This document discusses unscheduled care in the NHS in Scotland. It defines unscheduled care as care that cannot be reasonably planned in advance and must be available 24/7. It recommends shifting from an assess-transport-diagnose-treat model to an assess-diagnose-talk-treat model. Charts show patient flow for unscheduled care in 2008/09 and total attendances at A&E services from 2011-2012, with most attendances at emergency departments. A final chart shows the number of A&E attendances and proportion seen within 4 hours from 2009-2012.

1. UNSCHEDULED CARE
UNPACKED

2. Definition of Unscheduled Care
‘Unscheduled care’ is defined as NHS care which cannot
reasonably be foreseen or planned in advance of contact
with the relevant healthcare professional, or is care which,
unavoidably, is outwith the core working period of NHS
Scotland. It follows that such demand can occur at any
time and that services to meet this demand must be
available 24 hours a day
Kerr Report (2005)

3. Recommended shift from
Assess-Transport-Diagnose-Treat
to
Assess-Diagnose-Talk-Treat

4. Scotland Unscheduled Care Patient Flow Chart 2008/09
Rates per 100,000 Population
Patient
NHS24
22,450 GP
6,700
1,750
1,950
1,500
12,650 Healthcare 2,950
Professional 2,000
16,400
1,150 50 100
1,050 250 300
6,850
Emergency
Out of 550
A&E Ambulance
Hours
27,100 150 11,000
16,050 400 150 MIU
2,750 50
50
200
7,350 50
Treated
150 at Scene/
Admitted 1,400 Not
(Emergency 450
1,050 150 Conveyed
Inpatient) 3,450
2,200 1,100
10,400 PAA/ARAU/
MAU 1,350
200
3,100

5. Attendances by Site Type
Total Attendances at A&E Services by Site Type - Scotland
(April 2011 to March 2012)
160,000
140,000
120,000
Number of Attendances
100,000
80,000
60,000
40,000
20,000
0
Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12
ED MIU/Other
Source: A&E Data Mart, ISD Scotland

6. 4 Hour Wait Standard
Number of Attendances at A&E Services across Scotland and Proportion of those
seen within 4 hours (January 2009 to March 2012)
160,000 100
98
140,000
Number of Attendances
Seen within 4 hours (%)
96
120,000
94
100,000
92
80,000 90
May-09
Mar-10
Jan-12
Mar-09
Sep-09
Jun-10
Jan-09
Aug-09
Nov-09
Jan-10
Nov-10
Jan-11
Feb-11
Mar-11
Dec-11
Mar-12
May-10
May-11
Dec-09
Aug-10
Sep-10
Dec-10
Nov-11
Feb-12
Feb-09
Apr-09
Jun-09
Jul-09
Oct-09
Apr-10
Jul-10
Oct-10
Apr-11
Jun-11
Jul-11
Sep-11
Oct-11
Feb-10
Aug-11
Number of Attendances Seen within 4hr 4hr Wait Standard
Source: A&E Data Mart, ISD Scotland

7. Rate per 100,000 Population
-
S
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
ep
-
09
O
ct
-0
N 9
ov
-0
D 9
ec
-0
Ja 9
n-
1
Fe 0
b-
1
M 0
ar
-1
Ap 0
r-1
M 0
ay
-1
Ju 0
n-
10
Ju
l-1
A 0
ug
-1
S 0
ep
-1
0
O
ct
-1
N 0
ov
-1
Major Rate
D 0
ec
-1
Ja 0
n-
1
Fe 1
b-
1
Major/Minor Activity - Scotland
M 1
Minor Rate
ar
-1
A 1
pr
-1
M 1
ay
-1
Ju 1
n-
11
Major/Minor Activity
Ju
l-1
A 1
ug
-1
S 1
ep
-1
O 1
ct
-1
N 1
ov
-1
D 1
ec
-1
Ja 1
n-
12
Data Source: A&E Data Mart, ISD Scotland

8. Rate per 100,000 Population
-
S
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
ep
-
09
O
ct
-0
N 9
ov
-0
D 9
ec
-0
Ja 9
n-
1
Fe 0
b-
1
M 0
ar
-1
Ap 0
r-1
M 0
ay
-1
Ju 0
n-
10
Ju
l-1
A 0
ug
-1
S 0
ep
-1
0
O
ct
-1
N 0
ov
-1
Major Rate
D 0
ec
-1
Ja 0
n-
1
Fe 1
b-
1
M 1
Minor Rate
ar
-1
A 1
pr
-1
Major/Minor Activity - 0-4 year olds in Scotland
M 1
ay
-1
Ju 1
n-
11
Ju
l-1
A 1
ug
-1
S 1
ep
-1
O 1
ct
-1
N 1
ov
-1
D 1
Major/Minor Activity by Age Band
ec
-1
Ja 1
n-
12
Data Source: A&E Data Mart, ISD Scotland

9. Rate per 100,000 Population
-
S
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
ep
- 09
O
ct
-0
N 9
ov
-0
D 9
ec
-0
Ja 9
n-
1
Fe 0
b-
1
M 0
ar
-1
A 0
pr
-1
M 0
ay
-1
Ju 0
n-
10
Ju
l-1
A 0
ug
-1
S 0
ep
-1
0
O
ct
-1
N 0
ov
-1
Major Rate
D 0
ec
-1
Ja 0
n-
1
Fe 1
b-
1
M 1
Minor Rate
ar
-1
A 1
pr
Major/Minor Activity - 5-9 year olds in Scotland
-1
M 1
ay
-1
Ju 1
n-
11
Ju
l-1
A 1
ug
-1
S 1
ep
-1
1
O
ct
-1
N 1
ov
-1
D 1
Major/Minor Activity by Age Band
ec
-1
Ja 1
n-
12
Data Source: A&E Data Mart, ISD Scotland

10. Rate per 100,000 Population
-
S
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
ep
- 09
O
ct
-0
N 9
ov
-0
D 9
ec
-0
Ja 9
n-
1
Fe 0
b-
1
M 0
ar
-1
A 0
pr
-1
M 0
ay
-1
Ju 0
n-
10
Ju
l-1
A 0
ug
-1
S 0
ep
-1
0
O
ct
-1
N 0
ov
-1
Major Rate
D 0
ec
-1
Ja 0
n-
1
Fe 1
b-
1
M 1
Minor Rate
ar
-1
A 1
pr
-1
Major/Minor Activity - 20-24 year olds in Scotland
M 1
ay
-1
Ju 1
n-
11
Ju
l-1
A 1
ug
-1
S 1
ep
-1
1
O
ct
-1
N 1
ov
-1
D 1
Major/Minor Activity by Age Band
ec
-1
Ja 1
n-
12
Data Source: A&E Data Mart, ISD Scotland

11. Rate per 100,000 Population
-
S
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
ep
- 09
O
ct
-0
N 9
ov
-0
D 9
ec
-0
Ja 9
n-
1
Fe 0
b-
1
M 0
ar
-1
A 0
pr
-1
M 0
ay
-1
Ju 0
n-
10
Ju
l-1
A 0
ug
-1
S 0
ep
-1
0
O
ct
-1
N 0
ov
-1
Major Rate
D 0
ec
-1
Ja 0
n-
1
Fe 1
b-
1
M 1
Minor Rate
ar
-1
A 1
pr
-1
Major/Minor Activity - 50-54 year olds in Scotland
M 1
ay
-1
Ju 1
n-
11
Ju
l-1
A 1
ug
-1
S 1
ep
-1
1
O
ct
-1
N 1
ov
-1
D 1
Major/Minor Activity by Age Band
ec
-1
Ja 1
n-
12
Data Source: A&E Data Mart, ISD Scotland

12. Rate per 100,000 Population
-
S
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
ep
- 09
O
ct
-0
N 9
ov
-0
D 9
ec
-0
Ja 9
n-
1
Fe 0
b-
1
M 0
ar
-1
A 0
pr
-1
M 0
ay
-1
Ju 0
n-
10
Ju
l-1
A 0
ug
-1
S 0
ep
-1
0
O
ct
-1
N 0
ov
-1
Major Rate
D 0
ec
-1
Ja 0
n-
1
Fe 1
b-
1
M 1
Minor Rate
ar
-1
A 1
pr
-1
Major/Minor Activity - 70-74 year olds in Scotland
M 1
ay
-1
Ju 1
n-
11
Ju
l-1
A 1
ug
-1
S 1
ep
-1
1
O
ct
-1
N 1
ov
-1
D 1
Major/Minor Activity by Age Band
ec
-1
Ja 1
n-
12
Data Source: A&E Data Mart, ISD Scotland

13. Rate per 100,000 Population
-
S
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
ep
-
09
O
ct
-0
N 9
ov
-0
D 9
ec
-0
Ja 9
n-
1
Fe 0
b-
1
M 0
ar
-1
Ap 0
r-1
M 0
ay
-1
Ju 0
n-
10
Ju
l-1
A 0
ug
-1
S 0
ep
-1
0
O
ct
-1
N 0
ov
-1
Major Rate
D 0
ec
-1
Ja 0
n-
1
Fe 1
b-
1
M 1
Minor Rate
ar
-1
A 1
pr
-1
M 1
ay
-1
Major/Minor Activity - 85 year olds and over in Scotland
Ju 1
n-
11
Ju
l-1
A 1
ug
-1
S 1
ep
-1
O 1
ct
-1
N 1
ov
-1
D 1
Major/Minor Activity by Age Band
ec
-1
Ja 1
n-
12
Data Source: A&E Data Mart, ISD Scotland

14. Emergency Admissions
Proportion of Patients Admitted Following a New and Unplanned Return Attendance at EDs across
Scotland by Age Band and Gender (April 2011 to March 2012)
70.0
60.0
50.0
Proportion Admitted (%)
40.0
30.0
20.0
10.0
-
0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ All
Ages
Male Female
Source: A&E Data Mart, ISD Scotland