NHS AYRSHIRE AND ARRAN DRAFT WINTER PLAN 2015/16
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- Charla West
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1 NHS AYRSHIRE AND ARRAN DRAFT WINTER PLAN 2015/16 AUGUST
2 Contents Introduction... 3 Purpose... 4 Policy Context... 4 Winter Analysis Local Review Health and Social Care: Winter in NHS Ayrshire and Arran 2014/ National Review Health and Social Care: Winter in Scotland 2014/ Self-Assessment Resilience and Preparedness Unscheduled/ Elective Care Preparedness Out of Hours Preparedness Prepare for and Implement Norovirus Outbreak Control Measures Seasonal Flu, Staff Protection and Outbreak Resourcing Respiratory Pathway Management Information
3 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. 3
4 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. 4
5 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 postdiagnostic 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 48 hour access or advance booking to an appropriate member of the GP team (90%) 5
6 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. 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 6
7 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. 7
8 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) Single Point of Contact to improve GP access to wider community services (NAHSCP) Increased community alarm provision (NAHSCP) Red Cross Hospital to Home Service (Pan-Ayrshire) COPD Telehealth Home Monitoring (SAHSCP) Alternative to ED conveyance framework for SAS ambulance crews (SAHSCP) Development of Discharge Team (Acute) Establishment of Discharge Hub (Acute) Maximise Criteria Led Discharge (Acute) Realignment of surgical beds to medical beds (Acute) Promotion and protection of high turnover areas including GP Assessment Areas and ambulatory care facilities (Acute) Increased provision of Care at Home Services (NAHSCP) New models for rehab and re-ablement at Ayrshire Central Hospital (NAHSCP) Early Referral to Social Work (EAHSCP) Discharge to Assess service model (EAHSCP) District Nursing in-reach service (SAHSCP) Introduction of new MDT service model at Biggart Hospital (SAHSCP) 8
9 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. 9
10 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 Norovirus season in Scotland commenced in September, a month earlier than usual NHS Ayrshire & Arran s plan to limit the impact of Norovirus has been successful. 10
11 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. 11
12 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 Indicator Five-year quarterly average (Q Q42015) NHS Ayrshire and Arran Oct-Dec 2014 % change on Oct-Dec 2013 Five-year quarterly average (Q Q42015) Scotland Oct-Dec 2014 % change on Oct-Dec 2013 Number of A&E 28,385 28, , , attendances % within 4 hours Total Inpatient/Day Case Discharges (all specialties) 28,891 30, , , Total Inpatient/Day Case Discharges ("acute" specialties) Total Discharges ("acute" specialties) Inpatient Total Day Case Discharges ("acute" specialties) Total Inpatient Transfers ("acute" specialties) Total Emergency Inpatient Discharges ("acute" specialties) Total Inpatient Discharges ("acute" specialties) Elective Bed days lost to delayed discharge (Standard delays) 26,532 28, , , ,221 20, , , ,311 7, , , ,064 5, ,384 90, ,759 12, , , ,398 2, ,350 46, ,661 5, , , (note: * All Scotland figure excludes NHS Lanarkshire due to technical issues with data extraction; ** Delayed discharge figure are averages for three years 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 12
13 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). 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 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. 13
14 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 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: elements: Winter in Scotland 2014/15 report highlights several 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 Seasonal flu vaccination up-take improved on the previous year but remained below the target level of 50 per cent across Scotland. 14
15 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 multiagency 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. 15
16 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 multidisciplinary 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. 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. 16
17 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. 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. 17
18 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 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, selfcare, 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. Local media campaigns will be implemented to reinforce national messages and sources of information. These will link to partner communications and media. 18
19 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. 19
20 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 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 10 th 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 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. 20
21 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. 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 multidisciplinary 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. 21
22 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. 22
23 Appendix 2 Improving Patient Experience by Reducing Acute Occupied Bed Days: An integrated approach from NHS Ayrshire & Arran, East Ayrshire HSCP, North Ayrshire HSCP and South Ayrshire HSCP IPEP Steering Group 1 st Sept 2015 (to access presentation, double-click on IPEP in penultimate line above) 23
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