We worked alongside partners in Healthcare Improvement Scotland, Scottish Government, NHS24, Scottish Ambulance Service and Police Scotland to explore insights directly from people who need (regardless of whether they get access to) unscheduled or urgent care services. To do this, we combined systematic evidence review with service co-design principles and user research methodology.

The multi-disciplinary team put together two reports from this work.

Rethinking unscheduled care: A design investigation into people's experiences and journey through unscheduled care

The working group’s final report highlights critical person-centred insights that need to be taken into account in the work to redesign and improve unscheduled care services including:

• That there are three key categories of people accessing unscheduled care and they each have different needs that, if addressed, would reduce the demand on unscheduled care services:
  • people presenting due to sudden illness or injury
  • people with frailty or long term conditions, and
  • people with multiple disadvantages.
• The need to better understand the role of communities, friends and families in supporting individuals, which should be built into how services are designed and delivered.
• The vital importance of ‘gatekeepers’ to the system, not just in enabling access but also in how people feel about the unscheduled care system.
• The impact of individual context and backgrounds on experience of unscheduled care.

It also sets out recommendations for where future research is needed to understand people’s experiences of unscheduled care in Scotland.

After action review for the Rethinking Unscheduled Care working group

We undertook this work as a test of a collaborative leadership model with our partners, combining systematic evidence review, service co-design principles and user research methods across organisations to explore opportunities for redesign, improvement and/or system change for unscheduled care. The summary of our after action review captures key learning about our collaborative approach to this work, to inform an evidence-based and collaborative approach to the discovery phases of future national improvement programmes. This key learning includes:

• That there are both benefits and challenges to combining multiple approaches to discovery work, but flexible working means that challenges can be identified and redirected quickly.
• To support agile collaborative work, teams should invest early in activities surrounding:
  • defining roles and responsibilities,
  • understanding each other’s multidisciplinary expertise, and
  • planning, timelines and practical outputs.
• By protecting the space for the team to work in an agile way and embrace uncertainty, discovery work can pivot to follow new directions quickly.