FOR CONSIDERATION
AGENDA ITEM 2.1
24 April 2012
BUSINESS CONTINUITY ACROSS CARDIFF AND VALE UHB
Report of / Interim Director of PlanningPaper prepared by / The Strategic & Service Planning Team
Executive Summary / This Report updates the SPPC on a number of elements of Business Continuity Planning across the UHB, relating to:
- Capacity Plan
- Unscheduled Care
- Seasonal Pressures
- Olympics
- Fuel Strikes
- Exercise Gamma
- Special Events Weekend 17th&18th March
This had an impact on the elective stream with an impact on the ability to deliver RTT.Information on this is included within the Performance Report.
The Unscheduled Care Delivery Plan was also agreed by the Board at its September 2011 meeting, with updates provided at subsequent meetings. A re-focused USC Programme Board is currently working to develop a shared strategic vision for USC across the Cardiff and Vale of Glamorgan community, drawing on examples of good practice from other parts of the UK and to establish a supporting set of performance metrics. In addition, the UHB has shared its position against DSU recommendations received in January 2012, demonstrating how their advice is now embedded in existing work programmes.
The Seasonal Planning Group has been merged with the Capacity Plan Project Team as part of the new Business Continuity arrangements. The Committee will be aware that the UHB has been under significant pressure in the last quarter due to the high levels of emergency pressures, and this has placed unprecedented demands on the organisation. Lessons have been learned and reflected upon to influence our ongoing business continuity planning.
The Committee will be aware of the Olympics scheduled for the summer of 2012, and that several events will be held in Cardiff. The torch relay will also pass through the UHB area in May 2012, and there is a significant amount of planning for partnership organisations to support this.
The potential fuel tanker strike action has presented the UHB and wider community with Business Continuity Management (BCM) issues in relation to continuity of patient care especially in the community setting. The message from the UK and Welsh Government was to ensure BCM arrangements are reviewed and staff advised on what to do. The UHB will be kept informed by UK Government Briefings for any strike action planned in the near future.
A Major Incident Acute Response exercise, was held in March to test the Command and Control arrangements. Feedback was excellent and also highlighted the benefits of Divisional Managers attending formal training with the Advanced Life Support Group (ALSG) Hospital Major Incident Medical Management and Support (HMIMMS).
Planning arrangements for the Six Nations Rugby match on Saturday 17th and Cardiff City FC match on Sunday 18th March involved the Director of Nursing (chair), divisional teams and partner organisations. The planning involved implementation of additional resources, expediting discharges and providing Triage support from the EU for WAST. The overall feedback was that the planning was well managed; although meetings needed to be brought to the beginning of the week and that such planning should be introduced on a regular basis. Action from the planning and feedback will be taken forward through the BCM group.
Action/Decision required / To note and consider the actions taken in relation to Business Continuity Planning across the UHB.
Link to other Board Committee (s) and sub-committees / Elements of the Report are considered by the Board.
Link to Standards for Health Services in Wales / The Plan supports Healthcare Standards
1 Governance and Accountability Framework
2Equality, diversity and human rights
3Health Promotion, Protection and Improvement
4Civil Contingency and Emergency Planning Arrangements
5Citizen Engagement and Feedback
10 Dignity and Respect
24 Workforce Planning
Link to Public Health Agenda / The UHB Business Continuity Approach supports the delivery of public health principles and the Public Health Framework.
Link to UHB Strategic Direction and Corporate Objectives / Legislative and Regulatory Framework / The UHB is committed to providing safe, sustainable services and to ensuring equity of access for everyone. Business Continuity Planning is consistent with the UHB strategy described within the 5 Year Strategic Framework.
Link to relevant evidence base / The Plan is based on the UHB’s Five Year Strategic Framework, Operational Plan, Capacity Plan, Unscheduled Care Plan, Seasonal Pressures Plan, Major Incident Plan and Business Continuity Policy.
BUSINESS CONTINUITY ACROSS THE UHB
INTRODUCTION
As reported at the February meeting the UHB has introduced an overarching approach to managing business continuity across the organisation. This Report updates the Committee in relation to the:
- Capacity Plan
- Unscheduled Care Plan
- Seasonal Pressures
- Olympics
- Potential Fuel Tanker Drivers Strike
- Major Incident Exercise Gamma
- Rugby Weekend 17/18th March
CAPACITY PLAN
The Operational Plan, agreed by the Board in June 2011, set out the UHB’s approach of reducing reliance on hospital beds by delivering more services in the patient’s home or as near to their home as possible. The UHB’s Service and Capacity Plan was agreed as an Appendix to the Operational Plan.
Initial modelling work undertaken by the UHB identified that there was a bed capacity deficit of 110 beds across the whole system, resulting in significant operational risks to: the Emergency Unit; our ability to undertake sufficient elective activity; supporting the tertiary emergency pathway; the quality, safety and performance of service provision, all of which would ultimately affect the UHB’s overall efficiency, effectiveness and our reputation in terms of delivering high quality and effective care to patients. The Capacity Plan,and its five project streams, was therefore developed as the UHB’s response to meet this identified bed deficit.A total of £4.412m in 2011/12 (£5.56m recurring) was made available to support the development of services to meet the originally identified capacity gap. As planned, schemes were implemented from October 2011 onwards but not all the available finance has been utilised due to slippage in the planned programme, primarily due to delays in recruiting staff.
Progress was made with delivery of the planned schemes however, a short-fall remained in available bed capacity to deliver the capacity plan, manage winter pressures and maintain RTT. In addition, exceptional pressures were experienced in the Emergency Unit and with patient flow acrossthe whole system January to March 2012.
Consequently, action was required to create additional capacity, which included enhanced joint working with our partners in Cardiff and Vale of Glamorgan Councils; discussions on managing patient flow along the M4 corridor ; utilising existing non-medical speciality bed capacity for medical patients; and opening 33 additional beds across the UHB(24 UHW, 4 UHL, 4 Rookwood and 1 West Wing).
Despite the creation of additional capacity the increased emergency stream activity severely impacted upon the elective stream throughout the UHB, with a significant number of operations being cancelled and therefore a direct impact on the ability to deliver RTT by the end of March 2012.
Update on additional capacity
The initial plan was for the additional capacity to be curtailed by the end of April 2012. However, due to the ongoing pressures within the emergency stream and the need to ‘catch up’ with the cancelled elective operations the UHB has agreed to:
- Maintain existing surge capacity for remainder of Quarter1 2012/13 to support front loading of elective capacity(except 4 beds on W2 which are to be closedASAP).
- W5 to continue being used for medical and not orthopaedic patients
- C1 to remain open until June 2012, noting it is only available until September 2012, when it is required to continue the Making a Difference changes
- A1– consider potential for this to be opened as a nurse/therapist led ward for medically fit cohorted patients until the end of June.
- Cardiac Day Surgery and Paediatric Short Stay to be vacated asap and not to be used as part of escalation policy
- Barry Minor Injuries Unit Pilot to be started asap
- Investment in CRTs (as agreed by Divisional Teams) to complete Phase 1 and implement Phase 2
- Divisions working to seek to identify what services to maintain to reduce admissions
Financial Plan
The costs of continuing with the additional capacity for the remainder of Quarter 1 are being costed for inclusion within the financial plan. The draft 2011/12 expenditure is £2.85m against the £4.412m approved plan. This includes all the original planned schemes and the additional capacity opened in March 2012. The identified savings have been set against the UHB financial gap.
Developing the Plan for 2012/13
Further modelling work is being undertaken in recognition of changes in performance and patient flow and the impact of insufficient capacity during 2011/12. Based on current modelling for adult services, with no change to length of stay or volume of admissions the UHB has a deficit of 70 acute adult beds. This work needs to be completed for paediatric and critical care services.
An initial workshop was held on 23rd February 2012 to review the impact from the 2011/12 Capacity Plan and the additional pressures for more capacity. There is acknowledgment and agreement across the Divisions that there is a need to:
- change the focus from acute to community (invest in the community)
- change the service models
- utilise resources/investment in early part of financial year (take risk)
- make the decision and stick to it
- have a Social Care Plan which is aligned to the UHB Plan (to be taken forward as part of the WYN Campaign work-stream)
Work will continue to develop the Capacity Plan for 2012/13. A workshop iscurrently being arranged for the Strategic Planning and Performance Committee.
UNSCHEDULED CARE
In September 2011, the UHB Board approved the 2011/12 Unscheduled Care Delivery Plan. This described the UHB’s response to the national and local priority to improve access to unscheduled care and reduce waiting times within the Emergency Unit (EU), through a transformational approach. Updates have been presented at every subsequent SPPC, most recently in February 2012.
To support a whole system approach to improving unscheduled care services, a re-focused Unscheduled Care (USC) Programme Board provides strategic advice and direction to shape the future systems for USC across the whole of the community, including interfaces with partner organisations. Currently chaired by the UHB Interim Director of Planning, it is responsible for overseeing the delivery and updating of the USC Delivery Plan. In addition, an USC Operational Performance Group chaired by the Director of Innovation and Improvement meets weekly to oversee delivery of short term actions which have been identified as being key to improving UHB USC performance across the organisation
This Group reports monthly to the USC Programme Board.
Much of the work now being focused on at Programme Board level centres on developing a shared strategic vision for USC across Cardiff and the Vale of Glamorgan, drawing on examples of good practice from elsewhere in the UK. There is also work to establish a set of performance metrics to support the Board in understanding the USC pathway, the key pressure points within that system and to monitor how changes impact on outcomes.
As reported at the February meeting of the SPPC, a position statement from the Delivery and Support Unit (DSU) was received in January 2012 following interventional support triggered by the UHB escalation to level 2 in July 2011 as a result of failure to achieve the Tier 1 priority for delivery of the USC 95% 4-hour target. The UHB position against the 29 recommendations has now been shared with the DSU and is attached for information (Attachment 1). This seeks to demonstrate that DSU advice has now been embedded into actions now being progressed through established mechanisms including the Delivery Plan and Immediate Action Plan and is thus embedded in existing work programmes.
Seasonal Pressures
As previously reported to SPPC, the UHB established a local Seasonal Planning Group to provide a consistent approach in line with National Seasonal Planning requirements. The core membership for the group includes representation from across the UHB to include Divisions, Public Health, Communications, Civil Contingencies/Emergency Planning, Social Services and Local Authority.
The core function of the group was as follows:
- Ensure National Seasonal Plans disseminated to local group
- Review and update Cardiff and Vale UHB Seasonal Plans Checklist
- Update on Flu/Immunisation Programme
- Review Adverse Weather Plan
- Update on National and Local Escalation Plans
The Seasonal Plan & Checklist and the Adverse Weather Plan were submitted to SPPC in October for approval, and further work has been done to refine the Checklist and Action Cards. The Seasonal Planning Group has been merged with the Capacity Plan Project Team as part of the new Business Continuity arrangements.
The Committee will be aware that the UHB has been under significant pressure in the last quarter due to the high levels of emergency pressures, and this has placed unprecedented demands on the organisation. However, reflecting on what has worked well and what we could have done better during 2011/12 is important in terms of our ongoing business continuity planning.
We believe that we have managed the following areas well:
Infection Control – As a Health Board we have managed the outbreaks over the winter very effectively. Whilst the organisation lost significant capacity at one point this was short-lived and we were able to minimise the length of the loss, cohort affected patients effectively and restore capacity swiftly. This was managed by daily outbreak meetings Monday- Friday and also by strong links and communications between the site practitioners and Consultant Microbiologist on call.
Bank Pool – It was agreed with the Divisional Nurses that we should create a small “pool” of nurses which could be allocated by site practitioners to those areas of greatest need and/or utilised to provide cover for surge capacity i.e. Cardiac Day Cases. This approach has been so successful that it has been agreed to continue this for the next three months, although this is being constantly monitored and will be stood down if not needed.
Weekly Planning Meetings – The Executive On-Call attended the daily planning meeting on the Thursday of each week to plan for the forthcoming weekend. These have been successful due to the Executive lead, and most successful was the planning for the rugby grand slam weekend which took place on the Tuesday with a follow up meeting on Thursday (weekend of 17/18 March). This approach was successful as it secured attendance from senior level decision makers, both clinical and non clinical across the UHB and, most significantly, from the Local Authority. The outcome had some very positive results, such as the rugby weekend, and we will consider whether to continue this approach of having planning meetings earlier in the week throughout the year.
There are also areas where we recognise that we could have managed the pressures better, for example through:
Additional Capacity – our plans for additional surge capacity were not necessarily sufficient, and there were concerns over the resourcing of this capacity. Whilst planning for this additional capacity started early, it was only when the pressures truly emerged that clinical areas were willing to think more broadly about those areas that could be utilised. The difficulty we now face is how long we keep this additional capacity open.
Workforce – during the latter part of 2011 there was a substantial reliance on bank and agency staff to work in these surge areas which put significant pressure on them both individually, and in terms of maintaining the service. It also meant that the capacity was potentially more expensive than if it had been staffed through establishment levels. Delays in the ability to recruit to the CRTs in particular meant that we were more reliant on the acute sector to provide capacity than had been expected, which was partly reflected in the need to open additional surge capacity in the acute sector.
Elective Activity – RTT and elective activity was profiled throughout the year, without recognising that the unscheduled care pressures would inevitably result in reduced activity during the last quarter of the year. We recognise that we should have frontloaded this activity at the beginning of the year, when pressures were not so great to give some headway for the very difficult winter months, and this is the approach that will be taken during 2012/13.