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Unscheduled Care

Improving unscheduled Care across Scotland is a key ministerial priority for Scottish Government. Through the National Unscheduled Care – 6 Essential Actions Improvement Programme we aim to improve the timeliness and quality of patient care from arrival to discharge from the hospital and back into the community; we aim to ensure that 95% of patients attending A&E anywhere in Scotland are seen, treated and discharged or admitted with four hours, ultimately working towards 98%.  Scotland’s A&E Departments are the best performing anywhere in the UK.  Scotland also has the lowest rate of people experiencing long (12 hour) delays in the UK.  Not with standing these significant improvements we recognise more needs to be done to ensure these successes are sustainable for the benefit of the people of Scotland.  The launch of the new improvement focussed approach in May 2015, based on six fundamental actions developed in partnership with the Academy of Royal Colleges, has supported the progress we have seen in Scotland.  The Six essential actions are:

Over the last year the implementation of the Six Essential Actions has primarily focussed on what was required in the acute sector and through National learning workshops held throughout the year we have shared innovation and best practice across Health and Social Care Partnerships.  We have engaged and supported those Boards with the biggest challenges and have targeted investment to support improvement, which has resulted in Scotland seeing a sustained level of improvement that we will continue to build upon.    

We have published various guidance documents to support implementation of the six essential actions, for example:

In addition, we have published case studies from across Scotland on our website and introduced a monthly Case Study Bulletin in order to share best practice on an on-going basis.

However, we recognise that for us to maintain progress we must increase our whole system focus. This is particularly true given Emergency Departments and Assessment units are facing an ever increasing work load with our ageing population and an increasing numbers of patients are being referred to hospital for further assessment, investigation, treatment and potentially avoidable admission. 


While we will continue to build upon the work we have done over the last year we recognise that we need to increase our whole system focus and augment engagement and alignment of primary, secondary, voluntary and third sector organisations, which are vital if we want to change the system to one that allows each organisation to link seamlessly together and supporting our ambition of safe, effective and person-centred care for generations to come. 

We have begun work with our key partners to build on existing improvement activities designed to inform the people of Scotland of the alternatives to A&E, avoiding unnecessary attendance and admissions, and ensuring that patients are discharge as soon as they are fit and ready without delay.  This work will also improve capacity and capability around the goal of optimally caring for people in their own homes as well as improving performance and capability in our acute hospitals.   By making a concentrated effort to bring the whole health system together as one not only supports integration but also the Governments 2020 vision and the Quality Strategy.