staff experiences is essential for building a full picture of service quality: most definitions of care quality include patient experience as a component, and insight from patients and staff verifies the acceptability, sustainability, and person centredness of new interventions.
What is working well?
Patients who successfully accessed the redesign of urgent care pathway after calling NHS 24 111 generally reported positive experiences, particularly in their interactions with staff. For example, 86% said the person they spoke with at NHS 24 111 ‘definitely’ listened carefully, including 95% of those calling on behalf of a child.
The pathway was also effective in reducing waits for some users. When their call to NHS 24 111 led to an appointment being booked at A&E or a Minor Injury Unit, patients reported shorter waits compared to those who attended without an appointment.
Additionally, a high proportion of survey respondents who successfully accessed the redesign of urgent care pathway (82%) felt the number of different services or people that they contacted to get the most appropriate care or advice for their health concern was ‘about right’ and 73% would ‘definitely’ call NHS 24 111 to access urgent care if they had the same health concern at the same time of day or night in the future.
Urgent care staff viewed the development of alternative pathways and increased partnership working between services, particularly with the Scottish Ambulance Service (SAS), as positive outcomes of the redesign of urgent care. Some staff also appreciated the cultural change in how SAS manages patient care due to the redesign.
Challenges to address
While respondents felt elements of the redesign of urgent care pathway were positive, challenges remain. For example, the majority of respondents who ended their call to NHS 24 111 before speaking to someone reported it was because of long waiting times for NHS 24 111 calls to be answered. Around one third of respondents reported waiting more than 30 minutes before ending their call if they contacted NHS 24 111 out of hours.
Patients who successfully accessed the redesign of urgent care pathway also reported less positive experiences regarding how well different services within the urgent care pathway worked together. Only 54% of those respondents that had contacted more than one urgent care service felt they ‘definitely’ worked well together. Further research is needed to understand this finding in more detail so necessary improvements can be made.
NHS staff noted variations between Health Boards in the way the pathway has been adopted. Some highlighted challenges with the implementation of the redesign of urgent care pathway, including an insufficient number of available alternative pathways and/or a lack of capacity within services. Concerns were also raised about the pressures in the wider urgent care system, such as long waiting times in Emergency Departments, which may limit the implementation and impact of the pathway and that highlights the need for a whole system approach to transformation.
Looking ahead
The pathway shows promise in reshaping urgent care delivery for patients and staff alike. Nevertheless, the evaluation has highlighted challenges that should be addressed to maintain the benefits already achieved. Based on the evaluation we presented a set of recommendations for the Scottish Government – notably including that:
- additional support and resources should be put in place to reduce the length of NHS 24 111 time to answer, particularly at the weekend;
- professional-to-professional communication systems should be improved for better coordination across services; and
- Public messaging should continue to inform the public about when to contact NHS 24 111 and when accessing alternative services might be more suitable.
Scotland’s First Minister has recently announced the details of his plan to protect, strengthen and renew NHS Scotland, acknowledging the acute pressures on urgent and emergency care. This includes aspirations for a wider shift from hospital to community to improve capacity and patient care. As part of this, specialised frailty teams will be located at the door of every Scottish A&E department to support vulnerable older patients in receiving the specialist care they need, in the most appropriate setting. This should further improve the system’s options for providing appropriate unscheduled care.
Although the NHS is experiencing challenges across the United Kingdom, this presents opportunities for patient centred reform. Our evaluation shows how insight from patients and staff can be used to assess the impact of reforms, as well as helping to direct future improvement.
The full evaluation reports are now available for public access and can be found here:
