NHS 24 and the

Scottish Ambulance ServiceDr George Crooks

Medical Director NHS24 and SAS

A&E - Demand

100

105

110

115

120

125

130

135

140

145

2004/05 2005/06 2006/07 2007/08

(Since introduction of Priority Based Dispatch)

414,000 incidents

332,000 incidents

+25%demand

597,118 incidents in 2008

Cat A Performance 72.3%

Ave response time 6.96 mins

Costs £145M

A&E – Cat A since PBD

A&E – Cat A

100

105

110

115

120

125

130

135

140

145

2004/05 2005/06 2006/07 2007/08

(Since introduction of Priority Based Dispatch)

100

105

110

115

120

125

130

135

140

145

2004/05 2005/06 2006/07 2007/08

Cat A

100

105

110

115

120

125

130

135

140

145

2004/05 2005/06 2006/07 2007/08

Actual Cat A jobs reached on target

64,592

92,440 +42%

86,000

Ambulance demand

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

450,000

2001/02 2002/03 2003/04 2004/05 2005/06 2006/07

Emergency Urgent and planned

Emergency ambulance demand

Emergency 2004/05 2005/06 2006/07

Public 70% 69% 69%

GP 9% 7% 5%

NHS 24 7% 11% 15%

Other 14% 14% 11%

TOTAL 332,474 354,973 397,553

Performance – Air

3500+ missions

Demand up 4.4%

EMRS – separate co-ordination

NHS24 and A + E

Performance2006/07

• Total calls handled: 1,458,464 2006/07

• 8% increase in call volume

• 1,508,597 2007/08

• 3.5% increase in call volume

Typical weekly pattern

Typical daily pattern

11.9%

9.4% 9.7%8.6%

9.3%

26.4%

24.8%

0%

5%

10%

15%

20%

25%

30%

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Typical Weekdays

Typical intraday call arrival pattern

0

50

100

150

200

250

300

350

400

00:00 01:00 02:00 03:00 04:00 05:00 06:00 07:00 08:00 09:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 18:00 19:00 20:00 21:00 22:00 23:00

Time

Monday Tuesday Wednesday Thursday Friday

Typical Saturday

Saturday 9 June intraday call demand

0

100

200

300

400

500

600

700

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

Rate of Contact per 1,000 Population

0 5 10 15 20 25 30

Highland Hub

Western Isles

Shetland

GEMS

ADOC

Dum & Gall

Argyll & Clyde

Lanarkshire

Fife

Borders

Lothian

Tayside

Forth Valley

GMED

Orkney

Health Board Areas

May-07 May-06

Monthly Calls by Age Category

0%

10%

20%

30%

40%

50%

60%

0-5 17.1% 17.1%

6-12 6.3% 6.2%

13-18 5.0% 5.2%

19-65 48.6% 50.0%

Over 65 20.6% 19.6%

No Valid DOB 2.4% 1.9%

May - July 06 May - July 07

1.Monthly DispositionsSpread of Monthly Dispositions

0%

10%

20%

30%

40%

50%

60%

% of Total Dispositions

Nov-07 6.1% 6.0% 54.9% 2.2% 7.6% 1.8% 2.4% 11.1% 1.8% 6.1%

Oct-08 6.1% 5.8% 51.1% 2.1% 6.7% 2.0% 5.1% 10.2% 4.8% 6.3%

Nov-08 6.3% 5.5% 53.4% 1.9% 6.2% 1.8% 4.8% 10.1% 3.6% 6.3%

999 A&EGP within 4

hours

GP within 12

hoursGP routine Pharm. Other Prof. Self Care

Info.

ProvidedOther

NHS Lothian NHS24 Study

Dr M Crooks

• During the out of hours period, there were a total of 2,269 A&E attendances

• 1126 patients self-presented to A&E without prior contact with other out-of-hours services

• 288 had contacted NHS24 and been assigned a disposition leading to A&E attendance, 13% of activity

NHS24 NHS Lothian Study

• 288 patients were advised to attend A&E by NHS24 during this time. A compliance rate of 85%

• 4 self-presented following home care advice from NHS24

Outcome of patients self presenting to A&E (n=1,130)

Admissions Discharges

Male Female Male Female

38 27 589 476

Total = 65 (6%) Total = 1,065 (94%)

A total of 409 patients that self presented to A&E were deemed to have presenting complaints that may have been more appropriately triaged by NHS24. This represents 36% of patients self presenting to A&E during the out of hours period.

Patient Self Care Education

Evidence of Effectiveness: Staywell Empowering Patients

LTCs - National Refractory Angina Centre in Liverpool (NRAC)•First to have quantified the impact of high quality patient education and properly informed treatment choices on hospital admissions. •Study* focused on 271 chronic refractory angina sufferers between 1997 and 2002 • 26% reduction in admissions• 33% reduction in length of stay• £1337 per patient per year saved (£362,440 across their 271 patients)

*A brief Cognitive-Behavioral Intervention Reduces Hospital Admissions in Refractory Angina Patients. Journal of Pain and Symptom Management. Vol 33 No.3 March 2007

Health of the elderly - Gloucestershire Practice, creator of Staywell 75 (paper-based)

Older Persons Emergency GP Admissions

0

5

10

15

20

25

Stayw ell Surgery Average for non-Stayw ell practices in

locality

Surgery

Admissions per 000

2004/05

2005/06