Key Objectives To communicate business continuity planning over this period that is in line with Board continuity plans and enables the Board:

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1 NWTC/2014/12/15b NHS National Waiting Times Centre Winter Plan 2014/15 Introduction This plan outlines the proposed action that would be taken to deliver our key business objectives supported by contingency planning. This plan supports the existing NWTCB Business Continuity Planning Policy. Formal arrangements are in place, as part of the Board s business continuity measures, to ensure that access to resources, including staff, equipment and vehicles on a 24 hour basis, is maintained. Our Plan for 2014/15 We have identified within our Winter Plan a number of key pressures: In order to achieve our waiting time targets we will pre-plan and model elective activity to minimise disruption. In the event of severe weather impacting significantly on elective activity, appropriate communication will be initiated with the Scottish Government Access Support team to discuss arrangements for rescheduling activity and managing demand. Our activity is being planned to meet the Treatment Time Guarantee. The Board are currently implementing further Government approved expansion plans within ophthalmology and orthopaedics. To support demand for diagnostic imaging in other Boards we are providing additional MRI capacity through the use of a mobile unit. We are also reviewing available capacity to determine what additional support we may be able to provide to other Boards and have asked that referring Boards consider where they may require assistance. Cardiology emergency and urgent in-patients it is recognised that the number of unscheduled cardiology patients (either NSTEMI in-patient transfers from other hospitals or emergency STEMI heart attack patients) presenting to GJNH may increase over the festive period and there are greater challenges with repatriation of these patients to in-patient beds across the region. We will continue to work closely with referring Boards to manage these challenges. Period Affected This plan covers the winter period effective from 1 October Key Objectives To communicate business continuity planning over this period that is in line with Board continuity plans and enables the Board: To continue to provide the planned elective activity where possible ( in discussion with SGHSCD and other NHS Boards) and emergency/urgent services 1

2 To continue to work with partners i.e. social services and primary care services and ensure effective discharge. This is likely to be more challenging with the impact of financial pressures. To enhance the ability of staff to face the challenges of the winter period efficiently and effectively and with confidence. To continue to work with NHS Greater Glasgow and Clyde (NHSGGC) to ensure the effectiveness of the patient pathway for the repatriation of medical and cardiology patients. When developing this plan a number of key actions have been taken into account based on the following recommendations within the National Unscheduled Care Programme: Preparing for Winter 2014/15 guidance for NHS Boards: Resilience Robust business continuity management arrangements designed to manage and mitigate against all key disruptive risks are in place. Contingency Plan Demand Management & Communications NHS National Waiting Times Centre has:- Board wide and department specific Business Continuity plans A Senior Duty Manager rota to deal with out of hours operational issues 24 hour Senior Nurse cover including a Hospital at Night Service Bed Management and Discharge Coordination An external communications plan which is managed by our Head of Corporate Affairs with appropriate out of hours arrangements Governance Arrangements Staff Governance Plans are in place to provide information for staff on how to access services during the period and to ensure that they are offered flu vaccination in a timely manner. The Board has HR policies in place that cover: What staff should do in the event of severe weather hindering access to work, How the appropriate travel advice will be communicated to staff and patients The Board s website will be used to indicate advice on travel to hospital appointments during severe weather. Efficient Utilisation of Capacity & Optimisation of Patient Flow Priority Actions 1 Agree and test escalation policies for management of in-patient capacity across the whole system. Escalation arrangements are in place to ensure that the Scottish Government Health and Social Care Directorate receives appropriate and timely notification of winter pressures. 2

3 Escalation plans within Clinical Divisions describe the processes for managing clinical activity during periods of winter pressure. While it is intended that boarding of patients outwith the specialty area will be avoided as far as possible, cross-division arrangements are in place to manage any boarding through joint working with Operational Management, Nurse Managers and Bed Management support. 2 Undertake detailed analysis and planning to effectively schedule elective activity (both short and medium-term) based on forecast emergency and elective demand, to optimise whole systems business continuity. This should specifically take into account the surge in activity in the first week of January. A multidisciplinary planning group meets fortnightly to review elective admissions. These admissions are planned approximately six weeks in advance and are adjusted, if necessary, to accommodate last minute changes. Admissions around the festive period are largely dictated by the patients willingness to accept an admission date close to Christmas or New Year, or the availability of blood products. Our experience to date has been that patients are more receptive to accepting festive dates for major joint replacements than for minor orthopaedic procedures, we therefore plan to maximise the opportunity to continue with joint replacements at this time. Elective cardiac surgery will not continue over the festive period due to the availability of blood products. It is anticipated that elective cardiac activity will recommence with careful case selection by Monday 5 January 2015, subject to confirmation of from the Blood Transfusion Service. Between the Christmas and New Year public holidays there will be reduced elective activity for the other specialties. It is anticipated that elective orthopaedic activity will return to normal levels on Monday 5 January Staff rotas will be finalised in November for the fortnight in which the two festive holiday periods occur to match planned activities. These rotas should include services that support the management of inpatient pathways, e.g. diagnostics, pharmacy, allied health professionals, Infection Prevention and Control Teams (IPCT) Detailed rota planning will take place to ensure that staff are available during peak activity times and to facilitate discharge of patients over the festive period. Consultant cover along with multi-professional support teams will be planned to effectively manage predicted activity and discharge over the festive holiday period. 4 Optimise patient flow by implementing Estimated Date of Discharge as soon as patients are admitted. This will support the proactive management of discharge, ensuring there are no delays in patient pathways. Discharge planning arrangements will commence on admission or at pre-admission assessment to ensure there are no delays for patients admitted over the festive period. 5 Agree anticipated levels of homecare packages that are likely to be required over the winter (especially festive) period to facilitate discharge. Early notification of requirements is essential to allow social services to source the care package required. We have named contacts within most local authorities and the winter guidance advises territorial boards that refer their patients to us ensure that their local authorities ensure adequate resources are available during the winter period. Where available or appropriate for individual patients, discussions with local authority partners, 3

4 referring Health Boards, and/or primary care services around options for utilisation of community hospital capacity will be pursued. Most social work services have cut-off points for referrals over the festive period. We will be aiming to make all referrals no later than 22 December. 6 Ensure that communications between key partners, staff, patients and the public are effective and that key messages are consistent. The Internal Incident Escalation Procedure (attached at Appendix 1) should be used in emergency situations. The communications department will co-ordinate and respond to any press enquiries over the winter period. Exception reporting of events that are likely to or will significantly reduce the hospital s ability to manage waiting lists, will be made known to Scottish Government by the Nurse Director or delegated Executive Director. The Scottish Government Winter Management report will be returned by the Board on a weekly basis throughout the winter period until early April As part of ongoing bed management we provide information on a rolling basis through the year. Exception reports will include, for example: closure of a hospital to emergencies for any reason, unplanned closure of a ward or a number of beds, cancellation of elective procedures because of a lack of capacity, significant outbreak of infection, or significant increase in expected demand Our critical care bed availability is communicated on an automated basis via Wardwatcher providing Scottish Government Health and Social Care Directorate with up to the minute access to bed status across Scotland. Health Protection Scotland issue influenza updates and norovirus ward closures to the NHS during the winter period. Effectively Implement Norovirus Outbreak Control Measures The Board have a Norovirus Policy that is updated annually to reflect the latest guidance issued by Health Protection Scotland (HPS) HPS Norovirus Outbreak Guidance to ensure that the Board is optimally prepared and there has been awareness raising within the Board of the Norovirus Preparedness Plan. Any outbreaks of norovirus resulting in ward or bay closures will be included within the weekly reports that are sent to HPS. There is no requirement to report single cases. The Board s Communication team will consider how to inform the public about any visiting restrictions which may be recommended as a result of a norovirus outbreak. The Board remain vigilant to the challenge of norovirus and respond to national media releases by HPS as required. The Board has utilised the norovirus publicity materials to communicate the key messages around norovirus and support the Stay at Home Campaign message. Seasonal Flu 4

5 The impact of a flu or norovirus outbreak could have a significant impact on health and social services and could involve: Increased workload of patients with influenza/norovirus and its direct complications. Particular needs for critical care and infection control facilities and equipment. Depletion of the workforce and of numbers of informal carers, due to the direct or indirect effects of flu on themselves and their families, e.g. the need to provide childcare or care for ill members of their families. Infection Control/Immunisation Staff Flu Immunisation Programme Vaccination uptake amongst NHS staff was 34.7% for the 2013/14 season compared to 33.5% in season 2012/13. As set out in CMO letter (2014) 12, the Scottish Government encourages uptake of at least 50% of all staff working in areas with high risk patients. All our staff have easy and convenient access to the seasonal flu vaccine including dropin sessions, dedicated staff appointments, vaccination in wards/departments. Occupational Health is also collecting data on the groups of staff taking the vaccine, which will be passed to Health Protection Scotland (HPS) on behalf of the Scottish Government. Our Board flu vaccination programme commenced in October 2014 and to date the Occupational Health team have administered 550 vaccines with work continuing to further increase uptake. Operational winter pressure infrastructure Management Meetings Twice daily operational meetings will be held to ascertain: Levels of staff sickness Bed availability Theatre requirement and availability Cardiac Catheter lab requirement and availability The operational meetings will also consider any threats to the provision of clinical services, coordinated through the senior nurse on duty. Similarly twice daily multidisciplinary clinical briefings will be held to monitor bed status and handover unstable or problem patients. A process is established which will manage access to hotel rooms for staff in the event of adverse weather. This links to the Management meetings where a full assessment of risks to service delivery can be assessed and appropriate levels of control and authorisation will be put in place. Discharge lounge The efficient and effective flow of patients out of the NWTC on a daily basis remains an issue of service quality and patient safety. The purpose of the discharge lounge, which is co-located with an in-patient nursing unit, is to provide and appropriate supervised 5

6 environment for patients to wait discharge thereby freeing beds for new patient throughput. Transport We operate a range of vehicles to deal with transport requirements of our patients. All patient transport drivers have undergone basic first aid courses. Two dedicated ambulances, operated by SAS, are based at GJNH to facilitate the transfer of cardiothoracic and cardiology patients to GJNH and back to their base hospital. This will continue to be available over the winter and festive period. In the event of extreme pressures, we will review options for the use of our vehicles to assist with the repatriation of medical patients back to NHSGGC. Clinical Governance There is a need to ensure that patients are cared for in the most appropriate environment and that the quality and safety of clinical care is maintained throughout the winter period. There is heightened awareness of infection control arrangements and support as well as risk management arrangements. The purpose of the plan is to ensure that as far as is possible an acceptable level of service is maintained during the winter and festive period. Financial Governance It is anticipated that the plan will be achieved within existing resources, although, any exceptional demands on beds may require the use of external agencies to provide additional capacity on a short term basis. Should there be any resource implications, proposals will be discussed at Senior Management level. Equality & Diversity Every effort will be made to ensure that as far as possible the needs of all patients are met and that there is equality of access during the winter period. This plan has been assessed for relevance and screened for equality impact. The relevant assessment documentation is available on request from the Performance and Planning Department Performance and Planning November

7 Appendices Appendix 1 Appendix 2 Internal Incident Escalation Procedure Maintaining Patient Safety Ceasing Elective Treatment Algorithm 7

8 INTERNAL INCIDENT MANAGEMENT FLOW CHART In c id e n t M a n a g e m e n t F lo w C h a rt In c id e n t h a s o c c u rre d D o e s th e in c id e n t h a v e p o te n tia l to c a u s e m a jo r d is ru p tio n b e yo n d y o u r im m e d ia te a re a o f w o rk? In w o rk in g h o u rs : C o n ta c t D u ty M a n a g e r o n O u t o f h o u rs : C o n ta c t S e n io r N u rs e w h o in tu rn w ill c a ll D u ty M a n a g e r Y e s N o R e p o rt/m a n a g e u s in g in c id e n t re p o rtin g p ro c e s s a s p e r g u id a n c e in In c id e n t G u id e lin e s In c id e n t a s s e s s e d b y d u ty m a n a g e r a s m a jo r N o C a n b e m a n a g e d lo c a lly Y e s D u ty M a n a g e r c o n ta c ts c o re te a m a n d e x e c d ire c to rs. In c id e n t g ro u p re p o rt to In c id e n t R o o m a n d m a n a g e in c id e n t In c id e n t C lo s e d. S ta n d d o w n is c a lle d b y D u ty M a n a g e r W ill in c id e n t h a v e lo n g e r te rm im p a c t o n b u s in e s s Y e s N o D o c u m e n ta tio n c o m p le te d. In c id e n t re v ie w / ro o t c a u s e a n a ly s is u n d e rta k e n. B u s in e s s C o n tin u ity P la n s a rra n g e m e n ts in itia te d 8

9 Appendix 2- Maintaining Patient Safety Ceasing Elective Treatment Algorithm Stage 1: Normal / Steady State Emergency Activity Elective Activity Access Targets Maintained Stage 2: Minor Rescheduling of Appointments/Elective Procedures, but no Elective Breachers Increased Emergency Activity Reduced Elective Activity Cancellations rescheduled within target times Access Targets Maintained Stage 3: Higher Levels of Emergency Admissions, Trigger Escalation Procedures within NHS Boards Further Increased Emergency Activity Access Targets Maintained Stage 4: Increased Emergency Activity, Trigger Regional Mutual Aid Arrangements Further Reduced Elective Activity 1 st FLAG notify SGHD Higher levels of cancellations - escalate within Board e.g. increase daycases; rigorous discharge; etc 2 nd FLAG notify SGHD Further Increased Emergency Activity Further Reduced Elective Activity Some rescheduling can be done within Board Boundaries Some rescheduling CANNOT be done within Board Boundaries Some Patients may miss Access Targets: Re-book with Minimum Delay Trigger Regional Mutual Aid Stage 5: Very High Emergency Activity and with Significantly Reduced Elective Capacity Some Rescheduling Rescheduling Reduced reschedu- cannot be cannot be Heightened Emergency Activity Elective ling can be done in done - - Activity done in Board - retry classified Board Mutual Aid as breaches Some Patients may miss Access Targets: 3 rd FLAG - written Re-schedule with Minimum Delay notification to SGHD In extreme situations suspend targets for limited period 9

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