Resource Escalation Action Plan - NHS Foundation Trust · 2016-09-02 · REAP Level 1 – NORMAL WORKING ACTION REQUIRED By Whom Ensure adequate 999 contact centre cover is in place

North East Ambulance Service, NHS Foundation Trust Not Protectively Marked

Resource Escalation Action Plan

REAP

Version 11: October 2013

Prepared by: Paul Liversidge, Chief Operating Officer

Capacity Plan

CONTEXT

In order to ensure that a high level of ambulance response time performance is maintained at all

times and that capacity issues are effectively and consistently dealt with, the NEAS Capacity

Plan has been amended to include a ‘Resourcing Escalation Action Plan (REAP).

The REAP outlines actions that should be implemented in the event of certain triggers.

KEY TRIGGERS

The triggers below will apply. Each trigger has several parts. Some of the triggers are measured

against statistical data, presented weekly by the Performance and Information Team. The trigger

is activated when the data differs considerably from the ‘normal’ accepted value.

REAP – Level One

Normal Service

The Trust is operating at a ‘steady’ state

Demand is broadly at expected levels and being managed effectively.

Resourcing is satisfactory and therefore workload on each individual is considered acceptable.

There are no excessive demands on the Service, due to weather, big events, NHS capacity or technology issues.

The Trust is meeting its key performance targets.

Absences within seasonal levels

Normal response times in control

No reported supply chain difficulties

Hospital turnaround times do not exceed 20 minutes

REAP – Level Two

Concern

Red call performance falls below target by up to 3% (>72% to <75%)

Green 2 calls is less than 90% (>85% to <90%)

Calls requiring an attendance 5% above normal (contracted for 1000 incidents / day ~ >1000 to <1050)

Absences within the 999 contact centre have increased by 15% over normal seasonal levels

Absences within field operations have increased by 5 – 10% over normal seasonal levels

Call abandoned rate less than 10% (>5% to <10%)

90% calls answered within 5 seconds (>90% to <95%)

Supply chain difficulties are short lived.

Severe events are having a limited local impact on activity.

Hospital delays are being experienced (>50% to <60% of hospital turnaround times exceed 25 minutes)Critical infrastructure issues have been experienced for a period of 6 hours and are not expected to reoccur.

REAP – Level Three

Concern

Red call performance falls below target by between 3-5% (>70% to <73%)

Green 2 calls below 85% (>85% to <90%)

Calls requiring an attendance above 5% but below 10% above normal (>5% to <10% ~ >1050 to <1100)

Absences within 999 contact centre have increased by 15% above seasonal rates

Absences within field operations have increased 10-15% above seasonal rates

Call abandoned less than 15% (>10% to <15%)

80% calls answered in less than 5 seconds (>80% to <90%)

Supply chain difficulties are manageable

Severe events are having a wide spread impact in a region

Hospital delays are being experienced. (>60% to <70% of hospital turnaround times exceed 25 minutes)

Critical infrastructure issues have been experienced for a period of 12hours and are expected to continue for a specified time of no more than 6 hours.

REAP – Level Four

Severe Pressure

Red call performance falls below target by between 5 – 10% (>65% to <70%)

Green 2 calls below 80% (>70% to <80%)

Calls requiring an attendance 10%+ above normal (>10% to <25% ~ >1100 to <1250)

Absences within 999 contact centre have increased by 15% above seasonal rates

Absences within field operations have increased 10-15% above seasonal rates

Call abandoned rate less than 15% (>10% to <15%)

70% call answered in less than 5 seconds (>70% to <80%)

Supply chain difficulties are not manageable

UK alert is raised

Hospital delays are being experienced (>70% to <80% of hospital turnaround times exceed 25 minutes)

Major critical infrastructure issues have been experienced for a period of up to 24hours and are expected to continue for a specified time of no more than 24 hours.

REAP – Level Five

Critical

Red call performance falls below target by between 10 – 15% (>60% to <65%)

Green 2 calls below 70%

Calls requiring an attendance 25% above norm (>25% to <30% ~ >1250 to <1300)

Absences within 999 contact centre have increased by 15% over normal seasonal levels.

Absences within field operations have increased by 15% above normal seasonal rates

Call abandoned rate greater than 30% (>15% to <20%)

60% calls answered within 5 seconds (>60% to 70%)

Supply chain difficulties mean trust supplies are at a critical level

UK alert is critical

Major incident declared

Hospital delays are being experienced at multiple sites for a sustained period (>80% to

<90% of hospital turnaround times exceed 25 minutes)

Major critical infrastructure issues have been experienced for a period of 24hours and are

expected to continue for an unspecified time.

REAP – Level Six

Potential Service Failure

Red call performance falls greater than 15% below target (<60%)

Green 2 calls below 65% (<65%)

Calls requiring an attendance 25% above norm (>30% ~ >1300)

Absences within contact centre have increased by 20% over normal seasonal levels.

Absences within field operations have increased by 15% above normal seasonal rates

Call abandoned rate greater than 40% (>40%)

50% calls answered within 5 seconds (<50%)

Supply chain difficulties mean trust supplies are at a critical level

Hospital delays are being experienced (>90% of hospital turnaround times exceed 25 minutes)

Major critical infrastructure issues have been experienced for a period of 24hours and are expected to continue for an unspecified time.

Co-Ordination and Assessment of Information

The key to dealing with the above triggers is early identification of problems that may arise. The

entire NEAS management team should be alert to factors that could lead to capacity problems.

Information should be reported to the A&E Sustainability Group for consideration.

The A&E Sustainability Group will hold responsibility for assessing the key triggers. The decision

to change the REAP status level can only be made by the Chief Operating Officer (COO) or the

Emergency Care Business Manager in the COO’s absence.

Changes to the REAP level will be circulated via pager e-mail message to all NEAS HQ and

Operational Management staff by the PA to the COO. The NEAS intranet site will also show the

REAP status and this will be amended by the PR department.

RESOURCE ESCALATION ACTION PLAN (REAP)

1. Introduction 1.1. The Resourcing Escalation Action Plan (REAP) is designed to increase operational

resourcing to cope with periods of high pressure and maintain the highest possible quality of patient care.

1.2. This plan is in operation at all times. In normal circumstances it will operate at REAP level one. There are varying levels reflecting increasing pressure on the Service, up to level five, where there is the potential for complete service failure.

1.3. The REAP levels are: 1. Routine - White

2. Concern - Green

3. Moderate Pressure - Yellow

4. Severe Pressure - Red

5. Critical – Purple

6. Potential Service Failure - Black

1.4. The triggers are detailed in the NEAS Capacity Plan.

1.5. The REAP plan and the REAP levels apply to the whole organisation. The current level will be widely publicised. Every manager has a responsibility to know the current level. It is expected that all staff will have an understanding of the REAP levels and know what is required of them.

1.6. Each operational manager and head of department has a responsibility to understand the plan and to have a corresponding implementation plan for their area of operation. All areas of the Trust are required to take meaningful action, with the appropriate urgency, as the plan escalates.

1.7. The Resourcing Escalation Action Plan is aimed at protecting patient care. Consequently, actions taken under the plan should be considered to have been taken with the delegated authority of the Chief Executive.

2. The plan. 2.1. The following pages show the actions which will be taken at different levels of the plan.

REAP Level 1 – NORMAL WORKING

ACTION REQUIRED By Whom Ensure adequate 999 contact centre cover is in place Contact Centre Managers (CCM’s)

Assess RRV staffing and backfill as appropriate from other core areas Operations Managers (OM’s)

Ensure RRVs are at standby points / SSP plan fulfilled OM’s / CCM’s

Active liaison and dialogue with Contact Centre on ambulance standby arrangements

OM’s /CCM’s

Monitor and manage leave All line Managers

Monitor and manage mobilisation times CCM’s and OM’s

Monitor and manage job cycle times CCM’s and OM’s

Monitor and manage activation times CCM’s and OM’s

Monitor and manage individual cycle performance E/C Business Manager / OM’s

Monitor and manage demand profile/s E/C Business Manager / OM’s

Monitor weather conditions and action mitigation E/C business Manager

Monitor resource impacts of special events and mass gatherings E/C Business Manager

Monitor and manage performance targets CCM’s / OM’s / Informatics

Monitor and manage sickness/absence All line Managers

Monitor and manage all abstractions RSD / All line Managers

Monitor and manage hours produced RSD / All line Managers

Monitor, manage and maintain predicted staffing RSD / All line Managers

Ensure robust and appropriate operations management cover arrangements are in place

E/C / Contact Centre Business Manager’s

Ensure proportionate and balance cover of ambulance versus RRV provision CCM’s / OM’s

Ensure appropriate cover of HALOs at hospitals E/C Business Manager

Ensure good utilisation of all staff groups All line Managers

Ensure I,M&T and communication functions are working efficiently (IT, Airwave, Phones etc)

Assistant Director of I,M&T

Ensure Alternative Care Pathways are being utilised fully where appropriate Clinical Lead Contact centre

Ensure all Major incident vehicles and equipment are in a state of readiness including MEOCS which should be driven weekly and have daily shift checks

by ICD.

Head of Resilience and Specialist Operations

Monitor Hospital delays on an ongoing basis HALOs / Logistic Desk / CCM’s / OM’s

Consider escalation to next REAP level Chief Operating Officer (COO)

Actively engage local Union Representatives E/C Business Manager

REAP Level 2 – CONCERN Additional actions detailed in level 1 (above)

ACTION REQUIRED By Whom Increase monitoring at Divisional Level to ensure maximisation of resources

and optimal efficiency OM’s / CCM’s

Where funded ensure HALO cover at trusts and proactively manage delays elsewhere

Logistics desk / CCM’s / E/C Business Manager

Prioritise abstractions and recall staff where necessary and appropriate All line managers

Stringent local monitoring of Vehicles on Road OM’s / Fleet

Consider daily conference call for briefing staff and determining impacts Gold Commander

Increase focus and effort on 999 contact centre staffing CCM’s

Monitor for increase in complaints All Managers

Review and prioritise recruitment to vacancies HR with recruiting departmental manager/s

Review skill mix and capabilities of non-operational staff to identify where they can support operations or Contact Centre

Director of Workforce and Organisational Development

Review cleanliness regime in Contact Centre to minimise absence due to any infection risks

CCM’s

Review bank staff and reserve staff lists and ensure they are up to date RSD / OM’s

Re-iterate to crews the use of alternative care pathways to ameliorate pressure on acute provider trusts

CCM’s / OM’s / HALOs / logistics desk

Re-iterate messages in respect of “treat at home policies” including swine flu advice to patients

Clinical Care & Patient Safety Director / CCM’s / E/C Business Manager

Ensure increase in REAP status is reported in any SITREPS internally and upwards to the Area Teams.

PR / Gold Commander

Consider escalation to next REAP level Gold Commander or nominated deputy

REAP Level 3 – MODERATE PRESSURE Additional actions detailed in level 1 and 2 (above)

ACTION REQUIRED By Whom

Consider the use of PTS resources to support A&E operations at critical demand times

Gold Commander / CCM’s / OM’s

Refuse all short notice annual leave All line mangers

Encourage staff to work extra overtime, cold calling if necessary All line Managers

Consider the use of supervisory operational staff to cover vehicles E/C Business Manager / OM’s / CCM’s

Training school to provide staff for shifts Head of Clinical Education and Development

Cancel non-essential meetings Departmental Heads/ line Managers

Consider the use of operational senior managers to staff vehicles for additional hours

All line managers

Review all staff rosters for resilience All line managers

Review Departmental Business Continuity Plan All departments

Consider planned use of external provision E/C Business Manager / CCM’s / OM’s

Consider expanding conference call membership to include additional key personnel as the situation dictates

Gold Commander

Recall all non-essential abstractions Line mgrs / RSD

Review cover for all planned external events E/C Business Manager / RSD

Review Fleet management arrangements and maintenance schedules and consider extending hours to support operations

Head of Fleet

Review and prioritise training Head of Training and Education /HR

Ensure make ready systems are in place and able to escalate if necessary Head of Fleet

Re-deploy HALOs to hospitals where there are issues and review HALO shift patterns to cover problematic areas for extended periods of time

Logistics desk

Check (if pressure weather related) that rock salt is available for use at all stations

OM’s / Estates

Monitor and ensure adequate stocks of medical consumables, high volume fleet items and hygiene products

Head of Fleet / Procurement

Consider staffing additional RRVs CCM’s / OM’s


Gold Commander with PR

Consider escalation to next REAP level On call Gold commander

Communications

Communication department to issue media messages in regard to “using the service responsibly in line with plans and other NHS responders

Press Office

Communications department to ensure all NEAS Staff are briefed and Press Office

updated

REAP Level 4 – SEVERE PRESSURE Additional action required, over and above levels 1-3

ACTION REQUIRED By Whom Establish Surge Management Team and AREA SILVER CELLS to manage

situation and bring about recovery

Surge Management Team with relevant heads of department and supported by Area silver cells working with authority from Chief Executive Officer in collaboration with Duty Gold commander.

Consider attendance incentives

Review planned leave ask for staff on leave to consider returning to work

Implement daily conference calls with all areas of the organisation in line with the agreed battle rhythm

Consider buying back annual leave to maximise staffing available

Cancel all non-essential meetings

Deploy and maximise all alternative resources (VAS/PTS Staff) to support A&E delivery/manage demand

Cancel non critical training

Monitor HALO performance at Trusts and supplement with senior managers if necessary

Consider / deploy clinical staff to 999 contact centre to assist with triage of Response Calls

All non-essential vehicle maintenance/repair to be rescheduled

Ensure drivers available 24 hours to move vehicles and supplies

Each department to provide daily BC SITREP to Surge Management Team

/silver cells

Consider incentivising CFR scheme to encourage responders to book more hours available

Training school to free up clinical staff to assist with additional operational hours

Close liaison through the Surge Management Team with Area Teams to establish options for additional support

Special bulletin to all staff to advise of the situation


Consider escalation to next REAP level

Communications

PR to increase media messages to ask public to use service responsibly and

to utilise all available current NHS media campaigns with partners

Communications to issue Special Bulletin to staff informing of current pressures and mitigation strategies the trust is taking

REAP Level 5 – CRITICAL Additional action required, over and above levels 1-4

ACTION REQUIRED By Whom Establish GOLD COMMAND and consider declaration of a “MAJOR

INCIDENT”

Gold Commander

Through: Formal Gold Control Structure and Command Arrangements as defined in Trust Major Incident Plan

NB: The surge management team will continue to support at this level to

ensure de-escalation takes place in a safe, managed way

*** Consider request for assistance from or set up of National Ambulance Co-Ordination Centre (NACC) ***

Cancel ALL Leave

Suspend all training and recall all seconded staff

Consider requesting Mutual Aid from another Ambulance Trust or through the national mutual aid arrangements

Re-deploy staff where possible to cover operations

Deploy trained staff to support 999 contact centre (additional call handlers)

Deploy PTS Tier to support A&E work

Request a suspension of performance targets for a defined period of time

Review number of solo responders versus Ambulance crews to determine if mix can be altered

Deploy non-operation managers to manage A&E delays to free up operational response capacity and capability

Consider pairing up A&E crew staff with PTS to increase operational A&E resource

Cancel all event and stadia cover

Paramedics and Technicians to be instructed to refuse conveyance after assessment

Open workshops up 24 hours a day 7 days per week to maximise vehicle availability

Increase CFR booked hours

Each department to provide daily BC SITREP to Surge Management Team /silver cells

Use trainees to support operations

All managers to assist with additional ambulance cover

Training school to free up clinical staff to assist with additional operational hours

Close liaison through the Surge Management Team with healthcare Trusts to

establish options for additional support

Special bulletin to all staff to advise of the situation


Consider escalation to next REAP level

Communications

PR to significantly increase frequency and tone of media messages to ask public to use service responsibly

Continued and regular briefings to keep staff updated

All managers to ensure staff in their line management are briefed and up to date on current situation

REAP Level 6 – POTENTIAL FAILURE OF SERVICE Additional action required, over and above levels 1-5

ACTION REQUIRED By Whom Major Incident Declared

Chief Executive Officer and Management team support by:

Formal GOLD control structure and Command Arrangements as defined in

the Trust Major Incident Plan.

*** Request Activation of National Ambulance Co-Ordination Centre ***

Move all available staff to support Emergency Work

Use all available bank and agency staff

Deploy clinical staff to contact centre to oversee clinical re-triage of Red Calls

Consider the use of nurses and other health professional to assist with response

Request mutual aid via Area Teams from Healthcare Trusts to assist in control and operations to triage calls

Review treat and leave policies

Agree cessation of PTS taskings in conjunctions with service commissioners

Consider use of up skilled ECA as first responder on a solo vehicle

Extensive Media campaign through communications department to inform public of the situation

Ensure increase in REAP status is reported in any SITREPS internally and upwards to the Area Teams

Communications

PR to significantly increase frequency and tone of media messages to ask public to use service responsibly - this will be co-ordinated through the ERMA

groups and Area Teams.

Continued and regular briefings to keep staff updated

All managers to ensure staff in their line management are briefed and up to date on current situation

REAP Triggers:

REAP Level

Performance

Factors Affecting Performance

Demand Abstractions Control Room Issues

External Influences

NHS Internal Influences

6 Potential service failure

Red calls performance below 60% Green 2 calls performance below 65%

Calls requiring an Attendance 30% above contract

Abstractions within EMS have increased by 15% over normal seasonal levels.

Abstractions within Control have increased by >20% over normal seasonal levels. Call abandoned rate above 30% Less than 60% of calls answered within 5 seconds

Supply chain difficulties mean trust supplies are at a critical level UK Alert level is critical

Hospital delays are being experienced - Over 90% of Hospital turnarounds exceed 25 minutes Major critical infrastructure issues have been experienced for a period of 24hours and are expected to continue for an unspecified time.

5 CRITICAL

Red calls performance between 60% and 65%) Green 2 calls performance between 65% and 70%)

Calls requiring an Attendance between 25% and 30% above contract

Abstractions within EMS have increased by 15% over normal seasonal levels.

Abstractions within Control have increased by 15% over normal seasonal levels. Call abandoned rate between 20% and 30% Between 60% and 70% of calls answered within 5 seconds

Supply chain difficulties mean trust supplies are at a critical level UK Alert level is critical MAJOR Incident declared

Hospital delays are being experienced Between 80% and 90% of Hospital turnarounds exceed 25 minutes Major critical infrastructure issues have been experienced for a period of 24hours and are expected to continue for an unspecified time.

4 SEVERE PRESSURE



Abstractions within EMS have increased by 10 - 15% over normal seasonal levels.

Abstractions within Control have increased by 15% over normal seasonal levels. Call abandoned rate between 15% and 20% Between 70% and 80% of calls answered within 5 seconds

Supply chain difficulties are not manageable UK Alert is raised

Hospital delays are being experienced Between 70% and 80% of Hospital turnarounds exceed 25 minutes Major critical infrastructure issues have been experienced for a period of up to 24hours and are expected to continue for a specified time of no more than 24 hours.

3 MODERATE PRESSURE




Abstractions within Control have increased by 15% over normal seasonal levels. Call abandoned rate

Supply chain difficulties are manageable Severe events are having a wide spread impact in a region

Hospital delays are being experienced Between 60% and 70% of Hospital turnarounds exceed 25 minutes

between10% and 15% Between 80% and 85% of calls answered within 5 seconds

Critical infrastructure issues have been experienced for a period of 12hours and are expected to continue for a specified time of no more than 6 hours.

2 CONCERN


Calls requiring an Attendance up to 5% above contract


Abstractions within Control have increased by 15% over normal seasonal levels Call abandoned rate Between 5% and 10% Between 90% and 95% of calls answered within 5 seconds

Supply chain difficulties are short lived. Severe events are having a limited local impact on activity.

Hospital delays are being experienced Between 50% and 60% of Hospital turnarounds exceed 25 minutes Critical infrastructure issues have been experienced for a period of 6 hours and are not expected to reoccur.

1 NORMAL WORKING

All National performance indicators achieved

Calls requiring an Attendance contracted level

Abstractions within EMS are within normal seasonal levels.

Abstractions within Control are within normal seasonal levels. Call abandoned rate < 5% 95% calls answered within 5 seconds

No reported supply chain difficulties No severe events are a threat to activity

Hospital delays are within normal expectations. Less than 50% turnarounds exceed 25 minutes No critical infrastructure issues

English Ambulance Services REAP Matrix – Mitigating Actions

REAP Level Increase Capacity - Control

Change Processes -

Control

Increase Capacity – Field OPS

Change Process- Field OPS

Change Service Provision

Command and Control

6 Potential service failure

International mutual aid Move all available staff to EMS duties. Utilise private agency staff in Control Identify staff for national co-ordination centre Deploy volunteer back room staff trained in short call taking course or dispatcher course.

Request GP assistance in Control Red calls to go to Clinical Desk for prioritisation

International mutual aid Deploy clinician with non clinical driver (PTS VAS etc.) Cancel annual leave Review HART/HEMS deployment Use up skilled ECA as first responder solo vehicle Bring in additional/ retired staff

Review treat and leave education for all paramedics Consider use of other AHP/nurses to respond

Triage ALL calls before responding Stop all PTS work Stop attending private events

Establish national co-ordination centre 12/7 Gold – 24/7 Silver – 24/7 Bronze 24/7

5 CRITICAL

National mutual aid Cancel leave Suspend all training/ secondments and projects Establish home working Implement attendance bonus

Green 2 calls to go to the Clinical Desk before responding Set up flu management desk Implement NHSP flu protocol

National mutual aid Buy back annual leave Suspend all training/ secondments and projects Bring in additional/ retired staff where possible Deploy volunteer back room staff

Review number of solo responders versus ambulance hours Review attendance at Nursing Homes without prior GP approval

Stop attending Cat C Calls Triage Green 2 calls before responding GP admissions extended time to 4 hours at patient Cease mental health transfers

Establish national co-ordination centre 12/7 Gold – 16/7 Silver – 24/7 Bronze 24/7

4 SEVERE

PRESSURE

Utilise PTS/OOH/NHSD Control staff in EMS Implement co-caring schemes Cancel Non Critical training. Request those on leave to consider working. Cancel all meetings Consider external provision

Dynamically manage capacity issues within control

Implement attendance bonus Utilise taxis for low acuity transport Implement co-caring schemes Cancel selective training. Request those on leave to consider working.

Deploy managers to A&E depts. To manage turnaround Outsource fleet servicing Deploy VAS/PTS to undertake low acuity workload

Only undertake emergency inter hospital transfers Stop all PTS activity except Renal, Oncology and Discharges

National daily conference call Gold – 12/7 minimum Silver – 12/7 Bronze 24/7

3 MODERATE PRESSURE

Qualified staff used for frontline duties Review all secondments Request increase in clinical desk capacity Deploy additional staff

Green 2 calls to go to the Clinical Desk but continue responding

Review secondments Cancel all meetings Qualified staff/managers used for frontline duties Review supply chain resilience

Deploy VAS/PTS to undertake low acuity workload Deploy dedicated capability to town centre night time activity hotspots.

Cease remote monitoring in Control Stop work to Standard Day Hospital Units Stop work for Standard Outpatients

Weekly national conference call Gold – Weekly meeting Silver – Daily Bronze 24/7

Cancel non critical meetings

Media campaign

2 CONCERN

Caveat leave request approvals Deploy operational staff with Control background

Establish technical links with NHSD/OOH

Cancel non critical meeting Consider deploying VAS Caveat leave request approvals

Identify prioritised vaccination list

Cease Private Events and non- emergency call centre work

Gold – Not required Silver – Daily Bronze 12/7

1 NORMAL WORKING

None required None required None required None required None required None required

Documents

Resource Escalation Action Plan - NHS Foundation Trust · 2016-09-02 · REAP Level 1 – NORMAL WORKING ACTION REQUIRED By Whom Ensure adequate 999 contact centre cover is in place