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EAST AYRSHIRE HEALTH AND SOCIAL CARE PARTNERSHIP
STRATEGIC PLANNING GROUP: 28th OCTOBER 2015
REPORT ON WINTER PLAN
Report by Director of Health and Social Care
PURPOSE
1. To present to the Strategic Planning Group the Winter Plan 2015/16 for NHS
Ayrshire and Arran.
BACKGROUND
2. This report presents to the SPG the Winter Plan for 2015/16 (Paper 2b). The
report sets out factors giving rise to pressures within the health and social care
system during the winter months and the experience of NHS Ayrshire and Arran
during 2014/15.
3. The Improving Patient Experience Programme (IPEP) stretch aims are
highlighted. The report goes on to outline the plans and areas for action during
the October to March period of 2015/16.
4. The integrated approach taken to developing the Winter Plan for 2015/16 across
Acute Services, Health and Social Care Partnerships and other partners is
described in the report. The report highlights the collaborative work undertaken
to develop initiatives to address winter pressures, through IPEP and the
Unscheduled Care Interface Groups. There is a particular focus on the impact of
interventions on occupied bed days.
5. The report outlines key areas of investment, including non-recurring initiatives to
build capacity over winter and recurring investment in the transformation of
unscheduled care.
6. An integrated approach has been taken to Winter Planning for NHS Ayrshire and Arran in 2015/16.
7. A range of whole system activity and investment is planned to address winter
pressures between October and March 2015/16.
REPORT
8. The Winter Plan sets out NHSAA’s plans for the period between 1st October and
31st March 2015/16. The Plan has been prepared in line with guidance set out in
(DL (2015) 20). Work to produce the Plan for 2015/16 has taken place in the new
context of integrated Health and Social Care Partnerships (HSCPs) in NHS AA
and this collaborative approach is reflected in the content of the plan. For
2015/16 the Plan has been driven forward through the Unscheduled Care
Interface Groups with an overview provided by the IPEP.
9. The aim of the Plan is to ‘support early intervention and action at points of
pressure and to minimise the potential disruption to services, people who use
services and their carers’.
10. The Plan sets out the policy context with specific reference to the 2020 Vision for
Health and Social Care, the Six Essential Actions for Improving Unscheduled
Care, the Health and Wellbeing Outcomes and Local Delivery Plan standards.
The Plan dovetails with corporate major incident and business continuity plans.
11. A review of last winter at a local and national level informs the Plan and follows
on from the Review and de-briefing sessions held early in 2015/16.
12. There is a range of potential pressures across the health and social care system
related to the winter months. In summary these include:
Managing higher levels of complex patients which can significantly increase
length of patient stay and subsequent hospital reduced capacity;
Elevated levels of demand linked to levels of infection within the community,
eg, pressure across the respiratory pathway;
Reduced capacity due to bed closures arising from outbreaks such as
Norovirus;
Reduced capacity as a result of staff absence related to a higher incidence of
seasonal influenza;
Adverse weather affecting transport and attendance/absence rates;
Pressure on timeous discharge linked to demand within primary and
community services.
13. In winter 2014/15 NHS Ayrshire and Arran experienced sustained pressure
across services As a result, too often, patients waited for a long time in the ED for
an admission to an acute hospital bed and were frequently cared for outwith the
most appropriate speciality for their condition (ie, ‘boarded’). In addition there was
widespread cancellation and non-scheduling of planned elective activity.
14. This situation resulted in a negative experience for many of our patients and our
colleagues. From the perspective of the service, performance against key HEAT
targets (notably the 4-hour Emergency Access Standard and the Treatment Time
Guarantee) suffered badly and a significant financial cost has been incurred in an
effort to recover performance.
15. In light of this, the Improving Patient Experience Programme (IPEP) has been
established to help ensure the challenges of last winter are not repeated. IPEP
has set four stretch ambitions of:
Eliminating instances of patients being boarded;
Eliminating instances of patients having an elective procedure cancelled due
to a non-clinical reason;
Eliminating instances of patients waiting longer than 72 hours for discharge
from the acute hospital after they are deemed medically fit;
Ensuring that all patients are cared for by an appropriately trained clinician at
every stage of their journey.
16. The Plan describes actions to be taken against the key themes which structure
the Winter Preparedness Checklist provided by the Scottish Government.
Resilience and Preparedness
Unscheduled/ Elective Care Preparedness
Out of Hours Preparedness
Norovirus Outbreak Control Measures
Seasonal Flu
Respiratory Pathway
17. Actions within the Winter Plan align with the Six Essential Actions.
18. Partners in NHS Ayrshire and Arran have worked together in an integrated way to
develop capacity plans for winter 2015/16. This has been delivered through the
IPEP and Unscheduled Care Interface Groups.
19. The impact on the drivers of reducing emergency admission, length of stay and
delays to discharge was quantified in terms of occupied bed days. This is shown
in detail in the Winter Plan and links to good practice identified nationally
including increasing morning and weekend discharge.
20. The focus of this work has been on improving the experience of people using
services and of the workforce during winter 2015/16.
21. A range of initiatives has been developed across the health and social care
system on this basis and these are included in the Winter Plan. Estimated
occupied bed days avoided by these initiatives total over 9,400 for UHC and
8,400 UHA. The analysis suggests a need to increase bed capacity to achieve
an occupancy level of around 90 per cent. Plans to achieve this are set out
below and in the Winter Plan 2015/16.
Resourcing
22. There has been recurring investment of £2.1m committed through the Local
Unscheduled Care Action Plan (LUCAP) which lays the foundation for a New
Model of Care that will complement the Assessment Units under construction at
both acute sites and the new ED at UHA as part of the Board’s Building for Better
Care (BfBC) Programme.
23. For 2015/16 within Acute Services funding of £945,000 has been identified to
support the following winter initiatives:
An additional 30 beds at UHC to reduce occupancy over winter period
(£704,000)
Enhanced patient flow teams at both sites (£119,500)
Enhanced pharmacy provision at evenings and weekends on both sites
(£43,000)
Enhanced Advanced Nurse Practitioner service at UHA (£58,000)
Enhanced Scottish Ambulance Service on both sites (£20,000)
Over the winter period HSCPs will invest around £1,484,000 on specific
initiatives and escalation plans from Delayed Discharge, Integrated Care Fund
and Resource Transfer resources.
Testing the Plan
24. Resilience, contingency and escalation plans are being tested through
stakeholder events on 27th and 30th October 2015. These events focus on the
two main acute sites of UHA and UHC.
Management Information
25. Daily real-time performance monitoring will take place through dashboards
covering key performance measures. This will be further supported by whole
system conferencing. Daily senior leadership conferencing will assess system-
wide status and guide escalation.
POLICY/LEGAL IMPLICATIONS
26. The Report fulfils a Scottish Government requirement to produce winter plans
and further guidance issued under (DL (2015) 20) on ensuring that these plans
are developed in an integrated way.
COMMUNITY PLANNING IMPLICATIONS
27. The Report on the Winter Plan 2015/16 aligns with the Wellbeing theme of the
Community Plan 2015-30.
RISK IMPLICATIONS
28. The Improving Patient Experience Programme and Unscheduled Care Interface
Groups have identified the following risks and mitigating actions in relation to the
Winter Plan and agreed interventions.
Risk Mitigation
Emergency presentations above norm/ plan IPEP focus on prevention of admission
Shared escalation plan
Acute and Health and Social Care
Partnership winter capacity plans
Rate of admission above norm/ plan
Shared escalation plan
Acute and Health and Social Care
Partnership winter capacity plans
People remaining in hospital beyond acute
clinical need
IPEP focus on no delays
Active discharge management
Acute and Health and Social Care
Partnership winter capacity plans
Loss of workforce capacity due to influenza Early proactive communication plan to
encourage up-take of flu vaccine
Reporting of uptake among key workforce
groups
Significant loss of capacity due to norovirus/
adverse weather
Shared escalation plan
Resilience and Contingency Plans
RECOMMENDATIONS
1. The Strategic Planning Group is asked to:
I. receive the report; II. note the work undertaken across the health and care system to produce the
integrated Winter Plan for 2015/16; III. note the actions described in the Winter Plan to mitigate the potential winter
pressure impacts; IV. note that the Winter Plan for 2015/16 has been approved by the NHS Board;
and V. note that the Winter Plan for 2015/16 will be presented to Integration Joint
Boards for their approval.
Eddie Fraser Director of Health and Social Care 20th October 2015
For further information please contact: Erik Sutherland, Senior Manager
Planning and Performance, 01563 576016
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NHS Ayrshire and Arran Winter Plan 2015/16 Executive Summary Introduction This Plan joins up work in NHS Ayrshire and Arran across the Improving Patient Experience Programme (IPEP), ‘Winter Planning’ and the Six Essential Actions for Improving Unscheduled Care. The Plan sits squarely within the 2020 Vision for health and social care and has been developed with the comprehensive involvement of partners in Acute Services, Primary Care, Health and Social Care Partnerships, Allied Health Professionals, Scottish Ambulance Service and the Third Sector. It has been prepared, taking account of national planning guidance (DL (2015) 20). A local and national review of Winter 2014/15 is included in the Plan which assesses positive and negative experiences in the previous year. Last winter saw helpful developments in the use of real-time information, e-Whiteboards, huddles, enhanced services from Scottish Ambulance Service, home care capacity and multi-disciplinary working. However, vacancies, staffing gaps and increased demand for unscheduled care combined to compromise pathways and elective work. In 2014/15 there were higher than average and higher than national A&E presentations, emergency inpatient activity was also above average and again higher than the national picture. During winter 2014/15 there was a significantly increased and sustained level of patients admitted with respiratory conditions. Across the system this level of increased unscheduled care impacted adversely, resulting in a substantial reduction in performance on the 4-hour waiting time standard. Delayed discharge bed days also increased in NHS Ayrshire and Arran although not as markedly as that seen across Scotland. In the Plan for 2015/16, there is a focus on tackling delays, eliminating cancellation of elective procedures, eliminating patients being cared for outwith the optimum hospital ward setting through ‘boarding’ and ensuring that care is provided by trained and experienced professionals. The Plan is underpinned by action to respond when pressure is experienced through the implementation of shared health and social care escalation procedures. Acute Services and Health and Social Care Partnerships have worked together to collectively understand patterns of demand and capacity and used this analysis to develop plans to strengthen capacity centred on:
Reducing emergency admission;
Improving systems and processes; and
Reducing delays to discharge.
A range of interventions has been developed across these three themes and the impact quantified in terms of potential occupied bed days avoided.
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The Plan focuses on action linked to a self-assessment of preparedness in relation to resilience, unscheduled/elective care, out of hours, Norovirus outbreak, seasonal influenza, respiratory pathway, and performance monitoring. Resilience and Preparedness Arrangements are in place at a senior level through the Strategic Planning and Operational Group (SPOG) which meets weekly. This is further supported by a Heads of Service group and Senior Officer Resilience and Business Continuity meetings. Pan-Ayrshire arrangements supporting multi-agency coordination and response in relation to severe weather are also in place. Minimum staffing levels and rotas are established, planned in advance and organisational policies are in place to support resilience. Resilience, business continuity and escalation plans are tested prior to winter. Unscheduled/ Elective Care Preparedness Clear site management arrangements are in place with daily huddles across departments supporting the management of demand within the system. Health and Social Care Partnerships are in place with integrated management and commitment to participate in huddles. Whole system escalation plans have been developed for 2015/16. Discharge planning is coordinated across Acute, Health and Social Care Partnerships and in collaboration with Scottish Ambulance Service. The Red Cross home from hospital service has been rolled-out across NHSAA. Criteria Led Discharge (CLD) pilot work and the identification of individuals who may be suitable for weekend discharge are highlighted in the Plan alongside facilitating seven day discharge and pre-planning for public holiday periods. Action has been taken in preparing the Plan to understand expected levels of activity across the system and to plan interventions aimed at addressing anticipated pressures. Out of Hours Preparedness Single management has been established across Out of Hours community medical, nursing and social work. Rotas are in place to ensure availability. Extended professional roles will be utilised to support primary care out of hours response. Contingency plans are in place and are tested. Norovirus Outbreak Control Measures Norovirus Control Guidelines are in place and national publicity materials are disseminated widely alongside media and site-based awareness raising and expert advice.
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Seasonal Flu Partners work to the Chief Medical Officer’s letter of guidance in relation to actively promoting up-take of the seasonal flu vaccine for population target groups and the workforce. Respiratory Pathway There has been significant work undertaken to develop strong respiratory pathways and these are supported by guidelines and public information promoting appropriate self-management and support. Communications Local media campaigns will dovetail with the national ‘Be Health-Wise this Winter’ and will use a range of media both traditional and social media phased throughout the Winter period. Testing the Plan Resilience, contingency and escalation plans are tested through stakeholder events. Management Information Daily real-time performance monitoring will take place through dashboards covering key performance measures. This will be further supported by whole system conferencing. Daily senior leadership conferencing will assess system-wide status and guide escalation. An Integrated Approach to Building Capacity for Winter 2015/16 Previous Winter Plans have emphasised the importance of continuous and sustained improvement in unscheduled care provision as a central part of ensuring that the system is in a fit state to meet the demand placed upon it during winter and throughout the year. Most notably this has been apparent in the recurring investment of £2.1m committed through the Local Unscheduled Care Action Plan (LUCAP) which lays the foundation for a New Model of Care that will complement the Assessment Units under construction at both acute sites and the new ED at UHA as part of the Board’s Building for Better Care (BfBC) Programme. The significant progress made towards the integration of health and social care over the last 12 months has offered a further opportunity to build capacity within and beyond the acute hospitals to meet the demands of winter. This is reflected in the innovative and integrated planning approach adopted by IPEP. NHS Ayrshire and Arran’s Winter Plan 2015/16 outlines a range of measures which will be undertaken by the whole health and social care system to ensure the continuity of safe, effective and person centred care in the face of a number of anticipated epidemiological, climatic, staffing and demand related challenges.
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Using the best data available, IPEP has produced a planned programme of work which is targeted at improving the experience of our patients and colleagues by ‘de-compressing’ a healthcare system which is under evident strain. This approach is predicated on the reduction of acute occupied bed days (OBDs) which is an outcome which can be realised in one of the three ways. Figure 1: Drivers to reduce acute OBDs
Improve Patient Experience Improve Staff Experience De-compress the System
Reduce OBDs Reduce Emergency Admissions by providing accessible community alternatives
Reduce Acute Length of Stay by improving internal systems and processes
Reduce Delays in Discharge by providing appropriate community capacity
For each driver, colleagues from the three HSCPs and from Acute Services indicated a number of improvements which were planned to be enacted this winter. Against these, a projection was provided as to the number of acute OBDs which these initiatives would save. These initiatives and OBD savings are detailed by acute site in Figure 2 and Figure 3 below with North Ayrshire and East Ayrshire HSCPs contributing to the UHC total and East Ayrshire and South Ayrshire HSCPs contributing to UHA. There are additional initiatives which require further testing to fully quantify impact on occupied bed days, e.g., community connectors and single point of contact. The initiatives described illustrate improvement activity across the three themes and include work with Third Sector partners to prevent admission, increasing the level of morning and weekend discharge and achieving more timely discharge and assessment during the winter period.
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Figure 2: OBD Saving Initiatives - UHC
Initiative OBD Saving Owner
Red
uc
e
Em
erg
en
cy
Ad
mis
sio
ns
Red Cross Hospital to Home 564 EAHSCP
Community Connector Service TBC NAHSCP
Single Point of Contact TBC NAHSCP
Community Alarm Provision TBC NAHSCP
Red
uc
e
Acu
te L
oS
40% Morning Discharge 1743 UHC
Increase Weekend Discharges by 20
1040 UHC
Best Use of Available Capacity 1095 UHC
Red
uc
e D
ela
ys t
o
Dis
ch
arg
e
Increased Care at Home Capacity
757 NAHSCP
Reduced Delays to Assessment 1246 NAHSCP
Timely Transfer 1192 NAHSCP
Discharge to Assess 560 EAHSCP
Early Referral to SW 491 EAHSCP
Red Cross Hospital to Home 720 EAHSCP
TOTAL OBD Saving for 12 months 9408
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Figure 3: OBD Saving Initiatives - UHA
Initiative OBD Saving Owner R
ed
uc
e E
me
rge
ncy
Ad
mis
sio
ns
COPD Telehealth 500 SAHSCP
Ambulance Conveying 1000 SAHSCP
Anticipatory Care DN 1200 SAHSCP
Red Cross Hospital to Home 276 EAHSCP
Red
uc
e A
cu
te
Lo
S
40% Morning Discharge 1241 UHA
Increase Weekend Discharges by 15
780 UHA
Best Use of Available Capacity 663 UHA
Red
uc
e D
ela
ys t
o D
isc
ha
rge
SW Assessment at Biggart 900 SAHSCP
AHP –led beds at Biggart 430 SAHSCP
CLD at Biggart 500 SAHSCP
Discharge to Assess 140 EAHSCP
Early Referral to SW 327 EAHSCP
Red Cross Hospital to Home 480 EAHSCP
TOTAL OBD Saving for 12 months 8432
Having established the projected OBD savings for both acute sites as a result of these integrated improvements these were then applied to the projected OBD use for the coming winter. To arrive at this projection the OBD use for last winter was adjusted to take account of the following:
An upward adjustment for the anticipated 3% rise in emergency admissions
An upward adjustment for the demand not met last winter i.e.the bed days
which were avoided as a result of the cessation of orthopaedic elective activity
for a number of weeks
A downward adjustment for the projected savings outlined in Figures 2 and 3.
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As a result it is projected that for the six months between 1st October 2015 and 31st March 2016 UHC will operate at an average of 95.8% occupancy with 95% capacity exceeded on 106 days and 100% capacity exceeded on 30 days. Over the same time period UHA will operate at an average of 93.8% occupancy with 95% capacity exceeded on 44 days and 100% capacity exceeded on 3 days. This is represented in Figures 4 and 5 below. Figure 4: Projected net adjusted occupancy UHC – Winter 15/16
Figure 5: Projected net adjusted occupancy UHA – Winter 15/16
On the basis of the analysis described above, it is evident that capacity pressures at both acute sites will be inevitable this winter and will have a contingent negative impact on patient and staff experience. The sum of the integrated improvement initiatives will not decompress the system to a level where a range of quality and efficiency improvements might be expected and this situation is most especially the case at UHC. We should also note the optimism bias in this analysis which assumes that the OBD savings will be realised from the first day of winter and not follow a gradual improvement trajectory.
350
370
390
410
430
450
470
490
Net Adjusted OBD
100% Capacity
95% Capacity
200
220
240
260
280
300
320
340
360
Net Adjusted OBD
100% Capacity
95% Capacity
8
This assessment has informed the decision to increase capacity at UHC over the winter by an additional 30 beds. This increase in capacity will notionally reduce the average occupancy to 90%. At UHA, the physical constraints of the hospital building offer no opportunity to extend capacity by opening additional beds. The impact will be mitigated by an investment in staff at key points on the patient pathway who will facilitate the smooth flow of patients through and out of the acute hospital. A summary of the additional resource requirements is provided in Figure 6. Figure 6: Additional Resource Requirements Requirement Cost (5 months) UHC 30 Bed Ward £703,990 Patient Flow Team £31,481 Pharmacy £20,032 Ambulance £10,000 Sub Total UHC £755,503
UHA ANP £57,842 Patient Flow Team £64,939
Transfer/ Discharge Team £23,323
Pharmacy £23,200
Ambulance £10,000
Sub Total UHA
£189,304
Total £944,807
In addition to this acute investment to build capacity over the winter months, HSCPs will invest around £1,484,000 on specific initiatives and escalation plans from Delayed Discharge, Integrated Care Fund and Resource Transfer monies. A suite of performance measures will be used to monitor performance and inform decision making throughout the winter with the IPEP Steering Group meeting on a fortnightly basis to perform a proactive review function.
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NHS AYRSHIRE AND ARRAN
DRAFT WINTER PLAN 2015/16
AUGUST 2015
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Contents Introduction .......................................................................................................................................... 11
Purpose ................................................................................................................................................. 12
Policy Context ....................................................................................................................................... 12
Winter Analysis ..................................................................................................................................... 18
Local Review – Health and Social Care: Winter in NHS Ayrshire and Arran 2014/15 ..................... 18
National Review – Health and Social Care: Winter in Scotland 2014/15 ......................................... 22
Self-Assessment .................................................................................................................................... 23
Resilience and Preparedness ............................................................................................................ 23
Unscheduled/ Elective Care Preparedness ....................................................................................... 24
Out of Hours Preparedness ............................................................................................................... 27
Prepare for and Implement Norovirus Outbreak Control Measures ................................................ 28
Seasonal Flu, Staff Protection and Outbreak Resourcing ................................................................. 28
Respiratory Pathway ......................................................................................................................... 28
Management Information ................................................................................................................ 29
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Introduction This draft plan draws together ‘Winter Planning’, the Local Unscheduled Care Action Plan and plans linked to the Six Essential Actions into one Winter Plan (The Plan). The Winter Plan has been written taking full account of the winter planning guidance ‘The National Unscheduled Care Programme: Preparing for Winter 2015/16’ (DL (2015) 20) and the supporting ‘Winter Preparedness: Self-assessment’ framework issued by the Scottish Government. The Plan has been developed across the whole system of health and social care including Acute Services, Primary Care (including GPs, pharmacy, dentistry and optometry), Health and Social Care Partnerships, Allied Health Professionals, Scottish Ambulance Service, and the Third Sector. The work for this plan was taken forward under the direction of the Improving Patient Experience Programme (IPEP) and delivered by the Unscheduled Care Network and Unscheduled Care Interface Delivery Groups (North and South). Appendix 1 provides an overview of these groups. In NHS Ayrshire and Arran, work taken forward under the IPEP has focused on: tackling delays of people moving from Acute Services to more appropriate care settings outwith 72 hours; the elimination of elective cancellations of patient procedures arising from capacity issues; the elimination in hospital of patients being cared for outwith optimum ward area through ‘boarding’; and ensuring that care is provided by trained and experienced professionals at all stages. These improvement areas are directly relevant to the Winter Plan 2015/16 and the actions and measures developed as part of the IPEP work are incorporated into the plan. The Winter Plan 2015/16 aims to support providers of urgent and emergency care services in making best use of locally available resources as demand rises and /or capacity is limited in order to sustain safe, effective and person-centred care in line with our quality ambitions. ‘Escalation’ is a term generally used to describe pressure building in the system, often focused on acute services. In this plan ‘escalation’ is seen in a whole system sense where pressure or surge requires whole system action to manage. This approach to escalation underpins a system-wide response to increased demand or capacity pressures with an escalation framework applying to health and social care with agreed actions and triggers. The Winter Plan 2015/16 will be supported by a suite of measures across the system which will enable informed decision-making on a frequent basis through a snapshot of the system. The purpose of these measures is to enable dialogue on the whole system position and its management. These will develop over time and be available from October to enable weekly monitoring as information sharing progresses to support this – with an initial focus on a core set of measures.
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Purpose The aim of the Winter Plan 2015/16 is to support early intervention and action at points of pressure and to minimise the potential disruption to services, people who use services and their carers. The winter period can often be the most challenging in terms of these pressures, therefore, it is important to plan to minimise disruption. The focus of the Plan is on delivering the necessary systems, actions, capacity and business continuity arrangements for the winter period in 2015/16. The Plan is also relevant to managing pressure and surge throughout the year. The Plan aims to provide practical action prompts for individuals and groups involved in managing and responding to pressure within the health and social care system at any point in the year.
Policy Context The 2020 Vision for Health and Social Care forms the key overarching policy framework for this plan. The vision links to the delivery of the quality ambitions of safe, effective and person-centred care, and states that by 2020 ‘everyone is able to live longer healthier lives at home, or in a homely setting’. The vision describes a health and social care system which is centred on:
integrated health and social care;
a focus on prevention, anticipation and supported self-management;
day case treatment as the norm where Hospital treatment is required, and cannot be provided in a community setting;
care being provided to the highest standards of quality and safety, with the person at the centre of all decisions;
ensuring that people get back into their home or community environment as soon as appropriate, with minimal risk of re-admission.
The 2020 Vision drives the work of NHS Ayrshire and Arran and partners and is a key thread running throughout our Local Delivery Plan and the Strategic Plans of Health and Social Care Partnerships.
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Another key element in the strategic framework relates to the Six Essential Actions for improving unscheduled care. The Six Essential Actions cover leadership and operational management across the whole system, managing capacity and demand to deliver the right care in the right place at the right time. The Six Essential Actions link these to action aimed at delivering processes that support coordinated and person-centred pathways and effective and lean internal hospital processes to minimise delay. This also relates to action centred on reducing variation during the course of the week through Seven Day Services and optimising care at home through preventative, self-management, rehabilitation and enablement activity within the community. In summary, the Six Essential Actions are:
Clinically focussed and empowered hospital management;
Hospital capacity and patient flow (emergency and elective) realignment;
Patient rather than bed management ;
Medical and surgical processes arranged to improve patient flow through the unscheduled care pathway;
Seven day services appropriately targeted to reduce variation in weekend and out of hours working, and;
Ensuring patients are optimally cared for in their own homes or a homely setting.
The plan links to the delivery of the new Health and Wellbeing National Outcomes and the focused set of Local Delivery Plan standards which include:
People diagnosed and treated in 1st stage of breast, colorectal and lung
cancer (25% increase) 31 days from decision to treat (95%) 62 days from
urgent referral with suspicion of cancer (95%)
People newly diagnosed with dementia will have a minimum of 1 years post-
diagnostic support
12 weeks Treatment Time Guarantee (TTG 100%) 18 weeks Referral to
Treatment (RTT 90%) 12 weeks for first outpatient appointment (95% with
stretch 100%)
At least 80% of pregnant women in each SIMD quintile will have booked for
antenatal care by the 12th week of gestation
Eligible patients commence IVF treatment within 12 months (90%)
18 weeks referral to treatment for specialist Child and Adolescent Mental
Health Services (90%)
18 weeks referral to treatment for Psychological Therapies (90%)
Clostridium difficile infections per 1000 occupied bed days (0.32) SAB
infections per 1000 acute occupied bed days (0.24)
Clients will wait no longer than 3 weeks from referral received to appropriate
drug or alcohol treatment that supports their recovery (90%)
Sustain and embed alcohol brief interventions in 3 priority settings (primary
care, A&E, antenatal) and broaden delivery in wider settings
Sustain and embed successful smoking quits, at 12 weeks post quit, in the
40% SIMD areas
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48 hour access or advance booking to an appropriate member of the GP team
(90%)
Sickness absence (4%)
4 hours from arrival to admission, discharge or transfer for A&E treatment
(95% with stretch 98%)
Operate within agreed revenue resource limit; capital resource limit; and meet
cash requirements
75% of Category A incidents responded to within 8 minutes
95% of Category B incidents responded to within 19 minutes
Zero delayed discharges over two weeks and working toward discharge from
hospital within 72 hours of being ready for discharge.
Improving Patient and Staff Experience for Winter 2015/16 The Acute Services’ contribution to NHS Ayrshire and Arran’s Winter Plan 2014/15 focussed on the efforts to build year-round capacity robust enough to cope with the pressures of winter through an incremental introduction of a New Model of Care. Some key measures included the development of ambulatory care provision, the continued implementation of a continuous assessment model led by Consultants in Acute Medicine and the introduction of a Frail Older Persons’ Pathway at the front door of UHC. Despite these measures and the significant discretionary efforts of staff across the organisation, the experience of our patients and our colleagues was too often an unacceptable one. The Winter period was characterised by an unprecedented level of demand across the system and within the acute hospital patients waited in the Emergency Department for admission, were cared for out with the most appropriate specialty for their condition, had elective procedures cancelled as a result of lack of capacity and waited for discharge from their acute hospital bed after they had been deemed medically fit to leave. It is imperative that these events are not repeated. As such, the Chief Executive has established the Improving Patient Experience Programme (IPEP) with the four stretch ambitions of:
Eliminating instances of patients being boarded
Eliminating instances of patients having an elective procedure cancelled due
to a non-clinical reason
Eliminating instances of patients waiting longer than 72 hours for discharge
from the acute hospital after they are deemed medically fit
Ensuring that all patients are cared for by an appropriately trained clinician at
every stage of their journey.
Ultimately, IPEP aims to put into place the systems and processes and the bold thinking required to ensure sustainable future delivery of acute services. In the short-term, the focus of IPEP has been gaining an understanding of the interventions needed to provide the requisite robustness to meet the anticipated pressures over this winter.
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The approach has been integrated and data driven taking cognisance of the efforts across Acute Services and the three Health and Social Care Partnerships and putting in place a framework to ensure scrutiny, delivery and early escalation. These efforts can be categorised under the themes of i) Reducing Emergency Admissions ii) Improving Acute Systems and Processes and iii) Reducing Delays to Discharge. Figure 1 below outlines some of the key interventions under each of these themes, and Appendix 2 provides an overview of this integrated approach to improving patient experience.
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Figure 1 Reducing Emergency Admissions Improving Acute Systems and Processes Reducing Delays to Discharge
Community Connector service to target individuals who are frequent attendees at ED (NAHSCP)
Development of Discharge Team (Acute) Increased provision of Care at Home Services (NAHSCP)
Single Point of Contact to improve GP access to wider community services (NAHSCP)
Establishment of Discharge Hub (Acute) New models for rehab and re-ablement at Ayrshire Central Hospital (NAHSCP)
Increased community alarm provision (NAHSCP)
Maximise Criteria Led Discharge (Acute) Early Referral to Social Work (EAHSCP)
Red Cross Hospital to Home Service (Pan-Ayrshire)
Realignment of surgical beds to medical beds (Acute)
Discharge to Assess service model (EAHSCP)
COPD Telehealth Home Monitoring (SAHSCP)
Promotion and protection of high turnover areas including GP Assessment Areas and ambulatory care facilities (Acute)
District Nursing in-reach service (SAHSCP)
Alternative to ED conveyance framework for SAS ambulance crews (SAHSCP)
Introduction of new MDT service model at Biggart Hospital (SAHSCP)
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The four partner organisations have been challenged to quantify the projected impact of their improvements in terms of the acute beds days which will be saved. This metric is essential for understanding how the aggregate impact of improvements might combine to de-stress the system and allow the service to benefit from the increased efficiency and quality which comes as a result of working at below full capacity. This approach will allow evidence based decision making on the scope and nature of any surge capacity which is required. A decision on additional capacity will be made during the month of September and included within the final Plan to be approved by the NHS Board in October 2015 prior to submission to the Scottish Government.
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Winter Analysis Local Review – Health and Social Care: Winter in NHS Ayrshire and Arran 2014/15 A review of health and social care in Winter 2014/15 was undertaken by NHS Ayrshire and Arran. What worked well and we need to learn from?
Site-based hospital management structures, morning huddles and real-time
information sharing through the eWhiteboards were vital to the prioritisation of
resources and effective decision-making.
Embedded Multi-Disciplinary Team working and Criteria Led Discharge positively
contributed to shorter lengths of stay and reduced unnecessary consultant review.
Additional medical capacity was provided across the workforce including consultant
support at weekends.
Weekend pharmacy support extended to provide discharge support on a Sunday.
A temporary re-allocation of 15 beds from surgery to medicine at UHC made an
important contribution to patient flow but staffing challenges were experienced in
this area.
Additional resources were allocated to Scottish Ambulance Service and an
enhanced service was provided.
Closer working between Acute Services and Partnerships was beneficial and
included fortnightly discharge meetings and improved discharge coordinator and
social worker relationships.
Non-recurring funding to provide additional support to help avoid unnecessary
emergency admissions, e.g., investment in equipment.
Red Cross return to home service was introduced and supported patient discharge.
Enhanced role of District Nursing and Integrated Care and Enablement Services in
providing interventions which allowed people to stay in their own home as an
alternative to the acute hospital.
Additional home care provision was made available.
Community Hospitals enabled earlier discharge from acute sites and provide an
alternative to acute admission.
13 additional beds were opened in Cumbrae Lodge to facilitate discharge from
UHC.
Early planning to ensure all ADOC clinical shifts were covered over the Festive
period.
The Frail Older People’s Pathway operated during Winter 2014/15 at UHC and was
effective.
Ambulatory care pathways within the CDU continue to develop on schedule as part
of the Building for Better Care Programme.
Acute Physician led continuous assessment model developed at UHC.
IPCT and PHT prepared to respond to Norovirus in hospital and community. The
2014-15 Norovirus season in Scotland commenced in September, a month earlier
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than usual NHS Ayrshire & Arran’s plan to limit the impact of Norovirus has been
successful.
Despite the prolonged length and greater impact of the Norovirus season across
Scotland, A combination of public and staff awareness campaigns; effective
management of symptomatic patients on admission and the use of room closure as
opposed to whole ward closure wherever possible has minimised the impact on
patients, staff and the organisation.
What worked less well and we need to address?
Consultant, middle grade and trainee vacancies remained a significant challenge
throughout Winter 2014/15. This continues to be a challenge over 2015/16 with
international recruitment and the development of targeted recruitment campaigns in
place to enhance normal recruitment.
Medical staff gaps inhibited the establishment of Acute Medicine Consultant
outreach to UHA with cover only being provided on an ad-hoc locum basis.
The functioning of GP Assessment Areas and the Clinical Decision Units were
compromised by extreme capacity pressures. These facilities did not function in line
with the intended model of care.
The use of Clinical Decisions Unit (CDU) capacity to accommodate patients from
other specialties at times of peak demand, compromised pathways.
Demand for unscheduled care across the acute system was such that elective work
was compromised, particularly in the Orthopaedic Specialty with elective surgery
postponed over a period of 10 weeks.
Ambulance service capacity and the availability of staff to work overtime was a
limiting factor.
Some delays in home care provision to support discharge were experienced,
despite increased resource.
There were gaps in the ADOC clinical staff.
Due to capacity pressures a large number of patients were boarded out with their
speciality which inevitably compromised the quality of care which was received.
Boarding often took place in areas, such as Day Surgery, which and compromised
elective day case activity.
The lessons from winter 2014/15 feed directly into the current plan.
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ISD analysts are now embedded in Health and Social Care Partnerships in Ayrshire and Arran through the LIST initiative and have collated a range of data on unscheduled care across the system to be used within HSCP’s. The table below (Figure 2) benchmarks a number of key indicators for NHS Ayrshire and Arran and Scotland. Figure 2 NHS Ayrshire and Arran Scotland Indicator Five-year
quarterly average (Q12010-Q42015)
Oct-Dec 2014
% change on Oct-Dec 2013
Five-year quarterly average (Q12010-Q42015)
Oct-Dec 2014 % change on Oct-Dec 2013
Number of A&E attendances
28,385 28,896 4.1 341,431 331,033 3.18
% within 4 hours 93.5 90.6 -2.8 93.5 90.0 -3.3 Total Inpatient/Day Case Discharges (all specialties)
28,891 30,875 2.63 410,058 435,150 1.76
Total Inpatient/Day Case Discharges ("acute" specialties)
26,532 28,622 6.98 374,139 398,587 2.51
Total Inpatient Discharges ("acute" specialties)
18,221 20,744 11.05 260,098 281,218 2.23
Total Day Case Discharges ("acute" specialties)
8,311 7,878 -2.43 114,041 117,366 3.17
Total Inpatient Transfers ("acute" specialties)
4,064 5,798 26.95 76,384 90,189 3.66
Total Emergency Inpatient Discharges ("acute" specialties)
11,759 12,556 6.36 138,364 144,380 1.95
Total Elective Inpatient Discharges ("acute" specialties)
2,398 2,390 3.55 45,350 46,649 0.40
Bed days ‘lost to delayed discharge’ (Standard delays)
4,661 5,049 8.3 108,865 134,782 23.8
(note: * All Scotland figure excludes NHS Lanarkshire due to technical issues with data extraction; ** Delayed discharge figure are averages for three years 2012-2015 only)
In October to December 2014 A&E attendances in Ayrshire and Arran totalled 28,896 and up by 1.8 per cent on the quarterly average over the five years to March 2015 and up by 4.1 per cent on the same period in 2013/14 (Scotland down on five year average but up 3.2 per cent on 2013/14). During October to December 2014/15, 4-hour standard performance was on average 90.6 per cent. This is appreciably worse than the average performance over the five year period of 93.5 per cent and is down 2.8 percentage points on the same period for 2013/14 (Scotland 90.0 per cent and down 3.3 percentage points on 2013/14).
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Emergency inpatient activity totalled 12,556 for the three months to end December 2014, up by 8.5 per cent on the five year quarterly average of 11,579 and up 6.4 per cent on the number of discharges for the third quarter of 2013/14 (Scotland increase of 1.95 per cent between 2013/14 and 2014/15). Total inpatient/day case activity across all specialties increased during the third quarter of 2014/15 in NHS Ayrshire and Arran by 2.6 per cent compared with 1.8 per cent for Scotland as a whole when compared with the same quarter for 2013/14. Within this increase 2014/15 saw a substantially greater increase in inpatient activity for NHS Ayrshire and Arran than nationally (11.1 per cent compared with 2.2 per cent). Day case activity reduced locally by 2.4 per cent compared with an increase of 3.2 per cent across Scotland. Inpatient transfers for acute specialties increased more markedly for NHS Ayrshire and Arran than for NHS Scotland during the October to December 2014/15 – rising by 26.9 per cent and 3.7 per cent respectively – from the level experienced during the same period in 2013/14. The number of beds unavailable due to delayed discharge were 14 in the October to December quarter of 2014/15 compared with 12 in 2013/14 although the increase in bed days ‘lost to delayed discharge’ rose less markedly in NHS Ayrshire and Arran than across Scotland (8.3 per cent compared to 23.8 per cent). Community services experienced similar pressures during Winter 2014/15 with higher numbers of care at home starts and admissions to care homes. The analysis of these trends is being used to shape escalation and capacity plans for Health and Social Care Partnerships. Incidents of Norovirus-like symptoms during 2014/15 were the lowest in the last decade with the number of laboratory reports of Norovirus being 2.1 per 100,000 population compared with 15.8 for 2013. This compares with Scotland-wide rates of 24.5 and 36.0 respectively. The data summarised above relate directly to the experiences of NHS Ayrshire and Arran residents and combine to impact on the health and care system in relation to bed occupancy and the ability of services to respond to periods of surge in demand.
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National Review – Health and Social Care: Winter in Scotland 2014/15 On 6th August 2015 the Scottish Government published its learning from Winter 2014/15 (‘Health and Social Care: Winter in Scotland 2014/15’). Overview The report noted increases in activity and capacity within the NHS in Scotland. Rates of influenza and respiratory illness contributed to pressures. Delayed discharge is also flagged as a significant winter pressure in the review. These pressures are highlighted as contributing to a reduced performance on the 4 hour waiting time standard between December 2014 and February 2015. Integration and improving unscheduled care through the Six Essential Actions is viewed as central to ensuring that the health and care system can operate flexibly to meet demand throughout the year. Specific Findings The ‘Health and Social Care: Winter in Scotland 2014/15’ report highlights several elements: Measures were taken to strengthen capacity, by increasing the available workforce in line with expected demand, increasing acute medical beds temporarily, and making more intermediate care places available. Increasing activity through a rise in calls to NHS24 (up 17 per cent on 2013/14), an increase in Scottish Ambulance Service Category A-C calls (up 3.8 per cent on 2013/14), higher A&E presentations (up 0.5 per cent on 2013/14), and higher levels of cancelled elective activity which impacted adversely on inpatient and day case treatment times. Highest number of hospital admissions as a result of respiratory illness in a decade (up 22.5 per cent on 2013/14). Substantial and prolonged increase in influenza admissions (with 2014/15 levels of the previous three years combined). Norovirus incidence is comparable with seasonal averages and less of a factor in terms of Winter pressures during 2014/15. Delayed discharge bed days occupied increasing through Winter 2014/15 to December accounting for 55,000 days (up on around 40,000 in December 2012 and 45,000 in December 2013). While better in Scotland than in other areas of the UK, waiting times were significantly impacted in Winter 2014/15, particularly in January and February 2015 and for NHS Ayrshire and Arran, NHS Greater Glasgow and Clyde and NHS Lanarkshire. The impact was more severe than the previous two Winters and the position was not recovered across Scotland until May 2015. Seasonal ‘flu vaccination up-take improved on the previous year but remained below the target level of 50 per cent across Scotland.
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The 2014/15 review emphasises the need to improve delayed discharge, implement the Six Essential Actions for Unscheduled Care with an, additional focus on planning for additional pressures and business continuity and resilience in 2015/16.
Self-Assessment based on Winter Preparedness checklist provided by Scottish Government Resilience and Preparedness
A senior Strategic Planning and Operational Group (SPOG) is established at
Director level (three HSCP Directors, Acute Director, Head of Planning and
Performance) and meets on a weekly basis
A Heads of Service group is established supporting the Strategic Planning and
Operational Group.
Resilience and Business Continuity arrangements and management are in place.
Resilience and Business Continuity Group meetings take place regularly with
appropriate representation from Senior Officers.
Services within integrated Health and Social Care Partnerships have continuity
plans in place, Business Continuity and Resilience leads are identified and
supported by parent body leads and the Ayrshire Civil Contingencies Team.
An Ayrshire-wide severe weather plan is being developed including triggers for
multi-agency coordination.
Plans are tested in preparation for seasonal pressures.
Minimum staffing levels have been established and services categorised to support
the effective operation of essential services.
In addition, mutual aid plans are in place at a regional West of Scotland level.
Supporting human resource policies are in place covering severe weather, adverse
conditions and service disruption.
Communications teams disseminate information on the operation of clinics and
ambulance pick-up services and provide signposting to sources of weather and
travel advice.
Areas for Action Resilience, business continuity and escalation plans will be tested prior to the winter period. This work is being led by Unscheduled Care Interface Delivery Groups.
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Unscheduled/ Elective Care Preparedness Clinically focused and empowered hospital management
There is clarity of site management through Assistant Directors and Associate
Medical Directors and Ass Nurse Dir. Reorganisation of acute hospital
management arrangements ensures a site-specific approach and senior
management presence from 8.00 am to 8.00 pm, across the weekend and with 24
hour on-call support.
Health and Social Care Partnerships are now established with integrated
management teams in place.
Daily huddles are in place between clinical departments to identify and address
system pressures. Health and Social Care Partnership employees are participating
in daily huddles.
Escalation plans are in place for acute hospital sites. Whole-system communication
and escalation protocols between partners are being established through multi-
disciplinary Unscheduled Care Interface Delivery Groups covering University
Hospital Ayr and University Hospital Crosshouse.
An Ayrshire wide Discharge Group is in place, chaired by the Head of Service for
East Ayrshire Health and Social Care Partnership, with representation from acute
and partnership services to facilitate the identification of opportunities for timely
discharge. Detailed planning, analysis and forecasting is in place
System Watch predictors are utilised to anticipate the level of emergency
admission.
Elective activity is managed across each acute site and specialty.
Analysis and improvement tools are well established in acute services.
Support to further develop these approaches in community services is an identified
need with work ongoing to establish.
Winter Planning Fora for acute sites are re-aligning surgical capacity to support
increased medical admissions over winter 2015/16 and Health and Social Care
Partnerships are reviewing capacity across service areas to respond to seasonal
surge.
95 per cent performance against the 4-hour standard is a top priority for NHS
Ayrshire and Arran linked to patient safety outcomes. Where there are waits out
with the 4-hour standard these are reviewed, lessons learned and disseminated.
There is regular daily and weekly review of performance.
Staff rotas
Staff rotas are planned in advance to manage predicted activity.
Health and Social Care Partnerships rotas for supporting services will be set by end
of October.
Pharmacy rotas are agreed and communicated to an end of October timescale.
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Optimising flow and proactively managing discharge
East, North and South Health and Social Care Partnerships will ensure that
discharge planning is coordinated across agencies.
Agreement of additional resources to support extended Scottish Ambulance
Service (SAS) is planned to support people returning home over extended days
and weekends.
The Red Cross home from hospital service has been rolled-out across NHS
Ayrshire and Arran with additional resources in Winter 2015/16 will allow for
greater flexibility in response.
Huddles now take place in mornings and afternoons with a clear focus on ‘no
delays’ and discharge.
E-Whiteboards have been implemented in all acute wards and in most Community
Hospital settings. E-Whiteboards also record Estimated Date of Discharge which
is fed back into ward teams to support continuous improvement and earlier in the
day discharge.
Senior decision-making capacity and discharge during festive holiday period
Multi-disciplinary ward rounds are standard practice in several specialties and
Criteria-led Discharge (CLD) is being piloted as part of project with the Scottish
Government.
Individuals who are likely to be suitable for weekend discharge are identified by
General Medicine teams at the end of the week for further review and discharge
over the weekend.
Partners are working together to facilitate seven day discharge across settings and
pre-planning in relation to public holidays.
Anticipated home care and intermediate care requirement to facilitate discharge
Partnership working has been enhanced during 2015/16 with the establishment of
an Unscheduled Care Network and Unscheduled Care Interface Delivery groups
focused on the two main hospital sites.
Unscheduled Care Interface Delivery groups are developing escalation
arrangements that will be responsive to variation in demand.
Partners have developed plans to address expected levels of demand over the
winter period including additional care at home staff, additional commissioned
hours, additional Red Cross capacity, Royal Voluntary Service befriending, district
nursing capacity with a focus on discharge, temporary care home capacity and
tests of change within wards and Community Hospitals.
The Intermediate Care and Enablement Service (ICES) ensure direct access to
home care, intermediate care beds and rehabilitation to support discharge.
There has been a strong focus on Anticipatory Care Planning in NHS Ayrshire and
Arran. The identification of ‘at risk’ individuals through SPARRA and other
mechanisms are shared and proactively managed though social work-GP liaison
arrangements and e-KIS.
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Further development and the delivery of ACPs across services is recognised as a
requirement.
There has been some contraction in the care home market in certain areas and
capacity is recognised as an area for monitoring.
Effective communication
Communication mechanisms between acute services and HSCP managers are
established to support the early identification of system pressures. Escalation
procedures are in place and are communicated.
A system of daily situation reports is in place where flu incidences increase to
enable the monitoring of workforce availability.
Health Protection Scotland (HPS) population flu incidence reports are made
available.
Lead Partnership arrangements are in place for Mental Health Services covering
crisis team and A&E links where acute presentations require support.
Lead Partnership arrangements are in place for Out of Hours management across
Ayrshire for Medical, Nursing and Social Work services.
Templates with key contacts and service levels are established - these will be
further developed and shared across the health and care system in 2015/16.
Unscheduled Care Interface Delivery groups have supported the development of
whole system escalation plans which will be in place for winter 2015/16.
The local media campaign dovetails with national ‘Resilience’, ‘Be Health-Wise this
Winter’ and ‘Be Ready...’ campaigns. The campaign is delivered through a mix of
traditional and new and social media. Special emphasis will be placed on issues
of medicine stock-up, self-care, requesting repeat prescriptions and the closure of
GP practices during the festive period.
Areas for Action Daily huddles will be a key focus for identification and management of system pressure and will include representatives from across the health and social care system and stretch into community hospitals. Escalation processes will be established for Health and Social Care Partnerships dovetailed with those for Acute Services. Staff rotas will be agreed by end of October timescale. Templates including key contacts across all relevant services will be collated and disseminated. Partnership capacity plans will be implemented. Implementation of IPEP actions to increase weekend discharge, roll-out Criteria Led Discharge, ensure accurate Expected Date of Discharge, increase percentage of morning discharges, discharge to assess, early referral to social work, increasing care at home capacity, redesign to reduce length of stay and tests of change within community hospitals. Performance information will be reviewed daily within services and weekly as part of whole system arrangements. A whole system conference call approach will be implemented in Winter 2015/16. These will be coordinated and will include representatives of health and social care partners who have a remit for identifying pressures and coordinating appropriate action.
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Local media campaigns will be implemented to reinforce national messages and sources of information. These will link to partner communications and media.
Out of Hours Preparedness
Integration arrangements now provide single management across Out of Hours
community Medical, Nursing and Social Work services.
A contingency/escalation plan is in place for Ayrshire Doctors on Call (ADOC) and
this will be up-dated pre-winter 2015/16.
ADOC GP rotas will be put in place to ensure cover for the holiday period.
A pilot utilising ANP’s to support gaps in ADOC shifts has been effective and will
continue over the winter period.
Arrangements are in place with NHS24 regarding pre-prioritised calls.
Winter activity will be monitored to determine any requirement for additional cover.
Referral pathways are in place between A&E and out of hours, Single Point of
Contact and ADOC. The Single Point of Access covers Out of Hours Mental
Health. The Psychiatric Liaison Team and Crisis Team operate seven days per
week and 365 days per year.
Arrangements for community pharmacy services are made to ensure availability
over the festive period and this is communicated widely.
Emergency Dental Services are covered through NHS 24 for the festive public
holiday period. Escalation protocols and on-call arrangements are in place.
Out of Hours social work services have in place contingency plans and emergency
rotas. Consideration is also being given to sharing staff with comparable
registration requirements across services.
Areas for Action Out of hours winter and contingency plans will be implemented.
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Prepare for and Implement Norovirus Outbreak Control Measures
The Infection Prevention and Control Team (IPCT) have in place Norovirus Control
Guidelines which are effective from April 2014.
Guidelines cover general information, modes of transmission, symptoms, incubation
and infection periods and action to be taken in the event of an outbreak or
suspected outbreak.
The IPCT and the Public Health Protection Team (HPT) play a vital role in public
and workforce education. National publicity materials are distributed across primary
and secondary care and these are reinforced through local media and site visits
planned to coincide with Norovirus season. The HPT provide expert infection
control advice in the event of any community outbreak and the IPCT for any
hospital-related outbreak.
Areas for Action Dissemination of national materials through range of media and site visits. Briefings on national and local Norovirus situation to be provided to relevant fora and cascaded throughout the Board.
Seasonal Flu, Staff Protection and Outbreak Resourcing
Partners in NHS Ayrshire and Arran will work to deliver the seasonal flu vaccination
programme in line with the Chief Medical Officer’s letter of 10th July 2015
(SGHG/CMO (2015) 12).
Up-take targets at a population level are 75 per cent for over 65s and under 65s in
‘at risk’ groups (including morbid obesity) and cover pregnant women.
Free seasonal influenza vaccination will be offered to those providing care within
Health and Social Care Partnerships. This will be offered in an accessible way to
encourage up-take.
The range of national and local communication resources will used to promote
vaccination among residents and staff protection including
www.immunisationscotland.org.uk
Areas for Action Actively promote the up-take of flu vaccination among the workforce, offering vaccination in as accessible a way as possible. Promotional materials to be distributed and displayed in key staff areas and communicated through range of media across partners. Targeted programme of vaccine among workforce in ‘high risk’ areas. Vaccination of ‘at risk’ groups to be taken forward in line with Chief Medical Officer guidance. Health Protection Scotland weekly epidemiological bulletin monitored to detect potential surge at early stage.
Respiratory Pathway Partners in NHS Ayrshire and Arran have developed a strong respiratory pathway
over recent years.
Local guidance and information is in place to promote self-management and
supported self-management.
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The respiratory pathway links with Anticipatory Care Plans and telehealth.
Specialist respiratory service is in place.
Respiratory conditions are recognised as a significant factor in additional winter
pressures and were a particular feature of 2014/15.
During 2015/16 respiratory pathway work is being further enhanced through a multi-
disciplinary approach developed using Integrated Care Fund resources.
Areas for Action Promote range of respiratory guidelines and public information leaflets. Communicate self-management messages as part of communication plan.
Management Information
Collate and analyse available data through LIST and HSCDIIP to model system
demand and capacity and project impact.
Use real-time information to predict and react to peaks and troughs in demand.
Make use of additional whole system information, testing live data on availability of
care at home hours and care home places.
Areas for Action ISD, SystemWatch, Qlikview and local data to be actively used to inform decision-making. Whole system analysis and modelling to be undertaken. Development of whole system dashboard which will present the management information required for decision making, planning and escalation.
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Appendix 1 Unscheduled Care Interface Delivery Groups (North and South) The aim of the Unscheduled Care Interface Groups is to provide a forum for learning and sharing of practice in relation to whole system interventions and improvement linked to unscheduled care, the four hour standard and effective discharge. The groups centre on the two main acute hospital sites within NHS Ayrshire and Arran (University Hospital Crosshouse and University Hospital Ayr) and have a focus on developing whole system agenda’s and work plans. The Interface Delivery Groups support an Unscheduled Care Network and the Strategic Planning and Operational Group in delivery ambitions to reduce unscheduled care demand, develop integrated pathways, manage effective discharge and identify related workforce and resource implications. The membership includes wide ranging representation from Acute sites and Health and Social Care Partnerships and multi-disciplinary professional groups.
