Lothian NHS Board

Office of the Chair and Chief Executive Waverley Gate 2-4 Waterloo Place Edinburgh EH13EG
www.nhslothian.scol.nhs.uk

\:

NHS
'" lothian

rat!

Ms Kezia Dugdale MSP The Scottish Parliament Edinburgh EH991SP

Date Our Ref Enquiries to Direct Line

23 November 2011 RHSC16822 Complaints Team 01315363370

Dear Ms Dugdale Thank you for your letter of 24 October 2011, received in my office on 26 October 2011, in which you raised questions in relation to the Accident and Emergency Department at the Royal Hospital for Sick Children (RHSC). I passed your letter to our Chief Operating Officer, Mrs Jackie Sansbury, as she has operational management responsibility for this service and asked her to investigate this matter and my response is based on the information she has provided. Mrs Sansbury has confirmed that a short-term study was funded from the Heat T10 program (To supporl shifting the balance of care, NHS Lothian will achieve a 15% reduction in _",-,t,",""he rates o~endance l!.t A&Urom March_2Q09 to _M.arch~20t1)_that foc_uses_Qnreducing_ Accident and Emergency (A&E) attendances. This ran from November 2010 to February 2011 and involved the Lothian Unscheduled Care Service providing a General Practitioner between 18.00 - 22.00 Monday to Friday and 12.00 - 20.00 at weekends and bank holidays. Mrs Sansbury has advised that the objective of the study was to assess how safe, effective and acceptable to patients and carers it would be to stream appropriate patients presenting to the A&E Department to a parallel primary care service. Mrs Sansbury has advised me that this development was always intended to have a finite duration as it ran in addition to current services and there was a fixed resource allocated to it. Mrs Sansbury has informed me that the 4 hour Emergency Access target was being met at the RHSC A&E Department prior to the study and has been maintained since completion of the study. Once the study ended all patients attending reverted to being seen in the A&E Department by the A&E staff as they were prior to the study. Mrs Sansbury has reported that a significant benefit in terms of reduced workload for the A&E Department was seen at the weekends and on bank holidays, but only a relatively small number of children were suitable for streaming to the General Practitioner service on

Headquarters Waverley Gale. 2-4 Waterloo Place. Edinburgh EHI3EG Chair Dr Charles J Winstanley Chief Executive Professor James J Barbour D.B.E. lothian NHSBoard is the common name of lothian Health Board

,N~
Lothian

weekday evenings. She advised that the majority of families were satisfied with the care they received, but also indicated that they would still attend the A&E Department with similar problems in the future. Mrs Sansbury has advised that the cost per patient for the Lothian Unscheduled Care Service attendance was less than the average cost of an A&E Department attendance but this needs cautious interpretation as these patients will tend to use less resource than the average A&E Department patient who is more likely to require further more complex investigation. Mrs Sansbury has confirmed that there are no immediate plans in place to establish a permanent unscheduled primary care presence on the RHSC site. This is partly due to the concerns of the Clinical Management Team's that it may be seen as a way of bypassing the current access routes to primary care services. Mrs Sansbury advises me that the Clinical team at RHSC are currently undertaking an exercise to quantify the number of patients we feel would be suitable for streaming at all times of the day (not just out of hours) and when we have this data we will explore the best way forward to ensure that patients attending the A&E Department get the most __ approRriale care. ~_~~ _ I hope this response will answer your questions raised regarding the recent pilot study and the ongoing delivery of care in the A&E Department at the Royal Hospital for Sick Children. Should you wish to discuss this matter further please do not hesitate to contact the complaints team who will direct any further questions appropriately.

JAMES A SOUR Chief Exe