Improving Unscheduled Care for People in their Last Year of Life
Principle Investigator (lead Institution) Professor Colin McCowen (University of St Andrews)
Collaborating institutions – NHS Fife, NHS Highlands and Islands, University of Edinburgh, Yale University
Funding amount – £990,675
Lay Summary
Pressures on health services across Scotland are high. As people live longer, with more long-term health problems, pressures will get worse meaning people may struggle to access the care they need.
Unscheduled care services, including General Practice Out-of-Hours (GPOOH), Emergency Departments (ED), NHS24, and the Scottish Ambulance Service (SAS), are facing the brunt of this challenge and struggle to meet the growing needs of patients. In 2022, ED waiting times hit record levels and over a quarter-million calls to NHS24 went unanswered. Such delays worsen medical problems and contribute to avoidable deaths.
Care for people in the last year of life is important. The NHS has a duty to make sure that people can access the care they need from the most appropriate person at the right place and right time no matter where they live. When people struggle to access the care and support they need, it causes distress and suffering.
People use healthcare in very different ways, some people using a lot and others not accessing it much. We know for some people using a lot of unscheduled, urgent healthcare that this is not ideal for them and their families.
Our research team will study healthcare data to see how people have used unscheduled care in their last year of life and identify which patient groups access which kinds of unscheduled care services the most. We will then use a technique called Machine Learning to try and predict how people might use healthcare in the future. These preliminary steps will help us to design healthcare services to better meet people’s needs in their last year of life.
We will do this by working with patients and families to design the kind of healthcare that they feel is most helpful to them. This may involve developing a system with a helpline which can help to coordinate their care. Evidence from NHS Highland shows that, when clinicians suggest to patients they might benefit from enhanced care provided through a helpline patients and their carers are happy to use this service. The problem is that it is hard to identify people who could benefit from this extra care and many people who could benefit are not being offered it.
We will then work with the health services in Fife and Highland to test and compare if these new ways of providing care are better for patients and alleviate stress on unscheduled care services. Moreover, we will speak to patients and healthcare teams to understand how these changes affect them. If the changes we create seem useful we would then test them out on a larger scale across health board areas in Scotland.
By learning from healthcare data and directly from the people who use that healthcare in their last year of life, we should be able to make unscheduled care work better for everyone. This will lead to better care for individuals and families, by services that are able to respond quickly when needed and meet the challenges of increasing demand.