Wiltshire Wide Capacity Management and System Resilience 2015/16 Briefing for Wiltshire Health and Wellbeing Board November 2015

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1 Wiltshire Wide Capacity Management and System Resilience 2015/16 Briefing for Wiltshire Health and Wellbeing Board November Overview The aim of the document is to provide an update on the approaches that are being taken in relation to capacity management and systems resilience during 15/16. All involved will recognise that this is not an approach purely for winter, it is an approach that needs to be in place all year with the aim of providing evidence of the processes in place to manage any increased demand across the system and ensure we maintain high quality care in times of system challenge. For Wiltshire this will very much be a case of building on what is currently in place and maximising capacity appropriately for the right patients at the right time. The focus is very much business as usual with the aim that our approach to system resilience is embedded into the day practice of staff and brings identifiable benefit to patients even when the system is under pressure. Update The aim of this update to provide an overview of the actions that are being taken, building on the submission to NHS England on the 7 th September. This approach will incorporate all activities into one Wiltshire approach for capacity management planning. 1

2 2.0 Summary of Key Actions Key areas Summary actions /areas of focus Update 1.Handover of patients from ambulance Queue management at each acute trust to acute trust Hospital liaison led by SWAST Review /verification of handover Escalation procedures Governance and accountability Strategies to smooth ED arrivals (e.g. arranging home visits earlier- consider linkage with TCOP schemes) 2. Alternative access arrangements for SWAST Developing agreed pathways with ATC for a range of services Opportunities to convey directly to step up Enhanced DOS All areas being considered and will be discussed in a meeting with SWAST during October We have developed predictors for conveyance levels and we are playing this into the overall system resilience planning Referral guidance has been redrafted and, key focus on maximising initiatives such as step up beds and urgent care at home where appropriate. 3.Operational readiness 3.1 bed management Review and re confirm access pathways and referral criteria for community hospitals and ICT beds Rescope of escalation criteria for bed access and how beds can be accessed on weekend Agree with each Trust pathways for redirecting patients to step up following front door assessment. ( more detail below) Launch of step up beds action plan on the 1 st September, aim to increase volume of direct GP referrals and increase range of referrals from other sources such as acute front door /ECPs Increased domiciliary care capacity through Home First will ensure system beds are used appropriately. Complete and in place Discussions with each trust in relation to enhanced ATL and services now live GWH Community have drafted an action plan and will be circulated following approval. This has started to deliver benefits with 30 referrals to Step Up during October Template agreed 2

3 Develop daily reports on bed capacity (pan system) through established teleconferences. This will include daily updates on number of escalation beds open and reason. ( a reporting template will be developed ) Need to agree process for rapid repatriation of tertiary patients and out of area patients. Launch of Wiltshire wide choice policy on the 1 st November Enhanced access to Early supported discharges pathway for stroke Complete review of AWP in reach at each acute hospital Continue to roll out the enhanced 72 hour pathway for palliative care patients. As highlighted in all areas the aim is about using existing capacity more efficiently and effectively. 3.2 Patient review arrangements Daily update on shifts uncovered across system ( to understand impact of workforce challenges ) Assurance that daily ward rounds are in place across all IP areas Providers to update on further medical staff that have been identified for escalation in terms of Acute -Senior clinical presence over 7 day period -Weekend ward rounds -capacity of Discharge Liaison Nurses and presence on weekends MEDVIVO and access to care -clinician availability -ATL presence on weekends GWH Community beds -Clinical cover over 7 day period As above Currently provided through the daily dashboard amendments in development Signed off agreed and in place To be presented at the September SRG BCP Operational workforce group establishing indicators to launch in January

4 -Weekend ward rounds and discharge ICT beds -Detail on,mdts -Planned weekend discharges and ability to admit over weekends Social care /Domiciliary Care Need to clarify social care capacity and access to domiciliary care on weekends and bank holidays. 3.3 Integrated Discharge Team arrangements All 3 acute trusts will have a form of integrated discharge in place by October and the following areas will need to be reflected in capacity management planning. Regular attendance at White board meetings of ATLs and social care ( this will either be face to face or accessible via phone ) 9 ICT MDTs will meet once a week and there will be weekly MDTs for each community hospital The above will be supplemented by information from the Community Integrated teams (GWH Community) in terms of current and emerging caseload and referral information. Key aim is to establish discharge co ordination capacity at all key stages of the discharge pathway including the GP Led Integrated Teams and Discharge Coordinators. As normal daily reports on number of DTOCs and G2G and relevant actions will be provided for all bedded units. IDT processes are established or all issues outlined are being addressed through these forums and the established meetings. Updates provided on a weekly basis BUT there remains a real need to maximise this new approach. Complete 4

5 4. Seven day services A range of services implemented through the Better Care Plan and ORCP provide coverage across 7 days, this is supported by the 24/7 access to care /SPA arrangements led by MEDVIVO. A Wiltshire schedule of 7 day services in line with the DOS will be recirculated across the system and will include detail on all key services 5. System communications and management Process for daily conference calls established and in place across Wiltshire need to consider how outcomes are shared. 111 & 999- Daily sitrep monitoring in line with KPI. Live performance monitoring by Team leaders and escalation Wiltshire system daily dashboard used for daily review, escalation and action. There is a need to monitor emergency takes and capacity in real time and trigger system actions Management of REAP status in line with escalation plans for each acute hospital Scoped for all schemes developed through the Better Care Plan, this as well as other areas of focus across the system will be included within the Wiltshire wide winter communications plan. Work have been undertaken to establish tactical communications and messages in relation to alternative schemes / capacity and pathways. These will be circulated across the whole system from the 1 st December and will form part of the Wiltshire wide communications. 6. Service availability (diagnostics, pharmacy, additional GP sessions WIC etc.) Need to clarify provision of areas like diagnostics, 7 day a week pharmacy and other equipment. In line with Business Continuity arrangements already in place across Wiltshire this needs to be standardised. Will be clarified in the general comms message outlined above. 5

6 7. Step up /admission avoidance and rapid assessment planning Step up beds provision clarified and in place across the County. Key changes to be progressed will be - Access across a 7 day period - Access to a wider pool of referrers ( such as SWAST) - Sign off agreed referral pathways from hospital front doors - Summary of TCOP schemes in place and points of access to be circulated, this will involve key contacts in relation to the care co-ordinators SWAST to confirm additional provision over period for example use of emergency care practionners and additional cars over the period Business as usual Urgent care at home and SPA to be maintained 24/7 with appropriate cover. Need to re communicate aims, objectives and coverage of service Named Acute Trust Liaison leads in place at each hospital supporting discharge planning and admission avoidance and navigation at the front door. Arrangements in relation to 7 day social care access to be confirmed. Need for established community team in reach into the 3 acute hospitals for supported discharge and admission avoidance 6

7 8. Specific pathway planning End of life Mental health Other pathways Business as usual ( processes in place and established ) Fast-track pathways for stroke to dedicated and protected beds, MIs, and NoF.. There is a need to review ESD for stroke and discharge for spinal /trauma patients in SFT. Supported Hospital Discharge Service in place to facilitate discharges from the acute setting. The service is looking to extend working hours to enable more patients to be rapidly discharged. Age concern/age UK befriending services in place. 9. Escalation plans (Inc. Director-oncall arrangements) Wiltshire CCG will update the escalation plan in line with the updated Area Team plan. The framework has clearly defined indicators for normal, heightened and exceptional status within each organisation and across the system as a whole (equivalent to RAG The system wide escalation framework offers robust triggers and corresponding actions both within organisations and from partner organisations. This allows organisations and the system to manage demand and capacity, maintaining quality at peak times, ensuring clarity regarding responsibilities within and between services as organisations escalate and de-escalate. Clear arrangements are in place and follow the process we have followed for previous escalation plan submissions, 7

8 10. Communications A system wide communications plan will be developed to support this process, the CCG lead for comms will coordinate and update on the supporting approach. As outlined above It is likely that the key areas of focus will be around; - Launch of proactive comms for the period for the wider public - Focus on promotion of alternative services and access points - Signposting of services - Development of referral guides ( TBC) - Key public messages in relation to choice policy - Revised pathway and key service communications to GPs and other stakeholders in the system - Targeted community care homes (i.e. care homes, patients with LTC etc.) - Robust internal comms - Patient education and public health messages - Media plan - On call comms arrangements - Promotion of the SPA and the single number approach. 3. Ongoing Governance Oversight and governance of the capacity plan /system resilience plans will be maintained by the Wiltshire SRG Group. The SRG is fully established with Director and Chief Operating Officer Representation across health and social care organisations with clear terms of reference in line with National Guidance. 8

9 There are a series of task group meetings and programme boards already in place across Wiltshire which are attended by By directors and senior managers from all relevant health and social care providers, locality GPs and clinical leads for the CCG. These meetings have ensured that commissioners and providers are united in working together towards common goals in relation to capacity management. The Wiltshire SRG signed off the Wiltshire Capacity Management Plan /Winter Arrangements at the October Systems Resilience Group, prior to this was engagement and discussion with all stakeholders 4 Next Steps Wiltshire Health and Wellbeing Board are asked to: Review and sign off this plan Consider the capacity and demand analysis underpinning this in an accompanying presentation Launch weekly situation reports to begin on the 1 st December Agree to receive a further update at the January Health and Wellbeing Board James Roach Joint Integration Director Wiltshire CCG and Wiltshire Council and Jo Cullen Director of Urgent and Primary Care Wiltshire CCG 9

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