Surge Management. Prepared by NEAS Resilience,

Surge Management Prepared by NEAS Resilience, 13.09.2017

Plans for Winter 2017/18 Overview of system within locality The Strategic principles of the NEAS Surge Management Plan are to ensure: Response standards to the patients of North East are maintained for Access and Response, Emergency Care (EC) and Patient Transport Services (PTS). The services provided by NEAS are adequately resourced. That NEAS can deal with fluctuations in demand across the surge period and adapt to the flex. That no patient, member of the public or member of NEAS staff is put at increased risk. That relief staff are rostered in a fair and equitable way. The plan sets out details of: A clear leadership structure and focused management team, led by the Chief Operating Officer and Executive Team. A 24/7 Command, Control & Communications (C3) structure in the event of a major incident, or service delivery challenges. Resourcing strategy. Based on demand predictions covering our main service lines: Emergency Care, Patient Transport Services and Operations Centres, also drawing on regional requirements over and above core provision. Proactive management of key service delivery support departments, through Business Continuity Management (BCM). Demand management initiatives. Establishment of routine sharing of intelligence through information feeds and regional wide communications. Guidance on the use of the Trust s Resource Escalation Action Plan (REAP). A summary of the policies and procedures that support this plan

Managing Peaks in Demand NEAS plans have progressed to utilise Voluntary Ambulance Services during weekends and banks holidays with additional provisions for staff to support the day after a bank holiday. In addition, separate plans have been developed to address the demand over the Christmas period: Operations Centre: Dual trained staff within the operations centre (999, 111 and PTS) will be utilised in times of pressures; this will be highlighted via the Workforce Scheduling and Planning team. When required, Team Leaders can also be relied upon to support. Furthermore, when demand is faced, trained call Loading takers working within alternative roles (i.e. support services) will be called upon to assist with the demand. Individuals must be trained within pathways and took a % of calls to ensure registration is retained for 999 and 111 calls, PTS calls can be conducted with the relevant training. Additionally, there are employees within NEAS Headquarters who are trained to handle low acuity calls only when needed. Currently, this is NEAS staff only and no arrangements are in place with multi-agencies. Clinicians will be utilised to support call handlers and triaging of patients into alternative dispositions where appropriate therefore managing resource utilisation effectively, whilst accounting for mix of skills each call taker possess and the efficiency gains this provides.

Managing Peaks in Demand Emergency Care: Resourcing Emergency Care staff will be coordinated by the Resource Scheduling Department (RSD) who will apply expert knowledge in rota planning to maximise resource throughout the surge management period. RSD will also employ the use of relief rotas, PTS staff and Bank staff to maintain and enhance emergency cover where indicated. Additional resources available through the use of NEAS third party agency framework will also be maximised to compliment NEAS resources. In extreme instances, NEAS will utilise partner organisations which include: Third party responders, Mountain Rescue, RNLI, Great North Air Ambulance Patient Transport Service: Patient Transport services will be maintained throughout the surge period as per current arrangements unless adverse weather conditions persist. The majority of the Hospital s and Treatment Centre s will be maintained at normal service levels, in relation to clinics and elective surgeries. However, as part of the National Ambulance Services Resilience Plans (REAP), interdependence exists when PTS becomes Emergency Care resilience, by providing additional trained ambulance staff to support Emergency Care colleagues through periods of high demand, i.e. major incidents and severe weather conditions. Qualified PTS staff will be required to crew ambulances and act as first responders, when demand increases on Emergency Care incidents. The PTS Managers will liaise directly with the relevant Hospital/Treatment Centre, to ensure the ambulance emergency plans are understood and informed when the REAP level dictates the mitigating action to reduce PTS Services to support Emergency Care

Managing Peaks in Demand The Quarter 4 resource plan is routinely increased in response to activity predictions. The plan is currently being resourced to meet the predicted activity plan. Contingencies are in place to address increases in call demand, contact centre managers and team leaders constantly monitor the situation. In the event of mass call pressure within 111 where the call answering rate falls below 50% the team leader will escalate to section manager or on-call manager to request on of the pre-recorded messages (detailed in 111 S02) are switched on. All Ambulance Service Providers, as Category 1 Responders, under the Civil Contingencies Act 2004 (CCA), must ensure they embrace best practice national guidance. The Resource Escalation Loading Action Plan (REAP ) guidance provides a consistent and coordinated approach to the management of ambulance Trusts during times of pressure including excess demand and supports capacity management across the emergency and urgent care divisions. It provides a structure consistent with the wider NHS in terms of levels of escalation and provides a common framework nationally. Daily conference calls take place with all active on call officers to initiate shorter term changes to REAP. In the event of system pressures (when operating under REAP level 4) prolonged hospital handover times may cause additional pressure on the Trust resulting in fewer crews being able to respond in a timely manner. NEAS Clinical Escalation Plan will be initiated where trigger points are met, the purpose of the clinical escalation plan is to provide a risk based flexibility to resourcing at times when demand exceeds the capacity of the service to respond in spite of every effort having been made to match resourcing with forecasted demand. Internal and external partner s incl. multi-agency partners will be informed of escalation and de-escalation when initiated and stood down.

Local Flu Strategy/Outbreak Plans The Seasonal Flu Programme Task and Finish group 2017/18 are in the process of designing local promotional campaign for NEAS. The Occupational Health Team has developed a plan to hold flu clinics across the Trust area between October and February. Flu vaccinations will be administered by OH staff, Volunteer Peer Vaccinators and Flu Vouchers to be given to maximise uptake. The promotional campaign will be launched in preparation for Flu Month which commences on 2nd October 2017 and staff will be encouraged to take part in receiving the flu vaccination. The national target to achieve is 70% of frontline staff which is approximately 1280 staff. An agreement has been set of at least 50-60% of frontline staff being vaccinated. The flu programme will continue through to 28 February 2018: An FFP3 respirator should be worn by frontline staff when carrying out a potentially infectious aerosol generating procedure. Where a patient is known/suspected to have an infection spread via the aerosol route or when caring for patients known/suspected to be infected with a newly identified respiratory virus Diseases, such as Influenza and Norovirus are more predominantly wintertime illness, with Norovirus increasing late autumn or early winter. Public Health England (PHE) will continue to publish Norovirus outbreak reports and these will be actively monitored throughout the period. NEAS will expect local Acute Trusts to advise of local outbreaks.

Adverse Weather The NEAS Adverse Weather plan is used to assist and build on effective service and business continuity arrangements and be responsive to local challenges and needs when adverse weather causes severe disruption to service provision. The strategic principles of the adverse weather plan are to ensure: NEAS provide a business as usual service to provide a high level of patient care where possible during any adverse weather, whilst at the same time proactively reacting to any increase workload caused by climatic conditions Staff welfare needs are considered Identify resourcing strategies Reduce impact and mitigation of any risks Effective liaison with hospitals, NHS England Cumbria & North East (CNE), Clinical Commissioning Groups, Public Health England and various multi agency partners to maximise resource Adverse weather, defined as Conditions (at this time of year) that, due to their disruptive effect, impede on the operational effectiveness of the ambulance service. The three mains sources of intelligence regarding adverse weather are: The Meteorological Office. The Environment Agency. Intelligence from frontline crews or other agencies/organisations. Intelligence to NEAS officers will be disseminated via the Resilience Department and the Trust s Adverse Weather Plan will be implemented where appropriate.

System Wide Escalation Plans Clinical Escalation Plan: Clinical Escalation and Resource Escalation Action Plan The purpose of this plan is to provide the North East Ambulance Service NHS Trust (NEAS) with risk based flexibility to resourcing at times when demand exceeds the capacity of the service to respond in spite of every effort having been made to match resourcing with forecasted demand. The reason for the excess demand may be because of a variety of causes including major incidents, pandemics or any other unexpected eventuality. The overriding aim of this plan is to ensure that NEAS maintains the highest possible level of patient care services to the communities of the North East when experiencing demand pressures and reduce patient risk. This plan is linked to the NEAS Resource Escalation Action Plan (REAP) levels of response; it should be read and, where feasible, used in conjunction with it.

System Wide Escalation Plans Clinical Escalation and Resource Escalation Action Plan Resource Escalation Action Plan: For the purposes of planning, four levels of escalation will be utilised within REAP which aids ambulance services to integrate into the wider NHS surge or escalation framework. These levels will be used to determine what actions are necessary to protect the core services and supply the best possible level of service with the resources available. REAP will be reported nationally as well as utilised within the Trust dynamically each day to guide escalation planning. REAP is designed to be informed by any disruptive challenges and to inform internally and to the wider NHS, and other partner agencies, of the pressures facing the organisation. The considerations and actions contained within the REAP are designed to assist in protecting staff, patients and the organisation and should be viewed as a guidance in challenging situations. Processes will also be in place to report REAP data on a national level via the template. Any changes to the REAP levels will be communicated across the service provider internally each day and throughout the day including front line staff.

System Wide Escalation Plans Plans/Processes for system-wide operational SitRep/early warning and escalation reporting Whilst at REAP level 2 or above, the relevant NEAS on call commanders are required to participate in daily teleconference calls at 08:30hrs which will be chaired by the Strategic or Tactical Commander to review the current Trust level and divisional level REAP statuses and appropriate actions. This should be to appraise and discuss capacity and staffing issues, review overnight performance and forecast activity for the day ahead and form a plan of actions by those individuals in order to maintain service levels. A future plan for the forthcoming night and day will also be discussed and agreed. The commander will determine the need for future conference calls at 1pm and 4pm. At weekends the conference call will take place at 10am and 4pm. The Strategic or Tactical Commander will ensure the discussions focus on the previous overnight performance, available staffing and/or shortages and give direction on actions and what is expected for the 1pm conference call. all actions from the REAP action cards need to be put in place and that REAP level communicated across the Trust to frontline staff via Terrafix the Strategic or tactical commander will consider the requirement to increase the REAP level based on the parameters in the escalation plan. The 4pm conference call needs to assess if actions have been successful and if not another SitRep needs to be communicated, again if they had been successful and a safe performance level is resumed, the REAP is reduced and again communicated.

On-call Arrangements The NEAS 24/7 on-call rota system is designed to support business as usual. This is complemented by an Emergency Preparedness Function and Control Duty Officers on-call. The Executive Team also has a call-out agreement, in line with the Civil Contingencies Act Category 1 Responder. The on-call rota operates 24/7, 365 days a year with the following roles: Executive Press Officer Trust Tactical Trust Strategic Command and Control Operations Centre Resilience Advisor Operational (x 2) Clinical Team (Telephone on-call) Loading