Don’t go to A&E: Target says visits must drop by a THIRD

Eight draft goals have been set for key measures of health in West Dunbartonshire to gauge progress since new boards took over health and social care services.

But the target for attendances at A&E has raised concerns about how it can be achieved - and whether there will be any financial punishment if they don’t.

At last week’s Health and Social Care Partnership (HSCP) meeting, members questioned the basis for the figures they now have to meet.

The board picked 2015/16 as a baseline year, since the HSCP was set up then. That year, there were 22,348 visits to A&E from West Dunbartonshire.

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For 2018/19, the estimate was 32,800 visits. The goal for 2019/20 is the 22,000 figure - a drop of 32 per cent.

Jo Gibson, head of health and community care, told the meeting: “We need to be clear, that’s a significant commitment we are making.

“We need to work with the people of West Dunbartonshire to make better choices so they’re not attending at A&E.”

Allan Macleod, chairman of the HSCP, said: “These are extremely significant. How realistic are some of the targets that you’re proposing we sign up to and what are the implications if we fall way short?”

Ms Gibson said the board had a requirement to submit collective targets and they had to “walk a line” between what the health board and Scottish Government would each like to see.

She said the A&E targets held the biggest risk: “Some of that is in our control, some outwith our control.”

Beth Culshaw, the chief executive of the HSCP, said some of the targets were fairly achievable. She said “early intervention” with residents could help avoid them needing to go to A&E.

But she admitted the target was “hugely challenging”.

The figures in 2015/16 jumped in a year from 22,348 to 30,875 and have been largely steady ever since. But that lower baseline will be the target.

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Other targets set drops below 2015/16 starting points.

Emergency admissions need to drop from a projected 10,464 down to 8,626. Unplanned acute bed days need to drop from 69,528 to 63,402.

Delayed discharge bed days are already below a 2015/16 high of 4,832 and the target is set for the new lower number of 3,440.

The percentage of people spending the last six months of life in the community was 86.7 per cent and the goal is 89 per cent.

And the percentage of those aged 65+ living at home has a target of 96.5 per cent, about one per cent above where it has been for the last four years.

Mr Macleod said it was “realistic to expect some improvement” but questioned how they tell staff to contribute to such a drop in A&E attendances.

He said: “I think at least we should note them and our concerns about how achievable they are. We need to set challenging targets, but perhaps given the baseline, we have some reservations.”

Ms Culshaw said there was no suggestion of a punitive approach by the government or health board.

She said: “There has been a significant amount of work. It has been submitted as a draft target.”

Reacting to the A&E target, Gil Paterson MSP said: “Getting treatment in the right place means those with minor ailments will be seen quicker at the correct facility and, keeping the emergency service for emergencies, will benefit those with serious conditions.

“Unfortunately 40 per cent of those who present at A&E would be better going to alternative medical facilities for attention.

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“People should only use A&E for serious injury or a medical emergency. Therefore, I am pleased to see that there will be detailed regular analysis of those most frequently attending A&E to see if these people can be given support to reduce the number of times they present at the emergency department.”

A spokeswoman for NHS Greater Glasgow and Clyde said patients should only use emergency departments in an emergency, and “many patients” could use other services. She pointed to the minor injuries units, GP services, pharmacists, NHS 24 or online information from NHS Inform.

The spokeswoman said: “There are a number of developments underway in primary and community services in West Dunbartonshire which will offer people a wider range of choice in terms of getting the support they need.

“The development of the focussed intervention team in West Dunbartonshire will see additional nurses and therapists available to support people at home.

“We will continue to support patients to make the right choice about which service is best for them. Our hope is that as we see increasing numbers of local people using the new alternative services, fewer numbers will need to attend A&E.”

The Scottish Government said the country’s core A&E departments had been the best performing in the UK.

A spokesman said: “The aim of seeking to reduce A&E attendance is to help people find the right local service for them to meet their needs. Enhancing community-based services often provides a better alternative to hospital attendance or admission.”