Safely Reducing Avoidable Conveyance Programme

Urgent Care Pathway Improvement Programme

Brief Description of Initiative

The programme is designed to develop new and improve existing Urgent Care Pathways, and to enable SCAS clinicians, both mobile and in the community, alongside our current integrated urgent care services (Operational and in the Clinical Co-ordination Centres 999 and NHS 111) to have improved visibility and accessibility to appropriate urgent care pathways for our patients.

Date Initiative was introduced in Trust

June 2019.

Date of upload or review

Uploaded to Repository 1st January 2020.

Background Context

SCAS clinical strategy seeks to set out by patient need/condition the best practice pathway allowing us to better tailor our care and support to patients. This is in line with the Integrated Urgent & Emergency Care (IUEC) plan as defined by NHS England, NHS Five Year Forward View 7 Pillars, and SCAS 5 Year strategic plan and delivery of NHS fundamental standards.

There are a number of important NHS documents that have highlighted a specific requirement for Ambulance Services to provide improvements to integrated models of care, with clear referral pathways offering alternatives to conveyance, including:-

  • Taking Healthcare to the Patient: Transforming NHS Ambulance Services
  • The ECP Report – Right Skill, Right Time, Right Place
  • The NHS Five Year Forward View
  • Transforming Urgent and Emergency Care Services in England
  • Next Steps on the NHS Five Year Forward View
  • Lord Carter review : Operational productivity and performance in English NHS Ambulance Trusts: Unwarranted Variations

Wholesale system improvements to enable visibility and access to appropriate urgent care pathways for our staff has the potential to change the journey of over 14,000 patients every year within the SCAS network. This will directly improve the care they receive as well as their overall clinical outcome.

Which specific patient group or presenting need is this response targeted at?

The programme is not limited to any one specific patient cohort.  There have been priorities given to large patient groups where there are significant benefits for referring patients to hospital and community services. The below list is not exhaustive:

  • Medical Referrals
  • Surgical Referrals
  • Acute Frailty & Fallers
  • Respiratory
  • Mental Health
  • Paediatrics
  • Nursing and Care Home Residents
  • Early Pregnancy / Maternity
  • Gynaecology
  • Diabetes
  • End of Life /Palliative Care
  • Drug/Alcohol Support
  • Bladder/Bowel/Continence
  • Cancer/Haematology
Geographical area or location covered by this response model

All areas and demographics across the SCAS footprint.

Key Aims
  • Improvement in the quality of patient care and experience
  • Improved patient outcome
  • Improved patient safety
  • Support the delivery of both NHS and SCAS clinical plans and strategies
  • Improvement in See & Treat events
  • Reduction in See Treat and Conveyance to Emergency Department events
  • Improvement in See Treat and Conveyance to Non-Emergency Departments events
  • Cost efficiency savings to SCAS and to the local health economy
Benefits for Patients
  • Improvement in the quality of patient care and experience
  • Improved patient outcome
  • Improved patient safety
Benefits for Trust or System
  • Reduced Emergency Department investigation and treatment tariffs
  • Reduced inpatient costs
  • Enhanced integrated working relationships with local care system partners
  • SCAS reputation as a as a leading Ambulance Trust nationally with NHS England, other Ambulance Trusts, locally with care system partners/services and our patients.
  • Supports the delivery of National NHS Plans & delivery of NHS fundamental standards.
  • Supports the delivery of SCAS 5 year clinical strategic plan
  • Greater availability of clinicians to be respond to subsequent incidents
  • Conversion of a greater number of Cat 3 & 4 Incidents to See & Treat or See & Convey to Non-ED
Implementation

1.      How long has this initiative been operational?

Since June 2019.

2.      Days / Hours of operation:

N/A.

3.      Which clinicians are involved in the response and how many WTEs (if a specific cohort)?

The programme team currently consists of x7 WTE staff. All bar the Project Manager are clinicians:

  • Programme Manager
  • Project Manager
  • Area Leads x4
  • Programme Administrator

4.      Which other partners are involved in providing the response?

N/A.

5.      What other key resources are needed for this response to work? (vehicles, specific equipment etc)

N/A.

6.      How is the initiative funded? (level of engagement/support from CCGs etc)

Mainly, internally funded by SCAS.

MiDoS and part of the delivery team was part funded through the STPs, (licence, the database administration, 50% of three of the leads and the administrator).

7.      What were the main facilitators / blockers / interdependencies when introducing this response?

  • Supported by CCGs
  • Needs engagement with local Acute Hospital Delivery/Operational Groups who are largely supportive of the programme
  • Challenges have come from some Service Providers who don’t have the capacity to support SCAS Clinicians referring directly to their department/service.
Evaluation & Monitoring

1.      What are the key success measures?

  • Positive Patient Surveys
  • Positive Patient Stories
  • Improved/Increased See & Treat
  • Improved/Increased Convey to Non-ED
  • Improved/Reduced Convey to ED

2.      How are these being measured / collated / monitored?  (frequency / who reported to etc)

  • Monthly reporting into SCAS Executive Team
  • Monthly reporting through SCAS contract CCG

3.      Has a formal evaluation process been undertaken (independent / inhouse)?

Current ongoing internal monitoring and evaluation taking place – Formal review is being done later this year to evaluate the initial year’s progress & benefits.

4.      What are the current findings in terms of the success measures?

There are several initiatives across SCAS which are by design expected to impact on the key measures expected by this programme.  It is therefore difficult to establish the direct attribution of this programme to improvements made in the key conveyance rates.

However, In the first 5 months of the Programme the team established the existence of or set up new pathway access to 65 services.  This continues to rise month on month.

Sustainability

1.      Does the Trust intend to continue with this response for the foreseeable future?

  • Awaiting formal review

2.      What long-term resourcing requirements are there?

  • Awaiting formal review

3.      What risks have been identified (for patients / Trust / system) in providing this service and how have these been mitigated?

  • Failure of the project to meet the key objectives for reducing calls cycle times, increasing non conveyance to emergency department and increasing conveyance to non-emergency department.
  • Clinical risk to patients with pressure on staff to utilise urgent care pathways instead of conveying patients for ongoing assessment at an Emergency Department – Mitigated by utilisation of new Clinical Governance guidance.
  • Loss of Clinicians from operational duties during project phase reducing resilience and requiring post(s) to be back filled from current clinician pool – Mitigated by potential savings in incident cycle time and reduced time lost at acutes.
  • No cost efficiency savings made to call cycle times and incentive based tariffs if existing pathways are not used effectively or new pathways are not developed – Mitigated by training and regular communication and engagement with staff, commissioners and service providers.
  • Lack of system partner engagement resulting in minimal or no improved access to existing and new pathways – Mitigated by regular engagement with commissioners and services providers.
  • Inability for local service providers to resource new pathway initiatives due to capacity and increased demand – Mitigated by identifying appropriate gaps in pathway provision and collaborative working with partner agencies.
  • Lack of engagement from SCAS clinicians to use existing and new pathways – Mitigated by training and regular communication and engagement with staff.
  • Damage to organisational reputation caused by failure to implement proposals – Mitigated by development of strong team within the UCP Project.

4.      Is there potential to expand this response model?

N/A.

Sharing & Learning

1.      What has the Trust learnt most from introducing this process?

Awaiting formal review.

2.      What might be done differently with the benefit of hindsight if implementing again? (in another part of the trust for example)

Awaiting formal review.

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Please note, this enquiry facility is for the use of NHS colleagues to find out about the set up of this initiative. Patient enquiries about a case or care experience need to go direct to the relevant ambulance NHS trust.

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