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A&E performance

Published: 19 Jan 2016 10:10

Weekly figures published.

Scotland's A&E departments have dealt with what is likely to be the most demanding week of the year, yet performed better than the same week 12 months ago, figures published today show.

A&E performance for the week ending January 10 was nearly five percentage points better than 2015 - up from 83.5 per cent to 88.3 per cent. This reflects recent trends as the four hour performance for the 10 weeks up to 10 January 2016 was 93.7 per cent, up 5.1 percentage points from 88.6 per cent during the equivalent period last year.

The number of people spending eight or 12 hours in A&E has also been reduced. During the week ending January 10 there was a 39 per cent reduction in patients spending over eight hours in the department compared to the week ending 11 Jan 2015. For 12 hours, this reduction was 58 per cent.

Health Secretary Shona Robison said:

"This is a time of substantial increased pressure on our NHS. We know from previous experience that these weeks are always the period when the performance of our A&E departments are affected most significantly.

This week's figures show just how much A&E performance can fluctuate, not only from week to week, but also from hospital to hospital, particularly at this time of year. This first week of the year came after a four day public holiday, and we know that also impacts on performance the following week.

"Our clear focus is now on supporting boards and hardworking staff to ease pressure across the system. We have already invested some £10.7 million to help cope with extra winter demand and we have been providing expert support for boards where required.

"However, while we expected the first week of a New Year to be challenging, our NHS, from A&E departments to wards and community services, has worked together to delivered a marked improvement from last year. I would like to thank the efforts of our front line staff who have made this possible.

"The figures show many health boards have improved on last year – in particular some of those where there has been the greatest pressure. For example, NHS Greater Glasgow & Clyde has been extremely busy but is still 6.6 percentage points better than last year.

"NHS Borders and NHS Grampian must be congratulated for significant improvement, with rises in performance - 12.1 percentage points and 9.5 percentage points respectively.

"This isn't just a short lived improvement for one week – in fact our NHS staff have delivered sustained progress on the four hour performance since May 2015."

Dr Martin McKechnie, Royal College of Emergency Medicine Vice President for Scotland said:

"RCEM Scotland has worked closely and productively with the Scottish Government and other Colleges and key partners over recent years.

"There are clear indications that this work is improving many aspects of care for acutely ill and injured patients presenting to Scotland's Emergency Departments. Although there will be dips in performance at this time of year, often due to factors beyond the control of Emergency Departments and their staff, the performance of every service active in delivering this care over the last few months has been consistently better than the previous year, and with a five percentage point improvement on the most recent week their efforts and dedication are reflected in this improvement.

"Although early days, the six key strategic actions and linked winter guidance, which RCEM Scotland were instrumental in developing, does seem to be having positive effects on flow and patient care as a result. This is particularly true when you look at the relative performance across the rest of the UK as compared to Scotland."

Derek Bell, President of the Royal College of Physicians of Edinburgh said:

"The fact that the performance in Scotland is almost five percentage points better than the same week last year and has been maintained at this relative level of improvement over the festive period is cause for cautious optimism. The Unscheduled Care Six Essential Actions Programme has only been in place since spring last year and this early progress needs to be built upon by placing even greater focus on the linked principles."

Notes to editors

Scotland remains in a strong position on improvement when compared to other UK countries. Latest figures from NHS England show their performance at core sites in November at 87 per cent was lower than our performance this week, which is likely to be one the most challenging of the whole year.

Over the 10 weeks to 10 Jan there has been a 66 per cent reduction on those staying in A&E for more than eight hours and a 72 per cent drop in those there over 12 hours.

The national team have run several events and workshops to share good practice and learn from Boards. The team have continued to offer support and advice across a range of sites including GGC, A&A, Lanarkshire, Lothian, Fife and Highland. This year the winter plan incorporated the six essential actions and there is a common understanding and agreement that this will support a safe, quality, person centred approach to patient care.

Example of the key actions being progressed at site level:

  • Working with management team to review all current flow initiatives and identify areas for improvement / extension.
  • Working alongside improvement team on responses to pressures to reduce delays, support fast recovery and increase resilience.
  • Supporting local teams to facilitate discharges and transfers of care earlier in the day.
  • Supporting implementation of the A&E Capacity Management Guidance, facilitating sharing of best practice and offer support.
  • Working with the senior management team around the format of capacity and safety huddles.
  • Working with senior charge nurses and medics to eradicate the acceptance of delays.
  • Introduction of Check, Chase and Challenge (CCC) Methodology to identify opportunities for same day discharge and other opportunities to maximise discharges on the following days.
  • Developing pro-forma to ensure the bed managers are able to consider the appropriateness of discharge queries and supporting lead nurses to identify and use capacity in downstream and offsite beds.
  • Preparing discharge targets by ward.
  • Exploring the use of discharge lounges.
  • Exploring current bed management process.
  • Working with support services, for example, porting, cleaning, pharmacy, diagnostics, services to facilitate support at peak times.

The Scottish Government is funding the six 'Essential Actions' to improve Unscheduled Care which aim to minimise long waits in A&E and assessment units by improving patient flow throughout all areas of the hospital and community. These are:

  • Each major site will have a management team made up of a hospital manager and a senior doctor and senior nurse with the autonomy to manage all patient workload – elective and emergency. This is to ensure that each patient is seen by the right person at the right time in the right environment. This team will be expected to manage the internal and external clinical relationships and work with the new Integrated Joint Boards to improve patient care links.
  • Each hospital will develop a balanced elective and emergency patient capacity management plan. That will be used to manage patient flow 365 days of the year.
  • Patient rather than bed management – empowering and enabling specialty teams to get the right balance between patients arriving and being discharged each day, including weekends.
  • Improving patient flow between emergency departments and acute medical and surgical units and downstream specialty wards.
  • Focus on primary and secondary care seven day services that maintain people in their own home and promote early appropriate discharge.
  • Realign existing services across primary and secondary care to safely maintain patients in their own home.