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DECIDE TO ADMIT v. ADMIT TO DECIDE: WORKING TOGETHER TO IMPROVE UNSCHEDULED CARE IN NHSSCOTLAND
3. What Are The Problems?
Convention delegates were asked to consider the problem areas and the priorities for action. They were split into seven groups which all followed the same process. They were invited to classify issues under the headings of people, processes, resources and other issues. Common themes were then grouped together and a scoring system applied to identify the priorities for action.
People problems:
These included:
shortages of staff and problems with recruitment and retention
insufficient staff in the right place at the right time
a lack of people trained in emergency care
resistance among some professional groups to change
difficulty in breaking down professional boundaries
people working in isolation
a lack of home care staff
difficulties in developing new roles.
Resource problems:
resources spread too thinly
investment needed to create better support services
competing demands on resources
too few community-based services
investment in training to support new roles
need for improved IT systems
inadequate patient transport systems
lack of beds to cope with peaks in demand
recurring funding needed for successful initiatives
Process problems:
need for a whole systems approach to end fragmentation
competing internal pressures "waiting times versus emergency work"
joined-up working handicapped by separate budgets and diverse lines of accountability
links between primary and secondary care still not strong
agreed pathways of care needed for range of common conditions
focus on achieving targets skewing priorities
lack of shared documentation across systems
different services available in different areas - no consistency
lack of co-ordination between different agencies
Other problems:
unrealistic expectations among public and politicians about what the service can deliver
need for new professional groups to be formed to provide out-of-hours unscheduled care
lack of shared understanding between public, patients and professionals
too much change
poor infrastructure
emergency care does not have high enough priority
lack of shared vision within organisations
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