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

The complexity of the unscheduled care system and its multiple access points results in people being uncertain about how and where to seek help. In many cases people default to the emergency department or emergency services, leading to delays for service users and unsustainable challenges to service providers.

Much of the work to date on improving the unscheduled care system has been described through the lens of the system and focused on existing services, rather than through the perspective of the person needing unscheduled or unexpected care – i.e. what they need as an individual in the moment when they experience a care or support need they had not planned for.

In our publication, Rethinking unscheduled care: A design investigation into people's experiences and journey through unscheduled care, Healthcare Improvement Scotland’s Evidence and Evaluation for Improvement Team 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.

This investigation highlights some 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. These three categories are:
    • people presenting due to sudden illness or injury,
    • people with frailty or long term condition, and
    • people with multiple disadvantages.
  • The role of communities, friends and families in supporting individuals needs to better understood and 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.
  • Impact of individual context and backgrounds on experience of unscheduled care.

Access the design investigation report.

We undertook this work as a test of a collaborative leadership model, 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.

Healthcare Improvement Scotland are currently working on a companion piece to this Rethinking Unscheduled Care publication. The companion piece considers these findings through a strategic planning lens and identifies actionable learning insights for the design and delivery of unscheduled care services. This companion report is due to be released later this year.

Read a summary of our after action review. This captures key learning about our collaborative and multidisciplinary approach to this work, to inform discovery phases of future national improvement programmes.

Find out more about the Evidence and Evaluation for Improvement Team’s work by visiting our webpage or get in touch with the team on