Unscheduled care is a term used to describe any unplanned and urgent health or social care. It ranges from emergency hospital treatment to help for individuals to care for themselves at home. Other examples of unscheduled care services include 999 ambulance services, or booking an urgent or emergency appointment with a GP.

The system of unscheduled care meets a vast range of needs and demands, providing some form of help around the clock often when people are extremely vulnerable. The public think highly of certain unscheduled care services and value the highly skilled professionals working within the system. Nevertheless, the disjointed pattern of unshceduled care services can result in inefficiency, uncertainty and delays. The system is complex so that people are uncertain about how and where to seek help, often resulting in people unnecassarily calling 999 or attending a hospital emergency department. Part of this uncertainty stems from the wide range of different access points within the system which can lead to people accessing numerous services for the same care need, or accessing a level of service which is higher than is appropriate for their need. For example, a person suffering a minor injury may have a choice of attending an emergency department or minor injury unit, going to see their GP, phoning NHS Direct Wales or caring for themselves.

Further uncertainty stems from the variation in services available at different times of the day and night, at weekends and in different parts of Wales. The range of services can even be confusing for professionals. The report found that services are sometimes slow to respond or do not interact effectively.

Whilst it is a basic requirement of the current system that some form of help is available around the clock, the report found that the system is particularly disjointed during the out-of-hours period.

A fundamental weakness in the current planning of unscheduled care is that there is limited understanding of demand for services. More effective prevention work, particularly through community pharmacists, the use of telecare which links people in their homes with their clinicians and chronic conditions management, could reduce some of the demand that services currently face. Demands on emergency departments and the ambulance trust can be managed by preventing unnecessary ambulance journeys and helping people to access alternative services to emergency departments when their needs could be more appropriately met elsewhere.

Encouragingly, the report also found that the Assembly Government and local organisations are now giving a higher priority to improving unscheduled care. In particular, a national vision exists through the Primary and Community Services Strategic Delivery Programme, whose conclusions are consistent with the findings of this report.

The report, Unscheduled care: developing a whole systems approach, makes a number of recommendations:

• The new health boards should take the lead in studying and redesigning the system of unscheduled care. They must plan with a good understanding of demand for services.
• The new health boards should match their staffing to meet demand.
• The Assembly Government should develop a national communication strategy to help the public understandhow best to access unscheduled care services.
• The Assembly Government should help health and local government organisations join-up their information systems across health and social care.

Auditor General for Wales, Jeremy Colman, said today:

“Delivery of unscheduled care will not improve unless it is seen and planned as a whole system. Making the system easier for the public to use and linking up the current services more effectively are more important than focusing on access to particular parts of a disjointed system.”

Notes to Editors

• The report looks at whether there has been sufficient progress in the planning and delivery of unscheduled care from people’s perspective.
• The recommendations in this report should be considered alongside the recommendations made in previous reports on the ambulance service, patient handovers and NHS Direct Wales.  Appendix  2 of this report provides details of these.
• The Wales Audit Office is independent of government and is responsible for the annual audit of some £20 billion of annual public expenditure. Its mission is to promote improvement, so that people in Wales benefit from accountable, well-managed public services that offer the best possible value for money. It is also committed to identify and spreading good practice across the Welsh public sector.
• The Wales Audit Office was created in April 2005 through the Public Audit (Wales) Act, 2004, which expanded the functions of the Auditor General for Wales and enabled the transfer of staffs from the Audit Commission in Wales and National Audit Office in Wales to his employment.