As I said, there is a blurring of emergency care and primary care in and out of hours. In emergency medicine, at least half the volume of our workload is out of hours—there are more out-of-hours hours in the week than there are in-hours, but our workload is roughly 50:50. I work in Crosshouse in Kilmarnock, which has the fourth busiest emergency department in Scotland and I am a full-time ED consultant. The majority of our children now arrive out of hours: some 65 to 70 per cent of children who come to our emergency department come outwith the hours of 9 to 5, Monday to Friday. That is what the populace is choosing to do.
When the Royal College of Emergency Medicine talks about co-location—and this is what Professor Sir Lewis Ritchie alluded to in his report on out-of-hours care four years ago—we are saying that there may be some advantages to having everything on the same site. People come to where the door is open, which is the emergency department, because their learned behaviour is that they can rock up there at any time of day or night and something will happen—it might not necessarily be the best thing, but they will get something—so it could be beneficial to have other services available there, too.
I stress that those services are absolutely not part of the emergency department. What we are suggesting would mean, for example, having out-of-hours GP services on the same site—as there are in Grampian, which is a very good model. When I trained in Glasgow, the Glasgow emergency medical service would be an out-patient service, but we could refer patients to different services. Having mental health workers, allied health professionals or a single point of contact for social work and so on in the same place makes it much easier in some ways. It is attractive because the services are all on one site, they can co-ordinate and they can speak to each other. We might even be able to say to a patient, “Actually, you don’t need to come up, because they are going to come out and see you.” That is about information sharing. There are some challenges in that, which I alluded to earlier, such as in IT, different communication systems and so on.
When we talk about co-location, we are talking about having out-of-hours care on the same sites as much as possible, so that, if someone comes to the site and they do not necessarily need to come to the emergency department, the service that they require is there and they do not have to go to another site that may be 3 or 4 miles away, with all the transport problems that that creates.
I understand that there might be some issues for remote and rural sites, where someone might have to travel 60 or 70 miles, but in the central belt, most of the distances we are talking about make it an attractive idea. It is only that people have grown up being used to the idea of things being within walking distance that makes it difficult. I have friends who live in the south of England who think that it is totally normal for their nearest hospital to be more than half an hour away, whereas people in Glasgow would think that that is the worst thing in the entire world.