AGENDA ITEM NO: 075/18

Transcription

1 AGENDA ITEM NO: 075/18 GOVERNING BODY MEETING: Governing Body Meeting DATE OF MEETING: 14 November 2018 REPORT AUTHOR AND JOB TITLE: Carl Marsh Chief Commissioner REPORT TITLE: Winter Planning 2018/19 Sara Garratt Lead Commissioner Unscheduled and Scheduled Care and Ambulance Services STRATEGIC OBJECTIVES: Improve quality of services Please tick which strategic objectives the paper relates to Sustained financial balance Build an effective and motivated whole system workforce Sound governance arrangements Ensure integration and joint working arrangements OUTCOME REQUIRED (tick) Approval Assurance Discussion Information EXECUTIVE SUMMARY This report provides An overview of the system challenges experienced, and lessons learnt from Winter 2017/18 Warrington system-wide winter plans by sector for 2018/19 RECOMMENDATIONS The Governing Body is asked to; Note the Warrington system-wide Winter plan for Winter Planning 2018/19 Warrington CCG Governing Body Meeting 14 th November 2018

2 AGENDA ITEM NO: 075/18 Outline any engagement staff, clinical, stakeholder and patient / public Week of engagement with patients included as part of the joint mid Mersey Communications Plan. Are there any conflicts of interest which may be associated with this paper? None identified Does this paper address any existing risks which are included on the Assurance Framework or Risk Register? None identified Have the following areas been considered whilst producing this report? Equality Impact Assessment (if yes, attach to paper) Quality Impact Assessment (if yes, attach to paper) Regulation, legal, governance and assurance implications (reference in the report if applicable) Procurement process (reference in the report if applicable) Yes N/A Undertaken by respective organisations for each workstream Undertaken by respective organisations for each workstream N/A N/A Document development Strategic Objectives and Risks 2018/19 A1 A2 A3 B1 B2 B3 B4 C1 C2 Failure to performance manage to ensure continuous improvement Failure to agree and measure outcomes Failure to ensure clear arrangements are in place for quality management of noncommissioned providers in the independent sector Failure to implement the financial strategy Failure to ensure sound business practices are at the heart of running the CCG Failure to secure best value Failure to adequately provide for external factors, which impact on financial sustainability Failure to continuously develop the organisational culture that meets the needs of the changing needs of the workforce Failure of delivery by outsourced critical business functions Winter Planning 2018/19 Warrington CCG Governing Body Meeting 14 th November 2018

3 AGENDA ITEM NO: 075/18 C3 D1 D2 E1 E2 Failure to establish primary care capacity Failure to ensure that we are compliant with our statutory duties Failure to demonstrate patient and public engagement Failure to provide appropriate reporting, for joint working arrangements Failure to describe benefit of integration and joint working arrangements to local people Winter Planning 2018/19 Warrington CCG Governing Body Meeting 14 th November 2018

4 Warrington & Halton Whole System Presentation

5 Contents System Challenges Lessons Learnt from Winter 2017/18 Winter 2018/19 system-wide plans by sector Summary Agreed system-wide Top 5 interventions

6 System Challenges

7 System Challenge - Winter 2017/18 Over Winter 2017/18 the Warrington Health & Social Care economy faced significant pressures in meeting and managing the health and care needs of our local population. This was particularly evident for those patients over 65+ with conditions associated with Frailty. Our collective ability to provide timely access to high quality care and deliver good outcomes for patients became increasingly difficult as our health and care systems struggled to find the capacity to meet the demand and complexity of our ageing population. This was reflected in overall A&E performance, long Decisions To Admit (DTAs), high numbers of medical outliers, consistently running at 2 wards + of escalation beds (peaked at 96 beds) and patients frequently being placed into spot purchased transitional care beds.

8 Increase in delayed discharges and delays in decisions to admit over winter 2017/18 Delayed transfers of care Decision to admit (4-12 hours)

9 System Challenge On Average 13% of the WHHFT hospital beds are utilised to manage what are patients with conditions associated with Frailty Bed occupancy rates are high at WHHFT at an average 97% which is a significant safety, quality and financial risk The red area on represents the escalation in terms of bed base at WHHFT

10 Lessons Learnt from Winter

11 Ward Level MDT Multi Agency Discharge Events (MADE) Reactive implementation with success Proactive implementation for 18/19 embed New Consultant in Public Health appointed to support Command & Control Bed meetings with the masses Meetings every 2 hours meeting fatigue Moved to tactical meetings twice per day with system partners Comms and Social Media Multi-agency communications approach: 162 twitter posts, 414 increased followers, Avg reach website view (6095 unique page views) Newspaper advertising circulation readership 9 press release in Warrington Guardian with weekly online visitors

12 IMPACT 5 (Biggest impact over 5 days Mon-Fri) This was a local initiative to identify and implement the most effective interventions for managing flow within the hospital that require system partners to action Additional weekend support in January required Additional porter rota required Increased support from Red Cross required Care home patients renal profiling Domiciliary Care - higher demand v reduced capacity at Xmas etc Transition Beds Outcomes variable. Need quick assessment. SW Support and OT

13 2018/19 Winter Plan Highlights

14 Prevention - Seasonal flu Seasonal flu planning group meet monthly multi agency with agreed action plan Plan for prescribing of antiviral in care homes for flu outbreak Plan for pharmacy vaccinating care home staff to improve uptake rates Plans in place to ensure highly vulnerable groups are aware of vaccine and offered vaccine (i.e. homeless population) Enhanced care Home Support team to work with care home staff to ensure that training in phlebotomy is provided and all residents have had the required blood test Communications plan in place to improve uptake for under 65 s at risk Plans in place to vaccinate under 65 s at risk opportunistically via the discharge lounge Plan for additional vaccines for super spreaders and domiciliary care staff Business case developed for of point of care testing in care homes and out of hours service

15 Primary Care Extended Access Improvement 45 mins per 1,000 registered population by quarter 4 ECG service including 12 lead interpretation and 24hr tape 50% shifted from acute care Additional Practices open on 26 th Dec and 1 st January Dedicated Care Local Enhanced Service Identifying and supporting patients most at risk of admission to hospital Patient Advisors - first contact for all patients, navigating to the right part of the practice/system Home visiting service (Acute) for all practices after 12 noon.

16 GP Out of Hours Greater collaborative working across organisational boundaries The Acute Patient Assessment Service supporting admission avoidance Taking referrals direct from Ambulance control Increasing referrals from Paramedics to the team Direct Booking from NHS111 into Out of Hours

17 Whole System Frailty Hub Model Target patients who are deemed frail Transfer to sustainable services & care staff in the community Direct Access to the Frailty Assessment Unit (FAU) at Warrington and Halton Hospital Trust Rapid assessment (within 2 hours for Community and 1 hour A&E) Coordinated Community, Primary, Social and Secondary Care Interventions, including Palliative Care, Voluntary & Community Sector, Matron and District Nurses Access to diagnostics, pharmacy and comprehensive MDT assessment, Access to Step Up/Step Down Care provision in the community

18 Frailty Hub Model Pathway

19 Mental Health - Clinical Offer to Acute Care for Flow 8am-8pm service Flex the workforce Psychiatric liaison in A&E Bed Management lead clinician Increase out of Hours provision Patient Flow Working with AQUA to maximise current provision Crisis 24/7 service Out of Area prevention beds

20 Mental Health Park (Crisis) House Warrington Community Living Alternative to admission in a low level /emotional crisis Aim to avoid less than 7 day LOS (Hollins Park) North West Boroughs is the gatekeeper to the service Could be considered as a step-down from Hollins Park in exceptional circumstances

21 Community Services Intelligent scheduling tool being implemented to assist with SMART visit planning. Daily Situation report being implemented across all adult services to identify any issues with capacity Non-essential clinics (ear care and Doppler) to be cancelled for a period of 2 weeks and converted to general treatment room. Thus increasing treatment room capacity by 29 hours across the 2 weeks Work being undertaken by the Warrington and Halton Intravenous (IV) team to facilitate safe consultant supervised home diuretic service for both supported discharge and end of life patients Multi disciplinary meetings to commence as a pilot within central cluster to discuss top 5 risk stratification patients and determine best care outcomes using an asset based approach Joint work with the Hospital Trust to be undertaken to allow community specialist clinicians to refer directly in to specialities for urgent advice and review.

22 Social Care Prevent/Admission Avoidance Social worker support to Frailty Hub and A&E Falls Response Service; provide an overnight rapid response to Carecall raised alarms Third Sector- Red Cross Hospital to Home scaled up, Warrington Home Improvement Agency, Warrington Wellbeing Hub etc First Response Social worker & OT led assessment at front door My Life Warrington Directory of Services launched & strengths based training delivered across workforce

23 Social Care Independent Domiciliary Care - prioritise hospital discharge, Intermediate Care & Reablement cases to support flow Increased capacity & flexibility in Reablement Service for 3 years and now includes under 55 Contingency to use non framework suppliers when demand escalates for domiciliary care (higher cost) Commission block transitional beds for people waiting packages, or home of choice based on anticipated need

24 Warrington Intermediate Care and Hospital Discharge Single handed Care Project releases capacity in reablement and domiciliary care sectors Trusted Assessor Therapy pathway to avoid duplication and increase hospital flow Small scale Discharge to Assess Service Increased social work capacity on site to provide assessment function for all Care Home Discharge Co-ordinator Robust methodology embedded across services to manage patient flow and create a culture of onward momentum Red to Green /daily huddles

25 Ambulance Services Emergency Care Improvement Programme NWAS Review Approximately 50% of A&E attendances via NWAS could have been seen in alternative services. Commissioners to take action: Protected Learning Time event with NWAS East Crew completed to understand issues and included in winter plan.

26 Silver management of flow with a Senior Manager supporting the day Warrington & Halton Hospital Trust Ward level Multidisciplinary Team Meetings Every ward embedded Multi Agency Discharge Events (MADE) actions Weekly Delayed Transfer of Care / Length of Stay (LOS) meetings Integrated Discharge Team Colocation of hospital and social care discharge teams Development of business case for implementation Impact 5 (Biggest impact over 5 days) Agreement that IMPACT 5 will take place w/c 17th December 2018 and from 2nd January 2019 to 8th January Reducing LOS, create bed capacity, expedite safe discharge, engagement with whole Warrington and Halton system Command & Control

27 Warrington & Halton Hospital Trust Elective reduction Plan Week commencing 24th and 31 st December no routine electives will take place on the Warrington site (providing no breaches). Only Cancers and urgent cases. This will release surgical bed capacity and staff. Ward Reconfiguration - Maximising assessment capacity - WREN unit/acute Floor Discharge Lounge - Business Case has been agreed at Execs including substantive staffing and agreed location. Medicines To Take Out (TTO) and Discharge Planning - One business case for 7 day service, medicines safety officer, pharmacy support in ITU Emergency Care Improvement Programme Productivity Tool & Monday Surge - Review undertaken to maximise staffing with demand - Tuesday peaks - Junior Doctor rota s

28 Communications and Social Media CCG lead comms plan for mid-mersey A&E Delivery Board (AEDB). This includes a week long engagement with patients by service in November to gain insight on service utilisation and promote alternatives. Coordinated Mid Mersey Comms Approach Public information on how best to access services during winter using national Stay Well this Winter Campaign Promotion of NHS111 and use lessons learnt from North Mersey AEDB who have used social media to target use of online NHS111 A&E Waiting Time App Warrington Live, Whiston online soon Refined messages for Primary Care Focussing on alternatives

29 2018/19 Winter Plan Summary

30 Winter Plan 2018/19 Summary Comprehensive system-wide plan established covering all providers building on lessons learnt for previous winters System-wide winter planning assurance meeting held with to NHS England and NHS Improvement on 26 th July 2018 Fortnightly system-wide Directors winter planning calls established. Weekly system-wide Winter Planning Groups established and meeting weekly Daily joint bed meetings held at WHHFT Tactical meetings twice per day with system partners Working collaboratively with mid-mersey Accident and Emergency Delivery Board and Urgent Care Operations Group to address patient flow issues in a collaborative manner across the system

31 Warrington Winter Plan. Top 5 Interventions for Winter Ti me Implement Frailty Hub including Frailty Assessment unit, Step-up beds and Community Rapid Intervention Service. Establish new Discharge Lounge to support earlier discharges on the wards. Establish Integrated Discharge Team bringing together all the currently separate LA, Assess results of Whole System Demand & Capacity review and identify further quick wins for Winter System prioritising hospital discharge for patients waiting domiciliary care however capacity remains challenged an options being reviewed. sc ale for Del ive ry Timescale for Delivery January /11/ /12/ /10/ /11/2018

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