LINCOLNSHIRE NHS URGENT CARE BOARD TERMS OF REFERENCE

Transcription

1 LINCOLNSHIRE NHS URGENT CARE BOARD TERMS OF REFERENCE Urgent and Emergency Care Vision The Vision of the Lincolnshire Urgent Care Board (UCB) is to ensure that patients access the right Urgent/Emergency Care services which are safe, timely, and effective, personalised and deliver maximum benefit within the resources available. The UCB is a multi-stakeholder multi-disciplinary group that will lead the Lincolnshire Health and Social Care community in resolving clinical and managerial issues that cross existing organisational boundaries impacting on the quality and effectiveness of services. The UCB will deliver: Improved interagency collaboration Whole system monitoring to help improve quality and accountability The development of a culture which is comfortable with change and continuous improvement Stimulating more effective self-management in care especially for patients with chronic disease as a means of reducing demand for urgent care Improve graduated access to health care More community based diagnosis and management services The avoidance of unnecessary inpatient care which leads to poor quality and outcomes. The UCB will lead this through identifying the underlying causes of poor performance and holding partners to account for delivery. The Urgent Care Board will be accountable to the Governing Bodies 1 of its constituent members for the quality and effectiveness of its change programme. The minutes of the Urgent Care Board will be formally received by the Governing Bodies. There will also be formal cross membership and updating at meetings with the Lincolnshire Sustainable Services board and it s Urgent Care Design Group. This will ensure that there is strategic alignment for medium and longer term developments. Goals of the UCB The fundamental goal of the UCB is to give our population access to high quality Urgent/Emergency and follow up care delivered at the time that they need it by professionals with the right skills. The UCB s other goals include: Working across organisational boundaries to improve patient experience and clinical outcomes 1 Governing Body is used as a general term to represent the statutory governance forum of each organisation Lincolnshire Urgent Care Board Terms of Reference version 2.0 Page 1

2 Establishing partnerships and better working relationships between all Health and Social Care organisations across the Lincolnshire geographical area Agreeing and sharing goals, objectives and responsibilities throughout the community Making sure any developments produce system wide improvement Making sure delays are not caused by organisational boundaries or other non-clinical reasons The UCB will achieve these goals by; Reviewing the performance of the urgent care system, and monitoring the recovery and delivery of system performance Making patient perspectives and quality of care the top priorities in planning emergency healthcare Offering patients appropriate choices in line with the NHS Constitution Ensuring easy access to appropriate services at the appropriate time without unnecessary duplication and in line with national standards and the NHS Constitution Making sure all Emergency Care providers can help patients to get unscheduled or routine care when they do not need true Emergency Care Working with Health and Social Care Commissioners to agree our local priorities Agreeing and developing local standards and protocols to underpin audit and training Developing and sharing infrastructure e.g. cross organisational IT support, documentation and records To improve and spread knowledge throughout the system Developing and maintaining improvement work Keeping professionals and patients informed about developments and emergency care Focus of the UCB The initial focus for the UCB will be to review the following areas; 1. Pre A&E care 2. A&E care and patient flow through hospital 3. Discharge and out of hospital care The key focus of the review will be to examine the following areas; The patient and carer experience of Urgent Care in Lincolnshire The effectiveness, the range and scale of urgent care services including the range of professions and skill sets available The capacity and quality of community based alternatives and step up/step down services available across the county The effectiveness of proactive case management and Long Term Conditions interventions aimed at preventing crisis for those at risk The range and quality of integrated crisis support services available within the community both before A&E and post discharge Lincolnshire Urgent Care Board Terms of Reference version 2.0 Page 2

3 The capacity and quality of services managing the patient journey through hospital The integration of Mental Health and Physical Health Urgent Care services including Social Care Improving community wide resilience including the community wide escalation and response to winter pressures on the system Prioritisation The UCB will base its prioritisation for its work programme based on the UCB s answers to the following questions; 1. What is working well locally and elsewhere 2. Which areas can be improved 3. Whether services are safe, and providing a good patient experience 4. Where are delays occurring 5. Where are the weak points in access to emergency care and the rest of the patient journey 6. Is there any duplication or bottlenecks in the local system 7. Are services effective and providing good value 8. Are all services that patients and providers need available 9. What quality measures can be applied across the whole patient journey Responsibilities The Urgent Care Board has been delegated responsibility from the member organisation to: Oversee the performance management and delivery of any system wide Urgent Care recovery plans. Oversee recommendations as to the best use of the relevant non-recurrent funding allocations e.g. the marginal rate emergency tariff 70% which is retained by NHS England for breaching the NEL threshold and any seasonal non-recurrent winter pressures money to support the delivery of Urgent Care development Supervise any additional non-recurrent or recurrent resources specifically allocated to the delivery of Urgent Care standards including the recovery of operational performance. Promote the adoption of care pathways across all components of emergency Health and Social Care which deliver best practice and meet national Emergency Care standards and guidance. Hold the whole system to account to ensure that productivity and efficiencies are delivered through patients being treated and cared for by evidence based services that meet their needs in the least intensive environment. Ensure that individual organisations develop service resilience plans that are reactive to service fluctuations and also support the health economy response to a system wide Lincolnshire Urgent Care Board Terms of Reference version 2.0 Page 3

4 approach to pressure e.g. winter planning, business continuity planning and emergency planning. Ensure local service developments provide support to specific groups of patients who are likely to be at increased risk of needing urgent care services e.g. the frail elderly, children with disabilities or long term illness, vulnerable adults including people with Mental Health problems, learning disabilities and substance misuse problems. Ensure that the patient and carer perspective and quality of care are the priorities in planning emergency healthcare in the local Health and Social Care community. Ensure that assurance is received that stakeholder organisations are carrying out root cause analysis in relation to breaches and system failures and that these RCA s are resulting in action improvement and that the learning is being shared across the Health and Social Care system. Manage a programme of work to improve and maintain the urgent care system including full programme management office (PMO) responsibilities including the delegated power to commence, evaluate and close projects at completion or when assessed to be failing to deliver key performance indicators Performance To ensure these are all delivered the UCB will develop and publish an operational dashboard and the UCB will receive monthly performance reporting to monitor its progress. The current proposed metrics are as follows; Pre A&E Care 1. A Primary Care access metric at General Practice level (including OOH providers). 2. The effectiveness of admission avoidance schemes based performance metrics. 4. Ambulance conveyance statistics 5. The average time from referral to assessment for Mental Health patients 6. The average waiting times for cardiovascular and respiratory conditions 7. Social Care response and performance metrics. 8. Community based performance metrics including the performance of walk-in centres, minor injury units (e.g. the rate of delivery of a 4 hour standard for admission avoidance and a 12 hour standard for early supported discharge). A&E Care 1. Ambulance response time delivery 2. Ambulance turnaround times 3. The A&E 4 hour standard (underpinned by disposal profiles showing the percentage of patients leaving the department after 3 hours 45 minutes has elapsed and for admitted patients) and two hours for non-admitted patients. 4. Adult non-elective bed occupancy rate (using agreed non-expanded bed number consistently as a dominator) Lincolnshire Urgent Care Board Terms of Reference version 2.0 Page 4

5 5. The number of escalation beds open (which should be zero) Discharge and Out of Hospital Care 1. Percentage of discharges from hospital before and after midday. 2. Delayed transfers of care metrics. 3. Readmissions 4. Discharges by day of week All of the above metrics will be supported by Outcome and Patient Experience metrics (e.g. HSMR s, effectiveness of pain control, PROMM s). Communications The UCB will be responsible for ensuring stakeholder organisations are communicating and engaging with each other and within their own organisations and that all stakeholders have identified champions to optimise to delivering of urgent care pathways. Sub Groups Sub groups may be appointed by the urgent care board to deliver time limited pieces of work. These will report in line with their terms of reference to the Urgent Care Board. Membership and Responsibilities The Urgent Care Board membership is drawn from the local Health and Social Care organisations involved in Emergency Care provision. Service users and carers to be representatives on the board and additional members can be co-opted as required. The membership of the board and the attendance will be reviewed regularly to ensure constituent organisations are being represented by senior clinical and senior management lead (at director level) with delegated authority to make decisions on behalf of their organisations. The current membership is as follows; Senior membership of LUCN is required and received from all contributing organisations: Clinical Leaders Dr Yvonne Owen LECCG : GP overall urgent care clinical lead. Chair of NHS 111 clinical governance group, lead on LIVES co-responders Dr David Baker SWLCCG GP lead for Grantham focussed urgent care Dr Sunil Hindocha LWCCG: GP lead for Lincoln focussed urgent care Clinical lead from ULHT (TBC) Clinical Lead from EMAS (TBC) Lincolnshire Urgent Care Board Terms of Reference version 2.0 Page 5

6 Organisational Leaders CCG Accountable Officers (LECCG AO is UCB Chairman) Executive Nurse LECCG (Vice Chair) CCG Urgent Care Leads Director of Operations ULHT Chief Nurse / Director of Operations LCHS Director of Strategy, Performance and Information LPFT Director of Adult Social Care Lincolnshire County Council Divisional Manager EMAS Lincolnshire service manager NSL patient transport services Lincolnshire account manager NHS 111 Services Most organisations have further attendees with leads for specific programmes of work. Programme Members Urgent Care Programme Director (to be appointed) Simon Frampton, Urgent Care Lead for Lincolnshire (GEMCSU) Values and Behaviours Board members are expected to: Send apologies and delegate a suitable representative with authority to participate fully. Send agenda items to the UCB administration team. Share board business and information as appropriate within their organisations. Facilitate and implement the actions agreed by the board within their organisations. Participate in board work programmes and Task and Finish Groups as appropriate. Quorum Quorum will be 100% representation of the core membership: NHS Lincolnshire East CCG NHS South Lincolnshire CCG NHS South West Lincolnshire CCG NHS Lincolnshire West CCG United Lincolnshire Hospitals NHS Trust Lincolnshire Partnership Foundation NHS Trust Lincolnshire Community Health Services NHS Trust East Midland Ambulance Service Lincolnshire County Council Where this is not achieved the Chief Officer or Chair of the member organisation will be contacted by the Chair of the UCB to account for the absence. Lincolnshire Urgent Care Board Terms of Reference version 2.0 Page 6

7 Administration Administration for the UCB will be organised by NHS Lincolnshire East CCG. Review The Terms of Reference will be reviewed annually. Date of next review: August Lincolnshire Urgent Care Board Terms of Reference version 2.0 Page 7