Emergency care is by definition an immediate response to any time critical health care need. The DoH (2011) defines this in broad terms as, “the range of healthcare services available to people who need medical advice, diagnosis and/or treatment quickly and unexpectedly”.
To consider these in local terms and to map against a national picture reveals a continually changing landscape.
Other than 999 or self-presentation at Emergency Departments the general public have to navigate through numerous telephone options. These roles have primarily fallen to a call centre system and the ambulance service. Call centre advice/triage systems have undergone a number of changes with very limited success whilst the ambulance service has seen a year on year increase in demand. Though ambulance service indicators have become more clinically focussed with alternate disposition and the development of pathways emerging, the service faces the challenge of providing sufficient appropriately qualified staff to make any significant difference.
Unscheduled care can be defined as the provision of health or social care services without prior appointment when there is an actual or perceived care need that requires professional involvement. Note: this must consider holistic care needs and therefore include social care.
The challenge presented to healthcare delivery by demographic trends and advancement in medical science requires that health professionals remain proactive and vigilant to ensure the needs of the patient are met appropriately and effectively.
The priority has and always will be immediate care needs but with an ageing population, with often complex requirements there is now greater need for developing new health care roles and the development of existing health professionals to deliver evidence based practice to provide the right care, for the right patient at the right time, in the right place by the right professional.
Despite the current economic climate of financial restraint, emergency and unscheduled care has to change and be developed through education and research to achieve the right care. Practitioners are encouraged to deliver prudent healthcare as "the current situation is clearly unsustainable and Wales needs to quickly find new, brave, radical solutions best fitting the health needs of Wales to address the increasing challenges and parlous state which confronts us."1
Service providers along with educationalists should adopt an open minded approach and review established ways of working and healthcare delivery to enhance collegial partnerships and to expand scopes of practice, e.g. specialist and the advance practitioner roles, and so "consolidate services and remodel ways of working"1.
1. Aylward, M., Phillips, C., & Howson, H (2013). Simply Prudent Healthcare – achieving better care and value for money in Wales – discussion paper. Found at; http://www.bevancommission.org/sitesplus/documents/1101/Bevan%20Commission%20Simply%20Prudent