Winter Planning 2017/18. Marc Hopkinson - NGCCG Barbara Goodfellow - NuTH Nichola Fairless GHFT Simon Swallow - NEAS

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1 Winter Planning 2017/18 Marc Hopkinson - NGCCG Barbara Goodfellow - NuTH Nichola Fairless GHFT Simon Swallow - NEAS

2 Context Newcastle and Gateshead services have a history of consistently delivering high quality health care to patients. National benchmarking of urgent and emergency care shows Newcastle Hospitals NHS Foundation Trust and Gateshead Health NHS Foundation Trust as consistently being two of the top performers in England (number of patients being seen within 4 hours) NHS Newcastle Gateshead CCG have worked since inception to further build and enhance system relationships across health and care in order to create the right culture and climate to support large scale transformation and incremental change programmes. This has been achieved despite an exponential rise in demand for our urgent and emergency care services during the last few years.

3 Rising Demand, Rising Expectations Changing needs of an ageing population; Changing expectations as a result of 24/7 culture; Year round demand; Rising demand: Critically this demand also now includes a high proportion of out of area patients as both Foundation Trusts routinely provide healthcare to: o new patient groups as a result of service reconfigurations in other CCG areas; o patients being diverted/deflected due to other trusts requiring mutual aid during periods of surge (increasing the size of population which they potentially serve to approximately 1.3 million), which means that delivering timely, effective and safe care can be a significant challenge.

4 Background - Winter Each winter brings with it a number of challenges that affect health and social care service delivery, including the balance of urgent, emergency and elective activity, together with the flow of patients from admission to secondary care through to discharge to their usual place of residence.

5

6 Background - Winter Each winter brings with it a number of challenges that affect health and social care service delivery, including the balance of urgent, emergency and elective activity, together with the flow of patients from admission to secondary care through to discharge to their usual place of residence. Challenges such as severe weather, flu, norovirus and festive public holidays can, place additional pressure on the public, health and social care system. In addition these challenges can, and do, often occur at the same time which significantly exacerbates system pressures. In order to mitigate pressures detailed, the health and social care system work together to formulate integrated and whole system plans. These plans have been developed through the framework of the A&E Delivery Board. Representation from all key stakeholders including the NHS, social care and patients are on this group.

7 The number of people needing to be admitted from A&E into a hospital bed has increased. Those waiting for admission tend to wait in A&E longer than other people and this is the reason A&E waiting times are rising. This is particularly a problem in hospitals when the bed occupancy rate is already high as there is nowhere to put these patients. While there are a number of factors driving bed occupancy rates up, delays in discharging patients out of hospital and back to their homes or another more appropriate setting are a particular concern. The causes of the problems in A&E, and the solutions to address them, are not straightforward. It is often assumed that performance against the four-hour standard has deteriorated due to an increase in attendances inappropriate attendances. Whilst data shows that some people are discharged without treatment, this does not always mean that they have attended A&E unnecessarily. Complexity is the issue.

8 Headlines 2016/17 We had a mild winter! Surge in demand exacerbated the problems in a system we knew was already under strain. Strong upward trend in all contacts - acuity of patients severely impacted on patient flows. The surge problem was emergency admissions not A&E activity. Resilience and availability of community-based services (including care providers) led to unnecessary admissions and delayed discharges. Impact of out of area patients. All providers performed well albeit there was some significantly busy periods.

9 Winter Planning/Management Resilience/Escalation Plans developed by each organisation. Tested at regional event in Autumn. During Winter (Nov March) regular contact between providers, commissioners (health and social care). Currently this happens in a number of ways: Daily situation report (activity and data). Daily calls/weekly surge meetings in order to discuss operational issues. Chief Executive and Directors calls (In and OOH) and meetings to ensure effective deployment of resources. Working with border partners in view of our patient flows to Durham, North Tyneside, Northumbria etc. Review of winter undertaken by A&E Delivery Board members.

10 Resilience Planning 17/18 In planning for winter 2017/18 the A&E Delivery Board have agreed to focus on addressing the following areas: Patients being treated in the right place/closer to home; Working as a system to avoid point of crisis/escalation; 7 day working and availability of services 7 days a week; Build flexibility in the system; Improving system-wide communication.

11 Scheme Impact 7 Days a Week Working- health and care providers Expansion/Increase of current services to cover evening and weekends In and Out of hospital patient flow co-ordination Increased Senior Medical and Nursing support Adequate capacity to improve patient flow through the hospital and community Additional Senior staff, beds and support Winter Wards - additional Beds Extended availability of Ambulatory Care/Assessments units. Additional capacity to ensure A&E breaches due to bed capacity are minimised. Increased access to assessments/diagnostics. Extended primary care access for urgent, same day requests. Extended community nursing provision. Admission avoidance, supported and integrated discharge teams - 7 day working Same day, urgent appointments at scale delivered from hubs and bookable by NHS 111 and your own GP Integrated working practices to enhance care provided - acute and community. Increase discharges to home or appropriate care provider/avoid hospital admissions NHS/LA/NEAS Targeted support to specific groups of patients (Children and Older People) Right Care, Right Place, Right Clinician

12 People Empowerment Minor ailments scheme Think Pharmacy First

13 Think Pharmacy First You can access to your local pharmacist, to help you diagnose and treat your minor illnesses. For many illnesses, your local pharmacist can provide free advice and medication to help you and your family feel better. Also if you don t normally pay for your medicines, then you don t need to pay with Think Pharmacy First you can get them free and over the counter from your local pharmacist without the need to see your GP or use other services such as A&E or WiC s. Available in any community pharmacy in Gateshead and Newcastle.

14 People Empowerment People Minor ailments scheme Think Pharmacy First Little Orange Book

15 People Empowerment Minor ailments scheme Think Pharmacy First Little Orange Book Plasticine People - Behavioural analysis to understand how people act and think outcomes informed campaign.

16 People Empowerment The WHO cites two interventions that have the greatest impact on health outcomes. What are they? - Clean Water - Flu jab

17 Flu Vaccination Programme Very important that people who are at increased risk from flu have their flu vaccination. The injected flu vaccine is offered free on the NHS annually to: adults over the age of 18 at risk of flu (including everyone aged 65 and over) pregnant women children aged six months to two years at risk of flu Flu vaccine is the best protection we have against an unpredictable virus that can cause unpleasant illness in children and severe illness and death among at-risk groups. It won't stop all flu viruses and the level of protection may vary between people, but if you do get flu it's likely to be milder and shorter-lived than it would otherwise have been. Flu vaccination rates low last year across Newcastle Gateshead - Hospitals saw a significant rise in admissions for flu and pneumonia last winter which potentially could have been avoided.

18 Questions?

19 Discussion What are the challenges and ideas for solutions? Is there anything else/other services which would assist patients during winter? Any key messages about winter? How do we encourage more people to use their local pharmacy for minor illness? How do we increase the Flu Vaccination rate?

20 We are currently developing Extended Access to provide additional GP and Practice Nurse appointments which can be booked by your own GP practice or NHS 111. We are currently planning making appointments available Monday Friday and on Weekends. - What days and times would patients prefer to access appointments? - Should the appointments be for same/next day urgent appointments only? - Would patients be happy with a telephone appointment? - Would it be beneficial to have a pharmacist working as part of the service?

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